Synopsis
Select and use progestogen-only pills, the etonogestrel implant and injectable contraception safely, with exact timing, bleeding, interaction, bone-health and fertility-return counselling.
- Progestogen-only methods avoid oestrogen and are suitable for many people who cannot use CHC, but current breast cancer and some serious liver or vascular conditions still alter eligibility.
- Know the pill formulation: traditional norethisterone or levonorgestrel POP has a three-hour late window, desogestrel a 12-hour window and drospirenone a 24-hour window with different missed-pill rules.
- The etonogestrel implant is over 99% effective and, following the 2026 UK licence extension, provides contraception for five years; check the actual insertion and replacement date.
Key red flags
Severe abdominal pain, collapse or bleeding with a positive pregnancy test needs urgent ectopic-pregnancy assessment even though absolute pregnancy risk on these methods is low.
Investigation priorities
Identify emergency contraception, safe initiation and repeat-testing needs after missed or late use.
Management branches
A patient wants an oestrogen-free hormonal method.
- Compare daily pill timing, a five-year removable implant and a 13-week injection that cannot be withdrawn, including typical effectiveness and privacy.
- Apply UKMEC and assess enzyme inducers, bleeding priorities, future pregnancy timing, weight and bone-health factors relevant to DMPA.
Key medicines
Desogestrel 75 microgram progestogen-only pillTake one tablet orally at the same time every day without a pill-free interval; a dose more than 12 hours late is missed and requires the product-specific missed-pill pathway.
Drospirenone 4 mg progestogen-only pillTake one active tablet orally daily for 24 days followed by four inactive tablets in each 28-day pack; use its 24-hour missed-pill window and formulation-specific instructions.