Birth Control

The mini-pill

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What is the mini-pill (progestin-only birth control pill)? It might be for you if… How do you use it? How much does it cost? What are the side effects and benefits? Where can you get it?

What is the mini-pill (progestin-only birth control pill)?

The mini-pill is an estrogen-free birth control pill. It contains a single hormone, progestin, that prevents pregnancy primarily by thickening cervical mucus, making it harder for the sperm and egg to meet. Progestin-only pills need to be taken at the same time every day to be effective at preventing pregnancy.

Most brands and generic versions of the mini-pill require a prescription, but Opill is a type of mini-pill that is available over the counter. It contains the same type of hormone and works the same way as other progestin-only pills. You can get it at drugstores, grocery stores, convenience stores, and online.

Quick Facts

Very effective if you use it correctly. Easy to use, but you have to remember to take it every day.

Effectiveness

The mini-pill is pretty effective the way most people use it.

Perfect use: 98% effective

Typical use: 93% effective

What are perfect use and typical use?
Side effects

Nausea, irregular bleeding, headaches, acne, and sore breasts are the most common side effects, but they’re usually temporary.
Effort

You have to take your pill around the same time every single day, which can be hard.
Easy to get

You have to see a provider to get a prescription for some brands, but there is an over-the-counter option.
Cost

As low as $0 (with insurance) or as high as $200 a month.

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It might be for you if…

Effectiveness at preventing pregnancy is a top priority for you.

The mini-pill is 98% to over 99% effective at preventing pregnancy when used perfectly (exactly as directed). That means between two and fewer than one out of every 100 people using the mini-pill perfectly for a year will get pregnant.

However, the effectiveness of the pill with perfect use is based on the experiences of people involved in clinical trials who are taking the pill perfectly every single time for an entire year. The effectiveness of the pill with typical use, which means the way real people use it in real life, is going to be more relevant for most people. When the mini-pill is used as people typically use it, it is 93% effective at preventing pregnancy. That means that on average, seven out of every 100 people using the pill for a year will get pregnant.

In order for the mini-pill to be as effective as possible, you have to take it within the same three-hour window every day. There’s very little wiggle room with most brands of the mini-pill. The only exception is Slynd, a brand of mini-pill that allows more flexibility in timing.

You just had a baby.

If you’ve recently given birth and want to be on the pill, your provider may prescribe the mini-pill. That’s because it doesn’t contribute to blood clots, which you are at increased risk of after giving birth. Also, if you’re providing human milk through breastfeeding, chestfeeding, or expressing milk, the mini-pill is a good option because it doesn’t contain estrogen, which can decrease milk supply.

You can’t take estrogen or the combination birth control pill causes too many side effects for you.

Some people who experience side effects they can’t tolerate on the combination pill feel better with the mini-pill because it doesn’t have estrogen in it. Others may not be able to take estrogen because they’re already at high risk for blood clots, they have breast cancer or another estrogen-sensitive cancer, they have just given birth, they have migraine with aura, or other reasons.

You can remember to take a pill at the same time every day.

Most progestin-only pills only work if you take them within the same three-hour window every single day. The only exception is Slynd, a brand of mini-pill that allows more flexibility in timing.

You don’t mind changes to your period (or not getting one anymore).

When you are using the mini-pill you won’t have a regular period or a withdrawal bleed (the period-like bleeding you get during the days you’re taking the placebo pills that come with a combination birth control pill). With the mini-pill it’s normal to have bleeding or spotting that comes and goes or to have no bleeding at all. It’s totally safe and doesn’t mean you’re pregnant.

You aren’t looking for STI protection, or you’re okay with combining the mini-pill with another method.

Neither the mini-pill nor the combination birth control pill offers any STI protection. So if that’s something you’re looking for, you can use condoms or internal condoms along with the mini-pill. Dental dams and/or gloves can also offer STI protection, depending on what kind of sex you’re having. You may also want to consider PrEP (pre-exposure prophylaxis), which is a daily pill or an injection you can get every two months to decrease your risk of getting HIV.

You want a method that won’t affect your future fertility.

The only birth control method that permanently affects your fertility is sterilization. The mini-pill does not affect your ability to get pregnant after you stop using it. In fact, you’ll return to whatever level of fertility was normal for you quickly after you go off the pill. It is possible that you could be able to get pregnant within a day of stopping the mini-pill. So if you’re planning to stop using the pill, but you’re not ready to be pregnant, start using another method right away.

You want a method that is easy to get.

Opill, one brand of mini-pill, will be available in lots of places, from convenience stores to online, and you don’t need a prescription to get it. Other brands of mini-pill are prescription-only, but they all contain the same type of hormone and work the same way.

You want a method that you can stop without help from a provider.

You can stop taking the mini-pill anytime without having to go in for an appointment. Just keep in mind that you will quickly return to whatever level of fertility was normal for you before being on the mini-pill. That means you may be able to get pregnant soon after stopping the mini-pill. In fact, there’s a chance you could be able to get pregnant within a day of stopping the mini-pill. If you don’t want to get pregnant, you’ll need to use another form of birth control as soon as you stop taking the pill.

You don’t need to hide your method.

The pill is hard to completely hide. That’s because you’ll have a pill pack that you have to keep on hand, you may need to set reminders to take your pill, and you’ll need to get a new pack monthly or store pill packs you’ll use in the future.

You don’t have any of these risk factors.

Don’t use the mini-pill if you have breast cancer.

Talk with a health care provider about whether the mini-pill is safe for you if you have:

Liver disease or liver tumors
History of cancer
History of stroke
Lupus
Heart disease
History of bariatric surgery
Unexplained vaginal bleeding

Also talk to your provider about whether the mini-pill is safe for you if you are taking anticonvulsant medications, like seizure medication.

If you’re taking the Slynd mini-pill, the risk factors to keep in mind are different. Don’t use Slynd if you have any of the following risk factors:

Kidney problems
Adrenal insufficiency
Progestin-sensitive cancer, now or in the past
Liver tumors or other liver problems

How do you use it?

Taking the mini-pill is pretty simple—take one pill every day within the same three-hour window. Most brands of the mini-pill come in packs of 28, with each pill containing hormones. Unlike with the combination birth control pill, there are no placebo or inactive pills (pills that don’t contain any medication). When you take the last pill in a pack, you start a new pack the next day.

Here’s the tricky part: unlike with the combined birth control pill, most brands of the mini-pill have to be taken within the same three-hour window every day. If you are more than three hours late for a pill, you will need to treat it like a missed pill. That means you’ll take it as soon as you remember and also use a backup form of birth control, like condoms, if you have sex in the next 48 hours.

One brand of mini-pill, Slynd, works a little differently. With Slynd, you take 24 days of pills (one pill per day) that contain hormones, followed by four days of placebo pills. Slynd also allows more flexibility with the timing of the pill. Slynd allows users to be up to 24 hours late in taking a pill without compromising its effectiveness, just like with combination pills. That means that if you are less than 24 hours late taking a pill, you can take it as soon as you remember, and you don’t need to use a backup method of birth control.

Tips and tricks

Try taking your pill at the same time you always do something else in your daily routine—like waking up or taking other medication.
Set a reminder on your phone
Have condoms or another backup method of birth control on hand in case you miss a pill.
Have emergency contraception pills on hand, just in case you forget your pill sometime during the month, and then have sex without a condom or other barrier method. (Keep in mind that if you take the prescription emergency contraception pill, ella, you’ll need to stop taking the mini-pill for 5 days afterward and use a backup method of birth control until your next period).

How much does it cost?

With insurance

If you have health insurance—whether it’s from work, school, your parents, the ACA marketplace, or Medicaid—chances are good that you’ll be able to get the mini-pill with no out-of-pocket cost if you are okay with seeing a provider and getting a prescription for it. The exception may be if you want to use a brand-name pill that has a generic equivalent.

Without insurance

If you don’t have insurance or if your plan doesn’t cover birth control, the mini-pill averages anywhere from $7-$200 per month, depending on whether you use a generic or name brand version. Many telehealth providers sell birth control pills for $7-$20 per month to people without insurance, depending on the type of pill. You may also be able to go to a low-cost clinic to get it for less if you qualify based on your income.

If you need help covering the cost of the pill, there may be options. For brand-name pills, check the manufacturer’s website for information about coupons and discounts. Or contact the Partnership for Prescription Assistance at 1-888-4-PPA-NOW (1-888-477-2669) or www.pparx.org. Also, check with your local family planning clinics to find out if they offer free or low-cost birth control pills—most do.

What are the side effects and benefits?

Every method of contraception has positives and negatives. And everyone’s different, so what you experience may not be the same as what someone else experiences.

The Positive

There are lots of things about birth control that are good for your body as well as your sex life. Here are some of the benefits of the progestin-only pill:

Easy to use—just take one every day
Doesn’t interrupt the heat of the moment
One of the safest methods with the fewest contraindications (reasons why people can’t safely use that method)
May give you lighter periods (or no period at all) and improve period symptoms
May help with health issues like endometriosis, sickle cell disease, and migraines
Some pills offer protection against health problems like endometrial and ovarian cancer, iron deficiency anemia, and pelvic inflammatory disease.
You don’t have to see a provider to stop using the mini-pill, you can just stop. Just make sure you start a new form of birth control immediately if you don’t want to be pregnant, because you can get pregnant right away after stopping the mini-pill.

The Negative

Everyone worries about side effects, but for many people, they’re not a problem. Most people using the mini pill who experience side effects find that they go away with time. It can take a few months to adjust.

Things that will probably go away after two or three months:

Headaches
Bleeding between periods
Sore breasts
Nausea
Acne

Things that may last longer:

A change in your sex drive
Bleeding changes like not getting a period anymore

If you’re having trouble with side effects, your provider may suggest you give it a few months to see if they decrease or go away. But you can stop using the progestin-only pill at any time. Just remember that you can get pregnant right away once you stop using it, so you’ll need to start on another method if you don’t want to become pregnant.

For a very small number of users there are risks of more serious side effects, such as high potassium levels for people using Slynd.

Where can you get it?

You can get the mini-pill with or without a prescription. You don’t need a prescription to get Opill, which is a brand of mini-pill that will soon be available over-the-counter at drugstores, grocery stores, convenience stores, and online. You need a prescription from a health care provider to get all other brands and generic versions of the mini-pill. There are two main ways to do that: visiting a health care provider in person or seeing a provider through a telehealth platform.

In person

You can get a prescription for the mini-pill from any health care provider who can prescribe medications, like an OB-GYN, midwife, or primary care provider. If you don’t have a provider, you can search for a health center where you can get birth control. In a handful of states, a pharmacist can also write you a prescription for birth control pills right at the drugstore.

Online

It’s easier than ever to get birth control online. To find out what’s available where you live, check out our telehealth search tool.