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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Shared decision-making and contraceptive effectiveness

Obstetrics and gynaecology · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

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Recognise time-critical contraceptive needs

Unprotected intercourse within the emergency-contraception window, sexual assault, reproductive coercion, a late method or possible pregnancy requires a same-day pathway rather than a routine future-method discussion.

Action: Establish timing and pregnancy risk privately, offer emergency contraception and sexual-health or safeguarding care as indicated, then bridge immediately to a reliable ongoing method with explicit backup advice.

Synopsis

Support an informed, voluntary contraceptive choice by comparing real-world effectiveness, safety, bleeding effects, reversibility, privacy, infection protection and the patient’s reproductive priorities.

  • Start with the patient’s goal: avoiding pregnancy now, preferred timing of a future pregnancy, menstrual control, privacy, autonomy, infection protection and tolerance of procedures or daily tasks.
  • Typical-use effectiveness is the fairest comparison for user-dependent methods: implant and intrauterine methods are over 99%, injection 94%, pills, patch and ring 91%, external condoms 82%, internal condoms 79% and fertility awareness 76%.
  • Long-acting reversible contraception minimises adherence failure but is an option, not a default; obtain affirmative consent and make removal accessible whenever the patient requests it.
  • Only external and internal condoms reduce transmission of sexually transmitted infections; another method can be combined with condoms when both pregnancy and infection prevention matter.
  • Apply UKMEC to medical safety after identifying the patient’s acceptable methods: category 1 means no restriction, 2 generally usable, 3 usually not recommended without expert judgement and 4 unacceptable risk.
  • Pregnancy can often be reasonably excluded from menstrual, sexual and contraceptive history; if uncertainty remains, quick-start many hormonal methods with backup and a correctly timed repeat pregnancy test.
  • Discuss expected bleeding explicitly. Amenorrhoea may be welcome or concerning, irregular bleeding commonly drives discontinuation, and stopping a hormonal method may reveal the person’s untreated baseline periods.
  • Document the decision, information given, method start, when protection begins, missed-use instructions, medicine interactions, follow-up and how to obtain emergency contraception or removal.

    • Key red flags

    A partner who controls appointments, removes condoms, tampers with medicines or pressures a pregnancy outcome may be using reproductive coercion; create a safe private opportunity to speak.

    Severe lower abdominal pain, collapse, shoulder-tip pain or bleeding with a positive pregnancy test requires urgent assessment for ectopic pregnancy rather than contraceptive initiation alone.

    New focal neurology, chest pain, unilateral leg swelling or sudden breathlessness while using hormonal contraception needs urgent assessment and method-specific safety review.

    Sex without consent requires trauma-informed immediate care addressing injury, emergency contraception, infection prevention, forensic choices and safeguarding without making police involvement a condition of treatment.

    Investigation priorities

    01
    Pregnancy-risk historyFirst step

    Determine whether pregnancy can be reasonably excluded and whether emergency contraception is still indicated.

    Management branches

    ChoiceBuild the acceptable shortlist

    A patient requests contraception or wants to change an existing method.

    1. Clarify pregnancy intentions, method duration, bleeding goals, STI needs, privacy, procedures, daily routines and prior experiences without assuming a preferred hierarchy.
    2. Compare typical-use effectiveness, reversibility, adverse effects and non-contraceptive benefits in absolute, consistent terms, then remove medically unsuitable options using current UKMEC.
    3. Let the patient choose among the remaining methods, document voluntary consent and provide a practical start, supply, removal and follow-up plan.
    Quick startAvoid an unnecessary access delay

    The preferred hormonal method is requested outside its conventional menstrual start window.

    1. Assess recent intercourse and offer emergency contraception first when indicated; use history and testing to define what is and is not known about pregnancy.
    2. Start an eligible method now when guidance permits, give method-specific additional precautions and explain that oral emergency contraception may alter timing.
    3. Arrange a pregnancy test 21 days after the latest unprotected intercourse and provide urgent advice for pain, collapse or pregnancy symptoms.
    Open full textbook →Answer 2 questions
    Sources and review status4 sources · checked 27 Aug 2026 · clinical review pending+
    Sources

    Sources and review status

    National guidance is shown before implementation-dependent detail. Apply principles in context and verify current guidance when a decision affects care. Source check completed 27 Aug 2026; clinical approval remains outstanding.

    • CoSRH UKMEC 2025Current UK medical eligibility categories and method safety.
    • NHS contraceptive effectivenessComparable typical-use and perfect-use effectiveness figures.
    • NICE NG68 contraceptive servicesPerson-centred access, information and contraceptive service delivery.
    • NHS methods of contraceptionPatient-facing method overview and access routes.

    Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

    Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom