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Mental health Pregnancy Sexual health Women's health

Contraception - assessment

Last revised in July 2026

An assessment should be carried out on all women requesting contraception to identify any relevant medical conditions or medication

Contraception - assessment: Summary

  • The following methods of contraception are available in the UK:
    • Combined hormonal contraception (CHC) — combined oral contraception (COC) pill, combined transdermal patch, and combined vaginal ring.
    • Progestogen-only contraception — progestogen-only pill (POP), progestogen-only implant, and progestogen-only injectable.
    • Intrauterine contraception (IUC) — copper intrauterine device (Cu-IUD) and levonorgestrel intrauterine device (LNG-IUD).
    • Barrier methods — male condom, female condom, and diaphragm or cap (plus spermicide).
    • Sterilization methods — male sterilization (vasectomy) and female sterilization (tubal occlusion).
    • Natural family planning methods — fertility awareness methods and the lactational amenorrhoea method.
  • When a woman requests contraception:
    • Her needs and personal circumstances should be considered, including her preferred method of contraception, her future plans for having children, and her personal beliefs and views about contraception.
    • She should be assessed to identify the most suitable methods of contraception.
    • Information on all contraceptive methods, including long-acting reversible contraception methods (Cu-IUD, LNG-IUD, progestogen-only injectables, and the progestogen-only implant), should be provided to help her make an informed choice.
    • The method of contraception that is most acceptable to the woman should be offered, unless it is contraindicated.
  • As part of the assessment for contraception:
    • Pregnancy should be excluded.
    • A history and clinical examination should be performed to identify factors that can affect the choice of contraception, such as comorbidities (for example migraine and hypertension), allergies (including to latex or anaesthetics), lifestyle factors (such as smoking), reproductive history (postpartum/breastfeeding), drug treatments (including liver enzyme-inducing drugs), and age (approaching menopause or under 18 years of age).
    • The UK Medical Eligibility Criteria for Contraceptive Use (UKMEC) should be applied to assess the woman's eligibility for use of CHC, progestogen-only contraception, or IUC. If the woman is considering barrier methods, sterilization, or natural family planning, the World Health Organization Medical Eligibility Criteria for Contraceptive Use should be applied to assess eligibility, as these methods are no longer covered by the UKMEC.
    • The woman's risk of sexually transmitted infections (STIs) should be assessed and advice on safe sex given when appropriate. 
    • A risk assessment for sexual abuse, rape, and non-consensual sex should be carried out, particularly if the woman is considered to be vulnerable (that is, younger than 16 years of age; is from a disadvantaged background; is in, or is leaving, care; and/or has low educational attainment).
    • If a girl younger than 16 years of age requests contraception without parental consent, she should be assessed for her competency to independently consent to treatment. It should be documented in her notes whether or not she meets the Fraser criteria.
    • Women with learning and/or physical disabilities should be supported in making their own decisions about contraception.

Have I got the right topic?

From age 13 years to 60 years (Female).

This CKS topic covers the assessment of women for the different methods of contraception.  

This CKS topic does not provide full information on the contraindications and cautions for the different contraceptive methods. The UK Medical Eligibility Criteria for Contraceptive Use and the World Health Organization Medical Eligibility Criteria for Contraceptive Use provide guidance on the safety of different contraceptive methods in women with specific medical conditions or medically relevant physiological or personal characteristics. 

This CKS topic does not cover the assessment of women requesting emergency contraception. 

There are separate CKS topics on Contraception - barrier methods and spermicides, Contraception - combined hormonal methods, Contraception - emergency, Contraception - IUC, Contraception - natural family planning, Contraception - progestogen-only methods, Contraception - sterilization, Infertility, Menorrhagia, and Pre-conception - advice and management.

The target audience for this CKS topic is healthcare professionals working within the NHS in the UK, and providing first contact or primary healthcare.

How up-to-date is this topic?

Changes

July 2026 — reviewed. A literature search was conducted in June 2026 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. The topic has been aligned with the 2025 College of Sexual and Reproductive Health (CoSRH) UK Medical Eligibility Criteria for Contraceptive Use (UKMEC).

Previous changes

January 2024 — minor update. Levonorgestrel intrauterine systems (LNG-IUSs) are now referred to as levonorgestrel intrauterine devices (LNG-IUDs). The CoSRH updated the terminology to align with other international organisations.

July 2023 — minor update. The information on excluding pregnancy has been updated to align with College of Sexual and Reproductive Healthcare guidelines.

April 2023 — minor update. Recommendations relating to intrauterine contraceptive methods updated to align with the College of Sexual and Reproductive Healthcare guideline Intrauterine contraception.

February 2023 — minor update. Added link to the Diagnosis and management of individuals with Fetal Valproate Spectrum Disorder; a consensus statement from the European Reference Network for Congenital Malformations and Intellectual Disability in the drug treatment section. 

September 2022 — minor update. A recommendation to check additional considerations before prescribing drosperinone, as well as the UK Medical Eligibility Criteria (UKMEC) that relates to all progestogen-only pills, has been added in line with the College of Sexual and Reproductive Healthcare (CoSRH) Progestogen-only pills. 

