system (LNG-IUS) or POP initiation at time of IUD intrauterine device removal (avoid intercourse or (IUD) use condoms in addition for 7 days before the removal of an IUD). NO POP initiation at least 2 days before the removal of an IUD. NO POP initiation at time of IUS removal. YES, for 48 hours unless POP initiated on Barrier method (male condom, Can be initiated immediately if Days 1–5 of menstrual female condom, cap or barrier method has been used cycle consistently and diaphragm) correctly or if the clinician is reasonably certain that the woman is not pregnant and that there is no risk of conception. Ok to prescribe upto 12/12 at first consultation Women may be advised that a progestogen-only pill can be continued until the age of 55 years when natural loss of fertility can be assumed. Alternatively they can continue using a POP and have FSH concentrations checked on two occasions 1–2 months apart. If both FSH measurements are >30 IU/l this is suggestive of ovarian failure and they may continue with a progestogen-only pill or barrier contraception for one further year (or 2 years if aged <50 years). Women who have a change in bleeding pattern when using a progestogen-only pill need to be assessed and the risk of STIs, pregnancy or gynaecological pathology considered. is no evidence that changing the type and dose of progestogen will improve bleeding but this may help some individuals. If, after exclusion of other causes, bleeding patterns are still unacceptable then an alternative contraceptive method may need to be considered. LARCS Injection 12 weeks Deep IM injection
system (LNG-IUS) or intrauterine device (IUD) Barrier method (male condom, female condom, cap or diaphragm) POP initiation at time of IUD removal (avoid intercourse or use condoms in addition for 7 days before the removal of an IUD). POP initiation at least 2 days before the removal of an IUD. POP initiation at time of removal. Can be initiated immediately if barrier method has been used consistently and correctly or if the clinician is reasonably certain that the woman is not pregnant and that there is no risk of conception. NO NO YES, for 48 hours unless POP initiated on Days 1–5 of menstrual cycle Ok to prescribe upto 12/12 at first consultation Women may be advised that a progestogen-only pill can be continued until the age of 55 years when natural loss of fertility can be assumed. Alternatively they can continue using a POP and have FSH concentrations checked on two occasions 1–2 months apart. If both FSH measurements are >30 IU/l this is suggestive of ovarian failure and they may continue with a progestogen-only pill or barrier contraception for one further year (or 2 years if aged <50 years). Women who have a change in bleeding pattern when using a progestogen-only pill need to be assessed and the risk of STIs, pregnancy or gynaecological pathology considered. is no evidence that changing the type and dose of progestogen will improve bleeding but this may help some individuals. If, after exclusion of other causes, bleeding patterns are still unacceptable then an alternative contraceptive method may need to be considered. LARCS Injection 12 weeks Deep IM injection IUS