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Contraception - Management
How should a woman who is not using contraception start the progestogen-only pill (POP)?

  • 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:
  • 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

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