The progestin-only pill is a daily oral contraceptive (OC) pill containing only 28 tablets of 0.35 mg of norethindrone, and no estrogen. Because it contains only progesterone and not estrogen, it is used for women for whom estrogen is considered risky, such as those who are older than 35 and smoke, hypertension, or have a variety of medical problems. Progestin-only birth control pills have little effect on cardiovascular health, are not associated with an increased risk of stroke, myocardial infarction, or venous thromboembolism. However, they are contraindicated for women with liver tumors, cirrhosis, previous or current breast cancer, migraines with aura, or those with anti-phospholipid antibody syndrome. They prevent pregnancy less effectively if a woman is also taking certain types of anti-seizure medications, ritonavir, or rifampin.

Pregnancy protection is approximately 92% with progestin-only OCs, similar to combination OCs. Yet, progestin-only OCs must be taken daily within 3 hours of the previous days dose for maximal efficacy. They begin working within 2 days if started on the first day of menses. Unlike combination OCs, the progestin-only pack does not contain a pill-free week. The most common side effects of progestin-only OCs are unscheduled/unpredictable bleeding and spotting.

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