Synopsis
Prescribe the combined pill, patch or vaginal ring safely by applying UKMEC, measuring blood pressure, explaining thrombosis risk and using clear starting and review rules.
- Combined hormonal contraception includes the combined oral pill, transdermal patch and vaginal ring; all contain oestrogen plus progestogen and share major vascular eligibility considerations.
- Measure blood pressure and record BMI before starting. A pelvic examination, cervical screening, thrombophilia screen and routine blood tests are not prerequisites for an otherwise uncomplicated prescription.
- Ask specifically about migraine aura, smoking and age, VTE or thrombophilia, hypertension, cardiovascular disease, breast cancer, liver disease, postpartum state, surgery and interacting medicines.
Key red flags
Current migraine with aura, previous venous thromboembolism, known thrombophilia, major vascular disease or severe hypertension can make oestrogen exposure an unacceptable risk.
Investigation priorities
Identify hypertension before oestrogen exposure and at clinically appropriate follow-up.
Management branches
A patient prefers a combined pill, patch or ring.
- Measure blood pressure and BMI and take a focused history of aura, smoking, thrombosis, vascular disease, postpartum status, breast or liver disease, surgery and medicines.
- Apply current UKMEC, exclude category 4 methods and use expert judgement or a safer alternative for category 3 or important combined risk factors.
Key medicines
Ethinylestradiol 30 micrograms with levonorgestrel 150 microgramsTake one active tablet orally once daily for 21 days followed by a seven-day hormone-free interval, or use a supported extended or continuous tailored regimen with no break longer than seven days.