Switching or Starting Methods of Contraception Flashcards
Day 4 of natural menstrual cycle and wishes to start implant
Can quick start with no additional precautions
Day 1 of natural menstrual cycle and wishes to start estradiol COC (Qlaira)
Can quick start with no additional precautions
Day 2 of natural menstrual cycle and wishes to start drospirenone POP
Can quick start but will need condoms for 7 days
Consider need for PT and EC
Day 6 of natural menstrual cycle, had UPSI yesterday, wishes to start desogestrel POP
- Consider EC + follow-up PT + usual advice depending on method of EC
- Can quick start (if no EC, or if LNG EC) and use condoms for 48 hours
Day 7 of natural menstrual cycle, had UPSI yesterday, wants to start LNG-IUD
- Cannot quick-start
- Offer EC + PT + bridging contraception until 21 days post UPSI with neg PT, and can then have LNG-IUD inserted
Day 29 after term vaginal delivery, still amenorrhoeic, no UPSI since delivery, wishes to start drospirenone POP
- Quick-start and use condoms for 7 days
Currently taking CHC and is on day 9 (perfect use so far), wishes to switch to implant
Switch to implant with no additional precautions
Currently taking CHC (perfect use so far), and is on day 1 of hormone-free interval, wishes to switch to LNG-IUD
As day 1 of HFI, can switch to LNG-IUD with no additional precautions
Currently taking CHC (perfect use so far), day 2 of hormone-free interval, wishes to switch to DMPA
As day 2 of HFI, can switch to DMPA with no additional precautions
Currently taking CHC (perfect use so far), day 2 of hormone-free interval, wishes to switch to LNG-IUD
- Can only switch from CHC to LNG-IUD with no additional precautions on day 1 of hormone free interval
- Once day 2-7 of HFI, advice depends on UPSI
– No UPSI since start of HFI: switch and use condoms for 7 days
– UPSI since start of HFI: insert LNG-IUD, AND restart the CHC for 7 consecutive days
Currently taking CHC (perfect use so far) and is on day 4 of new packet. Wishes to switch to desogestrel POP, had UPSI yesterday
- Continue CHC until has used for 7 consecutive days, and then switch with no additional precautions required
Implant currently in-situ for 9 months, wishes to switch to CHC
Switch with no additional precautions
Implant currently in-situ for 3 years 1 month, wishes to switch to DMPA
- PT today, and assuming is negative
- Switch and use condoms for 7 days
- Follow-up PT if UPSI in previous 21 days
Implant currently in situ for 4 years 1 month, wishes to switch to LNG-IUD, UPSI 3 days ago
- Cannot fit LNG IUD as risk of pregnancy
- PT today, offer EC, PT at 21 days post UPSI
- Can fit LNG IUD once 21 days post last UPSI and neg PT
Last DMPA given 13+6 weeks ago, wishes to switch to implant
Insert implant immediately, no additional precautions
Last DMPA given 14+6 weeks ago, no UPSI since 14 weeks, wishes to switch to LNG IUD
Fit LNG IUD immediately, use condoms for 7 days
Last DMPA given 14+6 weeks ago, UPSI yesterday, wants to switch to desogestrel POP
- PT today, offer EC, PT at 21 days post UPSI
- Depending on EC, can quick-start POP and use condoms for 48 hours
Taking norethisterone POP but wants to switch to desogestrel POP
Switch immediately, no additional precautions required
Taking levonorgestrel POP but wants to switch to drospirenone POP
Switch immediately, but must use condoms for 7 days
Taking desogestrel POP, wishes to switch to LNG IUD
Switch immediately, no additional precautions required
Taking drospirenone POP, wants to switch to implant, is currently on day 14 of active pills
Switch immediately with no additional precautions (when on days 8-24 of active pills)
Taking drospirenone POP, wants to switch to implant, is currently on day 26 of pills and has not had UPSI in the past 10 days
- Placebo / hormone free interval is days 25-28
- If no UPSI since start of HFI, can switch to implant immediately but must use condoms for 7 days
Taking drospirenone POP, wants to switch to implant, is currently on day 27 of pills and had UPSI yesterday
- Placebo / hormone-free interval is days 25-28
- Insert implant today
- Restart DRSP POP until 7 consecutive active pills taken
Taking drospirenone POP, wants to switch to implant, is currently on day 2 of pill taking and had UPSI yesterday
- If in days 1-7 of active pills after HFI, and UPSI since start of HFI
- Can insert implant today
- Continue DRSP until 7 consecutive pills have been taken
Age 30, currently has 52mg LNG IUD in-situ, inserted 5 years 4 months ago, but wishes to switch to desogestrel POP, last UPSI 10 days ago
- Can switch immediately and use condoms for 48 hours (as per 2023 guidance)
[old guidance would be to remove IUD, commence POP, condoms 48 hours, PT today and PT again 21 days after UPSI]
Age 30, currently has 52mg LNG IUD in situ, inserted 5 years 4 months ago, wishes to switch to CHC, last UPSI 4 days ago
- Commence CHC
- Retain LNG IUD for 7 days after last UPSI
Age 30, 52mg LNG IUD in situ, inserted 6 years 4 months ago, wishes to switch to another 52mg LNG IUD, UPSI 10 days ago
- PT neg today
- Switch devices
- Follow-up PT 21 days after last UPSI
Age 30, 52mg LNG IUD in situ, inserted 7 years 4 months ago, had UPSI 10 days ago, wants another 52mg LNG IUD
- Cannot switch today
- PT
- Consider EC + bridging + ?removal
- Switch devices once 21 days after last UPSI with neg PT
Day 1 of natural menstrual cycle and wishes to commence drospirenone POP
- QS immediately
- No need for additional precautions
Currently on day 4 of HFI whilst taking CHC, had UPSI on day 2 of HFI, and wishes to switch to desogestrel POP
- Start CHC until 7 days of active pills/patch/ring
- Then switch to POP with no additional precautions
Currently on day 4 of HFI whilst taking CHC, had UPSI on day 2 of HFI, and wishes to switch to LNG-IUD
- Can insert immediately
- AND restart the CHC until 7 active pills/patch/ring taken
Has the 13.5mg LNG IUD in situ, inserted 3 years 1 month ago, and wishes to switch to 52mg LNG IUD. Had UPSI 9 days ago
- As >3 years and UPSI in previous 21 days, will need to consider retaining LNG IUD and PT 21 days after last UPSI
- Can then switch if no UPSI in previous 7 days, and will need to use condoms for 7 days