• 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.
• Assess the risk for sexually transmitted infection and, when appropriate, advise testing, promote safer sex, and/or refer for counselling.
• Check the woman's blood pressure, weight and body mass index (BMI).
• Check the UK Medical Eligibility Criteria to ensure that the woman is eligible for a progestogen-only pill (POP).

In depth

• Any licensed progestogen-only pill (POP) may be used first-line.
• However, rules about missed pills differ between products, and this may affect their acceptability.
• If the woman weighs more than 70 kg, then consider the desogestrel-only pill, Cerazette^®, as the first line option.
• Irregular bleeding (particularly in the first few months) may be more of a problem with the desogestrel-only pill than with other POPs.

In depth

• Women who are not amenorrhoeic and have not been pregnant in the past 6 months:
• Start the progesterone only pill (POP) on the first day of the period (licensed use), or up to day 5 of the cycle (unlicensed use), for immediate contraceptive cover.
• The POP can started at any other time in the cycle, but additional contraception is needed for the first 48 hours of taking the pill (unlicensed use).
• Inform the woman that the instructions in the packet may differ from those provided by the healthcare professional.
• If starting immediately after oral emergency contraception:
• Levonorgestrel emergency contraception used — advise additional contraception (condoms or avoidance of sex) for the first 2 days of use.
• Ulipristal acetate emergency contraception used — advise additional contraception (condoms or avoidance of sex) for the first 9 days of use.
• Advise the woman to take a pregnancy test no sooner than 3 weeks after the last episode of unprotected sex.
• If the woman is amenorrhoeic:
• Start the POP at any time, provided that it is reasonably certain that a woman is not pregnant (unlicensed use).
• Advise additional contraceptive protection (such as condoms) for the first 48 hours of pill taking.
• If the woman is postpartum and not breastfeeding:
• Contraception is not required before day 21 postpartum.
• Ideally, start the POP on day 21 postpartum for immediate contraceptive protection — this is the only licensed use for postpartum women.
• However, the POP can be started before day 21 if requested.
• If started after day 21, advise additional contraceptive protection (such as condoms) for the first 48 hours of pill taking.
• If the woman is postpartum and breastfeeding:
• Start on or before day 21 postpartum for immediate contraceptive protection.
• If started after day 21, advise additional contraceptive protection (such as condoms) for the first 48 hours of pill taking.
• These are unlicensed uses.

In depth

• Changing from a combined oral contraceptive (COC): the progestogen-only pill (POP) may be started immediately.
• Changing from an injectable progestogen-only contraceptive: the POP should be started on the day that the injection would have been given.
• Changing from a copper intrauterine device (IUD) or levonorgestrel-releasing intrauterine system (IUS):
• The POP is most conveniently begun within 5 days of the start of menstrual bleeding. No additional contraceptive protection is needed. The IUD can be removed at this time.
• The woman can also start a POP at any other time, if it is reasonably certain that she is not pregnant. Because the POP will become effective after 48 hours, the IUD or IUS should not be removed before this if she has been sexually active in the past 7 days, or if she requires interim protection from the IUD or IUS.
• Changing from a non-hormonal method (other than a copper IUD): start the POP within 5 days of the start of menstrual bleeding:
• If the POP is started outside of day 5, additional contraception should be used for the first 48 hours.

In depth

• First follow up at 10–12 weeks and then at least every 12 months thereafter, provided there are no problems.
• Review should include risk factors, correct use, lifestyle issues, adverse effects, possible drug interactions and information on how to manage contraception relating to missed pills and potential drug interactions.

In depth