Contraception Master Module
Clinical detail
Additional detail checked 2026-10-17 against the linked sources. This check covers the section below; the rest of the module retains its displayed verification status.
Choose contraception through shared decision-making about reproductive plans, effectiveness, bleeding preferences, health conditions and practical access. Medical eligibility is method-specific.
Assessment & interpretation
- Review pregnancy possibility, postpartum timing, breastfeeding, blood pressure, migraine aura, thrombosis history, smoking, breast cancer and interacting medicines.
- Consider the patient’s ability to use a daily method consistently and preferences about an implant, injection, intrauterine method, barrier method or permanent contraception.
Decisions that change management
- The CDC eligibility categories distinguish unrestricted use (1), benefits generally outweighing risks (2), risks usually outweighing benefits (3), and unacceptable risk (4). Check the actual method–condition combination.
- Combined hormonal contraception, progestogen-only methods and intrauterine contraception do not share the same contraindications.
- Emergency contraception and ongoing contraception are separate decisions; discuss both when relevant.
Follow-up & safety-netting
- Explain expected bleeding changes, what to do for missed use, warning symptoms, and how to return for review, switching or removal.
- Discuss condoms for STI-risk reduction because most contraceptive methods do not provide that protection.
Clinical pitfalls
- A history that makes oestrogen unsuitable does not automatically make every other contraceptive method unsuitable. The cited framework is U.S. guidance and should be labelled accordingly.
Admission & discharge
Admission/discharge guidance checked 2026-10-18 against the linked sources. This is a clinical checklist for an individual decision, not an automatic discharge order.
When admission or continued hospital care is needed
- Severe abdominal pain, suspected ectopic pregnancy/perforation, uncontrolled bleeding, infection/sepsis or a serious medicine complication requires urgent assessment.
When clinic, day care or home care may be suitable
- Routine contraceptive initiation, emergency contraception or uncomplicated IUCD/IUS care does not normally need admission.
Before going home
- The chosen method is clinically suitable, any procedure recovery is satisfactory and the patient understands efficacy, expected effects, backup needs and when to seek help.
Discharge medicines and treatment changes
- Provide the selected method’s complete directions and any indicated emergency contraception, without duplicating incompatible alternatives.
Tests, pending results and their reviewer
- Record pregnancy assessment, any STI tests and a follow-up pregnancy test when indicated; assign results review.
Home care and counselling
- Discuss expected bleeding/side effects, relevant device warnings, STI protection and how to obtain removal or a change of method.
Follow-up: when and what to review
| When | Action / responsible service |
|---|---|
At the method-specific review/test date when indicated | Confirm correct use, testing and concerns; do not require unnecessary routine admission. |
Whenever new symptoms occur | Review pain, bleeding, pregnancy concern or intolerance rather than persisting with an unsafe method. |
Return urgently
- Severe/unilateral abdominal pain, collapse, heavy bleeding, fever or chest/VTE symptoms requires urgent care.
Open the complete discharge checklist →
Treatment
① Immediate stabilization — first minutes
③ First-line treatment & drug regimens
| Method | Key practical points |
|---|---|
Copper IUD | >99% effective, 10 y; heavier periods; EC gold standard (within 5 d of sex/ovulation); insertion procedure page linked |
Mirena LNG-IUS 52 mg | 8 years for contraception; HMB and HRT have different durations. See product-specific cards. |
Etonogestrel implant | 3 y; irregular bleeding commonest discontinuation reason; insert days 1-5 or postpartum anytime |
DMPA injection | 150 mg IM q12 wks; BMD caution long-term; delayed return fertility |
COCP | ~9 in 100 typical-use failures; missed-pill rules on card; AVOID migraine-with-aura/VTE history/POSTPARTUM <6 wks breastfeeding (MEC 4) |
POP (desogestrel/drospirenone) | Breastfeeding-safe any time postpartum; strict timing for older POPs |
Emergency hormonal | LNG 1.5 mg single dose ASAP <=72 h (efficacy falls with delay); ulipristal 30 mg <=120 h where available |
Sterilization | Permanent: laparoscopic tubal occlusion/vasectomy - statutory consent documentation (India forms) |
- After unprotected/inadequately protected intercourse; assess timing and offer the most effective suitable option
- Ulipristal or copper IUD may be more effective later in the 5-day window; do not apply ulipristal’s delayed hormonal-restart rule to LNG.
