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The strip contains 21 tablets. Each day will line up with a row of pills. It is important to take the pills everyday. Follow the direction of the arrow indicated on the strip until the patient have taken all 21 tablets. Then take no tablets for 7 days. In the course of these 7 tablet-free days (otherwise called a stop or gap week) bleeding should begin. This so called "withdrawal bleeding" usually starts on the 2nd or 3rd day of the week. On the 8th day after the last Minipil tablet (that is, after the 7-day gap week), start the following strip, even if the bleeding has not stopped. This means that the patient should start the following strip on the same day of the week and that the withdrawal bleed should occur on the same days each month. When using Minipil in this manner, the patient is also protected against pregnancy during 7 days of not taking a tablet.
When to Start With The First Strip: If the patient has not used a contraceptive with hormones in the previous month: Begin with Minipil on the 1st day of the cycle (that is the 1st day of the patient's menstruation). If the patient starts Minipil on the 1st day of the menstruation, she is immediately protected against pregnancy. The patient may also begin on day 2-5 of the cycle, but then use extra protective measures (eg, condom) for the first 7 days.
Changing From Another Combined Hormonal Contraceptive or Combined Contraceptive Vaginal Ring or Patch: The patient can start Minipil on the day after the tablet-free period of the previous pill finished (or after the last inactive tablet of the previous pill). When changing from a combined contraceptive vaginal ring or patch, follow the advice of the doctor.
Changing From Progestogen-Only-Method (Progestogen-Only Pill, Injection, Implant or Progestogen-Releasing IUD): The patient may switch any day from the progestogen only pill (from an implant or the IUD on the day of its removal, from an injectable when the next injection would be due) but in all of these cases, use extra protective measures (eg, a condom) for the first 7 days of the tablet-taking.
After Miscarriage or An Abortion: Follow the doctor's advice.
After Having a Baby: After having a baby, the patient can start Minipil between 21 and 28 days later. If the patient starts later than day 28, she must use a so-called barrier method (eg, a condom) during the first 7 days of Minipil use.
If, after having a baby, the patient had an intercourse before starting Minipil (again), she must first be sure that she is not pregnant or must wait until the next menstrual bleed.
Let the doctor advise the patient in case she is not sure when to start.
If the patient is breastfeeding and wants to start Minipil (again) after having a baby: See Use in lactation under Precautions.
If The Patient Forgets To Take Minipil: If the patient is <12 hrs late taking a tablet, the protection from pregnancy is not reduced. Then still take the tablet as soon as the patient remembers and then take the following tablets again at the usual time.
If the patient is >12 hrs late taking a tablet, the protection from pregnancy may be reduced. The great the number of the tablets that the patient has forgotten, the greater is the risk that the protection from pregnancy is reduced.
The risk of incomplete protection against pregnancy is greatest if the patient forgets a tablet at the beginning or the end of the strip.
Therefore, the patient should adhere to the following rules: More than 1 tablet forgotten in the strip: Contact the doctor.
One Tablet Forgotten In Week 1: Take the forgotten tablet as soon as remembered, even if that means that patient has to take 2 tablets at the same time. Take the tablets again at the usual time and use extra precautions for the next 7 days eg, condom. If the patient has had sexual intercourse in the week before the oversight or has forgotten to start a new strip after the tablet-free period, the patient must realize that there is a risk of pregnancy. In that case, contact the doctor.
One Tablet Forgotten In Week 2: Take the forgotten tablet as soon as remembered, even if that means that the patient has to take 2 tablets at the same time. Take the tablets again at the usual time. The protection from pregnancy is not reduced and does not need to take extra precautions.
One Tablet Forgotten in Week 3: The patient can choose between 2 possibilities: 1) Take the forgotten tablet as soon as remembered, even if that means that the patient has to take 2 tablets at the same time. Take the tablets again at the usual time. Instead of the tablet-free period, go straight on to the next strip. Most likely, the patient will have a period (withdrawal bleed) at the end of the 2nd strip but may also have spotting or breakthrough bleeding during the 2nd strip.
2) The patient can also stop the strip and go directly to the tablet-free period of 7 days (record the day on which the patient forgot the tablet). If the patient wants to start a new strip on fixed start day, make the tablet-free period <7days.
If the patient follows either of these 2 recommendations, she will remain protected against pregnancy.
If the patient has forgotten any of the tablets in a strip and does not have bleeding in the 1st tablet-free period, this may mean that the patient is pregnant. The patient must contact the doctor before using the next strip. (See figure.)
Click on icon to see table/diagram/imageWhat to Do In Case of Vomiting or Severe Diarrhea: If the patient vomits within 3-4 hrs of taking a tablet or has severe diarrhea, there is a risk that the active substances in the tablet are not fully absorbed into patient's body. The situation is similar if the patient forgets a tablet. After vomiting or diarrhea, the patient must take another tablet from a reserve strip as soon as possible. If possible take Minipil within 12 hrs when the patient normally take the tablet. If this is not possible or 12 hrs have passed, the patient should follow the advice given under If the Patient Forgets to Take Minipil as previously mentioned.
Delaying of Menstrual Period: Even if not recommended, delay of menstrual period (withdrawal bleed) is possible by going straight on to a new Minipil strip instead of the tablet-free period, to the end of the 2nd strip. The patient may experience spotting (drops or flecks of blood) or breakthrough bleeding while using the 2nd strip. The patient may experience spotting (drop or flecks of blood) or breakthrough bleeding while using the 2nd strip. After the usual tablet-free period of 7 days, continue with the following strip.
The patient might ask the doctor for advice before deciding to delay the menstrual period.
Change of The First Day of The Patient's Menstrual Period: If the patient takes Minipil according to the instructions, then the patient's menstrual period/withdrawal bleed will begin in the tablet-free week. If the patient has to change this day, do this by making the tablet-free period shorter (but never longer). For example, if the patient's tablet-free period begins on a friday and the patient wants to change this to tuesday (3 days earlier), start a new strip 3 days earlier than usual.
If the patient makes the tablet-free period very short (eg, ≤3 days) then it may be that the patient does not have any bleeding during this tablet-free period. The patient may then experience spotting (droplets or flecks or blood) or breakthrough bleeding.
If the patient is not sure on how to proceed, contact the doctor for advice.
If The Patient Wants to Stop Taking Minipil: The patient can stop taking Minipil whenever she wants. If the patient does not want to become pregnant, ask the doctor for advice about other reliable methods of birth control.
If the patient has any further questions on the use of Minipil, ask the doctor or pharmacist.
