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.
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.
Investigation priorities
Determine whether pregnancy can be reasonably excluded and whether emergency contraception is still indicated.
Management branches
A patient requests contraception or wants to change an existing method.
- Clarify pregnancy intentions, method duration, bleeding goals, STI needs, privacy, procedures, daily routines and prior experiences without assuming a preferred hierarchy.
- Compare typical-use effectiveness, reversibility, adverse effects and non-contraceptive benefits in absolute, consistent terms, then remove medically unsuitable options using current UKMEC.
The preferred hormonal method is requested outside its conventional menstrual start window.