From Combined Pill to POP


Dear @Dr_Paula,

First of all, thank you so much in advance for your guidance!

I’ve taking the pill for about 9 years now (0,10 mg Levonorgestrel /0,20 mg Ethinylestradiol) with no side effects I’ve recently moved to the UK, so I’ve been trying to find an equivalent (although I’ve only found the 0,15 mg/0,30mg option). However, I have to admit this is the first time I’ve been doing proper research on my options.

I came across SH:24 and I took the suitablity test. The result shows that I’m actually not suitable for the combined pill (my BMI is over 35 and I had the gallbladder removed on 2016, as I had gallstones) and one of my gynecologist in Germany once suggested I should consider another contraceptive option because of the risk of thrombosis. I really didn’t understand much about this.
To be honest, due to the coronavirus crisis, I feel like this “problem” isn’t as important as other people’s problems, so I’ve been hesitant to contact my GP. That’s why I’m glad I found this forum.

Would you recommend switching to the progestogen only pill?

Thank you so much, @Dr_Paula for your time and advise!

I’m looking forward to hearing from you!

All the best,


Hello @Kari_Na

Many thanks for your question.

Yes, I agree, if your BMI is over 35 then you should not take the combined pill - all the guidelines agree on this.

If you want to stay on a pill then the progestagen only pill is a good option. The alternative progestagen only methods are the implant or the injectable or the hormone coil - all of which there is no BMI contraindication.

You can read more about the pros and cons of the progestagen only pill here

The main drawback of all the progestagen only methods is that they can change your bleeding pattern. Unfortunately you can’t predict whether this will happen to you - so if irregular bleeding (more frequent or more infrequent - hard to tell) then these methods may not be suitable for you.

The alternatives are non-hormonal - barrier methods, or coil or something like natural cycles (but you have to be completely organised about checking your temperature every day before you get up with this)

It might be worth trying the progestagen only pill as it is easy to start and stop and seeing how you get on with it?

Many thanks



Hello @Dr_Paula,

Thank you for your quick reply!

I’ll try the progestagen only pill. So, if I understand correctly, if I start getting irregular bleeding, I should stop taking them, right? I’ve read that some women don’t get their period while on the POP. Is this normal?

Thank you so much again!



Hello @Kari_Na

If you get irregular bleeding in the first 3 months then you should keep taking the pill and see whether it settles down.

If the bleeding is very irregular then it is always worth looking for other causes by doing a sexual health check, a pregnancy test and making sure that you are up to date with your smear test. If it continues then it is worth seeing your GP or local sexual health service to discus.

Some people don’t get a period on the POP and that does not do any harm.

Many thanks