Synopsis
Provide inclusive, life-course primary care for contraception, menstrual and menopausal concerns, preconception health, pregnancy possibility and sex-specific prevention while recognising urgent gynaecological presentations.
- Use the person’s anatomy, pregnancy possibility, goals and preferences rather than assumptions based on gender, relationship or age.
- Exclude urgent causes first: haemodynamic compromise, severe pain with possible ectopic pregnancy or torsion, sepsis, pregnancy with heavy bleeding, and postmenopausal bleeding need prompt pathways.
- Offer a private, trauma-informed consultation and ask sensitively about coercion, sexual violence and reproductive control.
Key red flags
Pregnancy possibility plus unilateral pain, bleeding, syncope, shoulder-tip pain or instability requires urgent assessment even if an early urine test is negative.
Sudden severe unilateral pelvic pain, often with vomiting, needs same-day emergency assessment; intermittent pain does not exclude torsion.
Reasoning priorities
Identify pregnancy in bleeding, pain, amenorrhoea or before relevant treatment.
A negative result before sufficient hCG rise does not safely exclude pregnancy or ectopic pregnancy when symptoms are concerning.
Worked reasoning
A 37-year-old requests the combined pill and describes recurrent zig-zag visual symptoms before headache.
- Clarify focal aura, frequency, smoking, blood pressure, BMI, thrombosis and cardiovascular history, pregnancy possibility, medicines and contraceptive priorities.
- Reason using current FSRH UKMEC that migraine with aura creates an unacceptable risk for combined hormonal contraception, while this does not make all hormonal or non-hormonal methods unsafe.
- Give the final action: explain the method-specific risk, offer eligible progestogen-only and intrauterine options using shared decision making, and address any need for emergency contraception separately.
- Verify understanding with teach-back, document the aura and UKMEC reasoning, provide switching or initiation instructions from current guidance and arrange review or urgent advice for new neurological symptoms.