• In young women and women with special needs, assess their competence to decide, and support them in making their own decisions about contraception.
• Exclude pregnancy.
• Check the woman's blood pressure, weight and body mass index.
• Check the UK Medical Eligibility Criteria to ensure that there are no contraindications.
• Assess the risk for sexually transmitted infection and, when appropriate, advise testing, promote safer sex, and/or refer for counselling.

In depth

• First-line options are monophasic preparations containing 30 micrograms of oestrogen, and either norethisterone or levonorgestrel.
• However, consider the person's preference, as any combined oral contraceptive (COC) can be provided first-line.

In depth

• Not currently using a regular method of contraception:
• Ideally start the COC on the first day of the period (or up to day 5) for immediate contraceptive cover.
• COCs can be started at any other time in the cycle, if pregnancy has been excluded. Additional contraception is needed for the first 7 days of taking the pill.
• Inform the woman that medical advice may differ from that included in the packet of pills.
• Specific advice for women who are amenorrhoeic, postpartum and breastfeeding, postpartum and not breastfeeding, or post-abortion is summarized in the table below.
• Starting immediately after oral emergency contraception:
• Levonorgestrel emergency contraception used — advise additional contraception (condoms or avoidance of sex) for the first 7 days of pill taking.
• Ulipristal acetate emergency contraception used — advise additional contraception (condoms or avoidance of sex) for the first 14 days of pill taking.
• Advise the woman to take a pregnancy test no sooner than 3 weeks after the last episode of unprotected sex.
• Using another COC, combined contraceptive patch, or progestogen-only pill:
• The new COC may be started immediately. There is no need to wait for the next menstrual period.
• However, the woman may want to complete the cycle of her current COC or progestogen-only pill, omitting any hormone-free interval (or the inactive pills of Every Day preparations), before starting the new COC. No additional contraceptive protection is required.
• Using a progestogen-only injectable:
• The COC should be started when the repeat injection would have been given.
• No additional contraceptive protection is needed if the COC is started < 14 weeks (98 days) after the injection (outside the terms of the product licence).
• Using a copper intrauterine device (IUD) or the levonorgestrel-releasing intrauterine system (IUS):
• The COC is most conveniently begun within 5 days of the start of menstrual bleeding. No additional contraceptive protection is needed. The IUD or IUS can be removed at that time.
• The COC can be started at any other time in the menstrual cycle, provided it is reasonably certain that she is not pregnant. However, she will need to abstain from sex or use additional contraceptive protection for the next 7 days.
• To provide the extra protection removal of the IUD or IUS could be delayed for at least 7 days.
• The IUD or IUS can be removed immediately unless she has had sexual intercourse in the past 7 days. In which case it should be left in until she has taken at least 7 pills sequentially.

In depth

• Follow up at 10–12 weeks after first prescriptions, and 6–12 monthly thereafter.
• Review blood pressure, risk factors, (e.g. new headaches), correct usage, lifestyle issues, adverse effects, and information on how to manage contraception relating to missed pills, diarrhoea and vomiting, surgery, and drug interactions.

In depth