Progesterone only pills ( POP ): problematic bleeding

This table provides a structured and succinct overview of this common issue, regarding the management of problematic bleeding in the context of POP usage as recommended by FSRH

Aspect	Explanation/Findings
Bleeding Characteristics with POP	Irregular and unpredictable bleeding is commonly observed. However, other causes should be ruled out by healthcare providers.
Evidence Availability	There's limited evidence guiding the management of problematic bleeding during POP use.
Double Dose Strategy with DSG POP	Some clinicians suggest using a double dose (150 μg daily) of Desogestrel POP to address bleeding. This approach lacks substantial evidence but a small study indicated potential effectiveness, especially in adolescents with dysfunctional bleeding. The safety of this double-dose is not established, although it's noted that this dose is used in COC preparations.
Switching POP Types	No evidence suggests that changing the type of POP will inherently improve problematic bleeding. Yet, different POPs might result in varying bleeding patterns for individuals. No evidence indicates that bleeding patterns with one Progestogen-Only Contraception (POC) can predict patterns with another.
Strategies for Bleeding Control	Some strategies include estrogen supplementation, or the use of mefenamic acid, naproxen, or tranexamic acid. These are generally applied for short-term relief, but there's no evidence for their...

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