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.
- Depot medroxyprogesterone acetate is given every 13 weeks: 150 mg intramuscularly or 104 mg subcutaneously. Effectiveness falls if repeat administration is late.
- Irregular, prolonged or absent bleeding is common with POPs and the implant; it is usually not dangerous but pregnancy, infection, cervical or uterine pathology and interactions still need selective exclusion.
- DMPA can reduce bone mineral density during use and delay return to fertility for up to a year after stopping; discuss this before initiation rather than when pregnancy is later desired.
- Hepatic enzyme inducers can reduce POP and implant effectiveness but do not reduce DMPA effectiveness; intrauterine contraception is also unaffected.
- None of these methods protects against STIs. Provide condom advice, exact start or switch backup, missed-use instructions and a route for troublesome bleeding or removal.
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.
An implant that cannot be palpated must not be removed blindly; use trained localisation and specialist referral, with alternative contraception if effectiveness is uncertain.
A new breast cancer diagnosis or serious liver disease requires prompt specialist contraceptive review because progestogen-only eligibility may change.
Neurological symptoms in a patient taking topiramate or another teratogenic medicine require both urgent clinical assessment and confirmation that contraception is unaffected by enzyme induction.
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.
- Agree the method voluntarily and give exact start, backup, missed-use, replacement or removal information in the product’s own terms.