Ensure client understands the method to aid satisfaction and compliance, and knows to take one tablet daily at the same time. Discuss methods such as phone reminders to support regular pill taking.

1. No extra precautions required if starting:

• Day 1 to 5 of the cycle (day 1 for DRSP POP)
• Up to 21 days postpartum; lactation is not affected
• Days 1 to 5 post termination or miscarriage (day 1 for DRSP POP)
• While taking combined pill: change by instant switch (that is, without the COC pill free interval).
• While using injectable contraception, POP should be started at least 2 days before the next injection is due (7 days for DRSP POP)
• With an IUD, IUS or implant in situ (within licence limit).
  Remove the IUS/IUD/implant at least 48 hours after starting the POP (7 days for DRSP POP).

2. POP may be started at any time in the cycle if it is reasonably certain that the client is not pregnant, using additional contraceptive precautions for two days (7 days for DRSP POP).

3. A POP started immediately after ulipristal emergency contraception (UPA-EC) could potentially reduce the effectiveness of the UPA-EC. The POP should be started 5 days after UPA-EC is taken. See WoS Emergency Contraception guideline.

Vomiting

If a woman vomits within 2 hours of taking a POP then she should be advised to take another pill as soon as possible.

• Complete or update the relevant parts of NaSH.
• Give written method information including contact number to client.
• Record and date the prescription in NaSH.
• If supply is under patient group direction, complete relevant documentation as local protocol.
• For new starts, notify the GP if permission has been given for correspondence.

Return visit

A women may be offered up to 12 months of POP at her first and subsequent visits, with follow up yearly to ensure satisfaction and concordance with the method. Thereafter, there should be a flexible approach to contraceptive supply with ease of access should problems arise.