For an overview of hormonal contraception please see BNF: Contraceptives, hormonal.

The Faculty of Sexual and Reproductive Healthcare (FSRH) provides detailed method specific guidance and links to UK Medical Eligibility Criteria for Contraceptive Use; see FSRH Clinical Guidance for further information.

In the first instance, all available methods of contraception should be discussed before reaching a decision. For most women, a monophasic combined oral contraceptive containing 30-35 micrograms of oestrogen with a low dose of either levonorgestrel or norethisterone, is a suitable first line option.

Different doses of oestrogen may be associated with different side-effect profiles in individual women. The risk of cardiovascular disease (including venous thromboembolism) is higher with pills containing 50 micrograms oestrogen but there is no evidence for a difference in cardiovascular risk between 20 and 35 micrograms. Evidence suggests that combined oral contraceptives (COC’s) containing gestodene and desogestrel (i.e. third generation pills) have a higher risk of venous thromboembolism, the absolute risk of venous thromboembolism is small. Provided that this is made clear to the patient, there is no restriction on the use of these.

When the pill is used for management of gynaecological conditions, such as menorrhagia or dysmenorrhoea, the risk/benefit ratio changes and it may be prescribed for women who would have relative contraindications if they were prescribed solely for contraception.

Some drugs, including enzyme-inducers and antibiotics, may impair the efficacy of oral contraceptives; see BNF: Contraceptives, interactions for details.