💡 Contraception should be tailored to the individual, taking account of effectiveness, safety, medical eligibility, bleeding profile, reversibility, and patient preference. Before starting, exclude pregnancy where reasonably possible; if needed, quick start can be used with advice about additional precautions and follow-up pregnancy testing.

⏱️ When methods become effective (if not started at the recommended immediately effective time)

⚡ Immediate: Copper IUD (including emergency contraception).
⏳ After 2 days: Progestogen-only pill (POP).
📆 After 7 days: Combined hormonal contraception, implant, progestogen-only injection, and levonorgestrel IUD/IUS.

🌀 Copper IUD (Copper Coil)

A small intrauterine device that releases copper, which is toxic to sperm and ova and prevents fertilisation.
Very effective (>99%); duration depends on device type, often 5–10 years.
Most effective emergency contraception; can be used up to 5 days after UPSI or up to 5 days after the earliest estimated day of ovulation, depending on timing.
Possible adverse effects include heavier periods, more dysmenorrhoea, expulsion, and rare perforation.
Hormone-free, suitable in breastfeeding, and fertility returns immediately after removal.

💊 Combined Hormonal Contraception (CHC – combined pill / patch / ring)

Contains oestrogen + progestogen and mainly works by inhibiting ovulation.
Highly effective with perfect use, but typical-use failure is higher because of missed pills / user error.
Can improve cycle control, dysmenorrhoea, and sometimes acne.
Risks include venous thromboembolism, and CHC is unsuitable for some people depending on UKMEC criteria.
Do not use in people with migraine with aura; avoid in many with major VTE risk factors, severe hypertension, or other UKMEC contraindications.
Before prescribing, check BP, BMI/weight, smoking status, migraine history, and relevant thrombosis risk.

💊 Progestogen-Only Pill (POP)

A suitable option when oestrogen is contraindicated or not wanted.
Becomes effective after 2 days.
Desogestrel-containing POPs generally allow a 12-hour late window; some traditional POPs have a 3-hour window.
Often suitable for smokers, people aged over 35, and people who are breastfeeding.
Common downside: irregular bleeding.

📍 Implant (etonogestrel)

A subdermal rod inserted into the upper arm; lasts 3 years.
Very effective (>99%) and does not depend on daily adherence.
Common side effect is unpredictable bleeding; some also report headache, acne, or mood change.
Fertility returns quickly after removal.

💉 Progestogen-Only Injection

Given at intervals depending on the preparation; DMPA is commonly repeated every 13 weeks.
Very effective with correct use.
Can cause irregular bleeding, weight gain, and a delay in return to fertility after stopping.
There are concerns about reduced bone mineral density, especially with prolonged use and in younger people, so risks and alternatives should be discussed.

🌀 Levonorgestrel IUD / IUS (Hormonal Coil)

A levonorgestrel-releasing intrauterine method.
Very effective (>99%); licensed duration depends on the device.
Often improves heavy menstrual bleeding and dysmenorrhoea; some users become amenorrhoeic.
Common early issue is irregular spotting.
Insertion risks include pain, expulsion, and rare perforation.

🛡️ Barrier Methods

External and internal condoms are the only contraceptive methods that also reduce STI transmission.
Effectiveness depends heavily on correct and consistent use.
They are hormone-free and can be combined with other methods.

👩‍👧 Contraception in adolescents and young people

Young people may need additional attention to confidentiality, safeguarding, STI risk, adherence, and coercion. Under-16s may consent if Gillick competent / Fraser competent, but safeguarding must always be considered.

⚖️ Legal & Ethical Framework (UK)

Under-16s may consent if they demonstrate sufficient understanding and intelligence to make the decision.
Confidentiality should usually be maintained unless there are safeguarding concerns.
Encourage involvement of a parent or trusted adult where appropriate, but this is not required if the young person is competent and safe.

🔑 Key counselling points

LARC is often a strong option for those who want very effective “fit and forget” contraception.
Advise condoms for STI protection even when another method is used.
Always consider safeguarding, exploitation, and relationship safety.
Explain common bleeding changes upfront to reduce early discontinuation.

🚫 Caution in young people

Depot medroxyprogesterone acetate (DMPA) is not usually first choice in adolescents because of concern about bone mineral density; use requires an informed discussion of risks and alternatives.

🧪 Emergency Contraception

⚡ Copper IUD: most effective EC; should be offered to all who are eligible.
💊 Levonorgestrel EC: licensed within 72 hours of UPSI; some UK services may use it off-label later, but Cu-IUD or ulipristal are preferred where appropriate.
💊 Ulipristal acetate: licensed up to 120 hours (5 days) after UPSI.
After ulipristal, wait 5 days before starting hormonal contraception, then use condoms/abstain until that method becomes effective.

✨ Key exam tips

🌡️ Copper IUD = immediate protection + best emergency contraception.
⏱️ POP = 2 days; CHC / implant / injection / LNG-IUD = 7 days when quick-started outside the immediate effective window.
💔 CHC is contraindicated in migraine with aura and unsuitable in many patients with major thrombotic risk factors.
🌸 POP and implant are commonly suitable in breastfeeding and when oestrogen is contraindicated.
🛡️ Condoms are the only method that protects against STIs.

📚 References

The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms.

Contraception request/advice ✅