Contraception

• Weight gain:

  • Weight gain associated with DMPA
  • Little evidence linking weight gain with other progestogen-only methods
  • No evidence of weight gain with combined hormonal contraception use
• Acne:

  • Combined hormonal contraception can improve acne
  • Progestogen-only implant may be associated with improvement, worsening or onst of acne
• Fertility:

  • No delay in return of fertility following discontinuation of the POP, CHC, progestogen-only implant or intrauterine contraception
  • Can be a delay of up to 1 year in the return of fertility after discontinuation of DMPA
• Bleeding patterns and dysmenorrhoea:

  • Irregular bleeding is common within the first 6 months of starting progestogen-only contraception
  • Primary dysmenorrhoea may improve with use of CHC
• Bone health:

  • DMPA is associated with a small loss of bone mineral density - can be used in under 18s after consideration of other methods, not recommended in over 50s
  • CHC is protective of bone mineral density
• CHC cancer risk:

  • Increased risk of cervical and breast cancer
  • Protective against ovarian and endometrial cancer
• Breast cancer (including history):

  • Non-hormonal contraception is preferred - copper intrauterine device or female/male sterilisation
  • Hormonal contraception (CHC and progestogen-only) should be avoided regardless of breast cancer hormone receptor status
• Obesity:

  • CHC is UKMEC 3 for women with a BMI of 35 or greater