- Pregnancy test if no withdrawal bleed/period within 3 weeks; assess pregnancy symptoms or abdominal pain
- Can start/resume hormonal contraception immediately after LNG, using condoms/abstinence for 7 days
- Contraception after pregnancy exclusion and eligibility assessment
- 52 mg systems/indications are not interchangeable with lower-dose IUS products. HMB symptom recurrence requires reassessment before assuming device failure.
- Bleeding/pain, expulsion/perforation symptoms, thread/insertion follow-up and pregnancy symptoms; investigate persistent/new abnormal bleeding
④ Drug treatment detail (1 agents)
- Indication: Eligible nonpregnant patient seeking contraception or PCOS cycle control after BP/VTE/migraine assessment
- If starting >5 days after menstrual bleeding begins, use backup for 7 days. This formulation is an example; PCOS guidance does not establish one universally preferred progestogen.
- BP, adherence, bleeding, new migraine aura or VTE symptoms; review interacting medicines
Definitive treatment
Method continuation with scheduled reviews; switching strategies documented.
Monitoring
- IUD string checks; BP reviews for hormonal users; weight/BMD awareness DMPA long-term
⑮ Complications & their management
IUD expulsion/malposition
US localisation; reinsertion options
Ectopic pregnancy on contraception
Any pain+positive test = ectopic pathway regardless of method
Post-treatment care
- Postpartum/post-abortion immediate-LARC counselling improves uptake
Diagnosis & assessment
Initial assessment
- Pregnancy exclusion when relevant
- Medical eligibility screening (WHO MEC categories 1-4 per condition)
- STI risk assessment pre-IUD/implant insertion
- Informed-method counselling documented
Investigations
| Test | Looking for |
|---|---|
BP measurement | MEC screening for oestrogen methods |
Principles & follow-up
Management principles
Sources (9)
· checked 2026-10-18 · verified-live
Open source ↗
Scope: additional clinical-detail explanation for contraception. Checked the assessment, management-decision and follow-up statements in that section against this source. This does not certify all pre-existing regimens, calculations or recommendations in the module. Additional admission/discharge ch…
· checked 2026-10-18 · verified-live
Open source ↗
LNG 1.5 mg, 5-day window with time-related effectiveness, repeat if vomiting within 3 hours, contraception restart/backup and pregnancy-test follow-up. Additional admission/discharge check 18 October 2026 (limited to the following): Emergency-contraception instructions, pregnancy testing and timing/…
· checked 2026-10-18 · verified-live
Open source ↗
One sterile 52 mg system, trained insertion, contraindications; 8-year contraception, 5-year HMB then symptom review and maximum 8 years if continued, 4-year UK-labelled HRT endometrial protection. Indication-specific durations are not interchangeable. Additional admission/discharge check 18 October…
· checked 2026-10-17 · verified-live
Open source ↗
21 active 30-microgram/150-microgram tablets plus 7 inactive in a 28-day pack; one tablet daily, no gap between packs, seven-day backup for a later start and eligibility contraindications. No claim to update every missed-pill algorithm.
· checked 2026-10-18 · verified-live
Open source ↗
Maternal/newborn transfer assessment, first void and effective feeding, handover, support/safeguarding, first midwife visit within 36 hours after transfer, postnatal danger symptoms. Full recommendations page read.
· checked 2026-10-18 · verified-live
Open source ↗
Normal-delivery discharge not less than 48 hours: full primary SOP PDF normal-delivery/discharge passages read. Corroborated by NHM CEmONC 2024 Part 1, chapter 8. This does not define a universal post-caesarean or complicated-case stay.
· checked 2026-10-18 · verified-live
Open source ↗
Official WHO summary read: at least 24-hour facility care after birth; additional contacts at 48–72 hours, 7–14 days and week 6; individual assessment/support. Summary facts only, not a claim that the full 242-page PDF was reviewed.
· checked 2026-10-18 · verified-live
Open source ↗
Full primary patient recovery page read: pain control, wounds, activity/VTE, urinary/bowel and infection warning signs, adult support and no driving/important decisions during the first 24 hours after general anaesthesia. Used as general recovery/handover principles, not operation-specific discharge…
· checked 2026-10-18 · verified-live
Open source ↗
Full primary recommendations read, focusing on critical-care-to-ward transfer: structured written handover, shared plan, monitoring, rehabilitation and receiving-team capability. Step-down is distinct from home discharge; no universal organ-support discharge cutoff is asserted.