Oral Progestin: Progestin-only pill

Hormonal Contraceptives

The following are the standards for midwives to independently prescribe, order and administer hormonal contraceptives in the community, hospital or other sites of midwifery practice for clients in care, as designated under specialized practice certification. Midwives without Specialized Practice Certification in Hormonal Contraceptive Therapy are required to refer their clients to an appropriate health care practitioner for treatment. 

Norethindrone (Micronor®):
Also known as the “mini pill”, this is a very safe and effective when used as directed. It prevents pregnancy through changing the molecular structure of cervical mucous, including reduction in volume and increase in viscosity, so that little or no sperm can penetrate. It also impairs sperm motility. Ovulation may be suppressed or partially suppressed although forty percent of those using progestin-only contraceptives will continue to ovulate. Endometrial changes that reduce the potential for implantation may occur.

Dosage and Administration:

Supplied in packages of 28 tablets, each containing 0.35 mg of norethindrone (Micronor®). It should be started on the first day of the menstrual cycle, although it may be started at any time during the menstrual cycle as long as pregnancy can be excluded. There is no pill-free interval. A backup method of birth control should be used for the first 7 days. It is very important that pills are taken at the same time each day within 3 hours.

If a pill is missed outside of the 3 hour window, it should be taken as soon as possible and a backup method of birth control should be used for the next 48 hours. The next pill should be taken at the regular time even when it coincides with the taking of the missed pill. If 2 or more pills in a row have been missed, then the individual must take 2 pills per day for 2 days and use a backup method of birth control for 48 hours. Emergency contraception may be considered if appropriate. An advance prescription for emergency contraception for use can be provided.

Contraindications:

Absolute:

  • pregnancy and current breast cancer

Contraindications:

Relative:

  • active viral hepatitis
  • liver tumours

Adverse Reactions:

Irregular bleeding and hormonal effects including headaches, acne, bloating, and breast tenderness.

Follow up:

A follow-up visit should assess bleeding patterns, satisfaction, and provides an opportunity for health assessment and counselling around condom use for protection against STIs and HIV.

As noted above, prescribing contraceptives requires certification as a specialized practice. (See Framework for Certification in Prescribing Contraceptives).