quick note – contraception

1. Quick-Start & “When Effective?” Table

Method	Cycle day(s) you can start†	Back-up condoms required
COC / NuvaRing	D 1-5	None
	> D5 or > EC	7 days
Traditional POP (norethisterone 350 µg / LNG 30 µg)	D 1-5	None
	> D5 or > EC	2 days
Desogestrel POP 75 µg	D 1-5	None
	> D5/EC	2 days
Drospirenone POP 4 mg (Slinda®)	Any day if pregnancy excluded	7 days
Depot-MPA (DMPA)	D 1-5	None
	> D5	7 days
Implanon NXT®	D 1-5	None
	> D5	7 days
Mirena® / Kyleena®	D 1-7	None
	> D7	7 days
Copper IUD	Any day	None

†Pregnancy must be reasonably excluded (neg test ≤ 72 h & no unprotected I/C since LMP, etc.) iris.who.intshvic.org.au

---

2. COCP Side-Effect “Troubleshooting”

Symptom	First-line adjustment
Headache, nausea	↓ EE dose (e.g. 20 µg); take at night
Breast tenderness	↓ EE ± switch to lower-androgenic progestogen
Break-through bleeding	↑ EE (30–35 µg) or change P; consider vaginal ring
Amenorrhoea	Reassure; ↑ EE if bothersome
Menorrhagia / dysmenorrhoea	Extended (3-pack) cycling or switch to LNG-IUS
Acne/hirsutism	Change to anti-androgenic P (cyproterone 2 mg/35 µg†, drospirenone)
Bloating	Usually settles; ↓ EE
Mood change / ↓ libido	Limited evidence; trial 20 µg EE or drospirenone pill; exclude other causes
Weight gain, depression	No robust causal data—advise lifestyle, consider alternative if patient perceives link
Chloasma	Use P-only or non-hormonal method

†Use cyproterone formulation only when acne/seborrhoea or hirsutism present (maximum 24 months).

---

3. Late or Missed Pills — At-a-Glance

3.1 Combined Pills (any EE dose, including Zoely®/Qlaira®—see product for specifics)

1. Late < 24 h (≤ 48 h since last pill):
   Take missed pill ASAP; continue pack; no back-up needed.
2. Missed ≥ 24 h (> 48 h since last pill):
   Take most recent missed pill ± 2 in one day → 7 days condoms.
   If < 7 active pills after episode → skip placebo.
   If < 7 active pills taken since last placebo → consider EC if I/C ≤ 5 days.

3.2 POP windows

Formulation	“Missed” if >	Back-up
Traditional NET/LNG	3 h	48 h
Desogestrel 75 µg	12 h	48 h
Drospirenone 4 mg	24 h	7 days

---

4. Emergency Contraception Triggers

Method failure	EC indicated when…
COC / Ring	≥ 2 active pills missed in week 1 or the week before hormone-free break
NuvaRing	Ring-free > 48 h or ring out > 3 h in week 1
Traditional POP	Pill > 3 h late (or desogestrel > 12 h; drospirenone > 24 h)
Implanon	Beyond 3 years expiry
DMPA	Injection > 14 weeks
IUD	Unprotected I/C within 7 days before expulsion/removal

---

5. Menopause & Ceasing Contraception

Method	< 50 y	≥ 50 y
Barrier / Cu-IUD	Stop after 2 y amenorrhoea	Stop after 1 y amenorrhoea
CHC (COC/ring)	Continue to 50 y then switch to POP/LARC/non-hormonal	Avoid (↑ VTE/stroke)
DMPA	Continue to 50 y then switch	Stop at 50 y; use POP/Implanon/Mirena
POP, Implanon, Mirena	Continue > 50 y	If amenorrhoeic: stop 1 y after two FSH > 30 IU/L (6 w apart) or at 55 y; else continue until 55 y then 1 y no menses

---

6. PrEP Baseline Checklist (GP)

• Follow ASHM PrEP 2024 pathway:
  1. High-risk per ASHM criteria
  2. HIV Ag/Ab test negative & no exposure in last 7 days
  3. eGFR ≥ 60 mL/min/1.73 m²
  4. No concurrent nephrotoxic drugs
  5. Full STI screen (CT/GC NAATs, syphilis serology)
  6. Hep B serology (HBsAg, anti-HBs, anti-HBc) – infection is not a contraindication; manage flares if PrEP stopped; vaccinate if non-immune
  7. Hep C Ab / RNA negative