October 2021 — minor update. Information that a progestogen-only injectable can be considered a highly effective method of contraception for women taking known teratogenic drugs if repeat injections are documented as having been administered on schedule by a healthcare professional has been added for clarity.

April 2021 — reviewed. A literature search was conducted in March 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. The structure of the topic has been changed. No major changes to the recommendations have been made.

September 2019 — minor update. Updated to clarify that the ethical and legal issues that need to be considered when assessing suitability for contraception apply to women with learning disabilities, not those with learning difficulties.

May 2019 — minor update. Topic updated in line with the College of Sexual and Reproductive Healthcare (CoSRH) guideline Overweight, Obesity and Contraception [CoSRH, 2019]. 

December 2017 — minor update. Added information on fetal malformation as a possible adverse effect of topiramate.

August to September 2016 — reviewed. A literature search was conducted in August 2016 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of the topic. Minor structural changes have been made.

July 2014 — minor update. Update to the Have I got the right topic section to state that this CKS topic does not cover the management or contraceptive choice in women who have cardiovascular disease (CVD). Links have been inserted within the topic to the CoSRH guidance Contraceptive Choices for Women with Cardiac Disease [CoSRH, 2014].

August 2013 — minor update. Added a text to clarify that when used for the purpose of oestrogen replacement therapy the levonorgestrel intrauterine system (LNG-IUS) should be retained for no longer than 5 years after insertion (the licence states 4 years) regardless of the age of the woman at insertion.

June 2013 — minor update. The 2013 Quality and Outcomes Framework (QOF) options for local implementation have been added to this topic.

May 2013 — minor update. Linking error corrected in the Epilepsy node in Scenario: Comorbidities and special situations.

March 2013 — minor update. The telephone number for NHS Direct has been updated.

February to June 2012 — reviewed. A literature search was conducted in December 2011 to identify evidence-based guidelines, UK policy, systematic reviews, and key RCTs published since the last revision of the topic. No changes to clinical recommendations have been made. However, recommendations have been rewritten for clarity, and superseded guidelines and manufacturers' Summaries of Product Characteristics have been updated accordingly.

January 2012 — mirror error corrected. Clarified the UK medical eligibility criteria for the use of progestogen-only pills in women with a past history (5 years or more) of migraine with aura, at any age.

March 2011 — topic structure revised to ensure consistency across CKS topics — no changes to clinical recommendations have been made. Issued in June 2011.

February 2011 — minor update. The CoSRH no longer recommends that additional contraception is required during or after courses of antibiotics that do not induce liver enzymes. However, additional contraceptive precautions are required if the antibiotic or illness causes vomiting or diarrhoea. 

August 2010 — updated. The section on Contraceptive choices in women approaching menopause has been updated to include the CoSRH guidance on Contraception in women aged over 40 years.

June 2010 — updated. The section on Contraceptive choices in young women under 18 years of age has been updated in line with the CoSRH guidance Contraceptive choices for young people. A prescription for Levest®, a new ethinylestradiol plus levonorgestrel combined oral contraceptive pill, has been added. 

March 2010 — minor update. The section on prescribing for women with epilepsy has been updated in line with the CoSRH statement on antiepileptic drugs and contraception.

February 2010 — updated to include the revised UK medical eligibility criteria for contraceptive use as published by the FRSH, formerly the Faculty of Family Planning and Reproductive Healthcare (FFPRHC).

October 2009 — minor update. The advice on when to remove a copper intrauterine device (Cu-IUD) or LNG-IUS in a woman with pelvic inflammatory disease has also been updated. 

March 2009 — minor update. The QOF indicators for sexual health have been updated in the Goals and outcome measures section.

September 2008 — minor correction. Typographical and table heading corrections to UK medical eligibility criteria tables on Cu-IUD and the LNG-IUS. 

April to September 2007 — converted from CKS guidance to CKS topic structure. The evidence base has been reviewed in detail, and recommendations are more clearly justified and transparently linked to the supporting evidence.

September 2004 — updated to include the 2004 World Health Organization (WHO) Medical eligibility criteria for contraceptive use. 

January 2004 — reviewed. Validated in March 2004 and issued in June 2004.

January 2001 — rewritten. Validated in March 2001 and issued in June 2001. Guidance on emergency contraception is no longer included in the contraception guidance but can be found as a separate CKS topic.

December 1997 — written.

Update

New evidence

Evidence-based guidelines

No new evidence-based guidelines since 1 June 2026.

HTAs (Health Technology Assessments)

No new HTAs since 1 June 2026.

Economic appraisals

No new economic appraisals relevant to England since 1 June 2026.

Systematic reviews and meta-analyses

No new systematic reviews or meta-analysis which reach the CKS threshold for inclusion since 1 June 2026.

Primary evidence

No new primary evidence which reaches the CKS threshold for inclusion published since 1 June 2026.

New policies

No new national policies or guidelines since 1 June 2026.

New safety alerts

No new safety alerts since 1 June 2026.

Changes in product availability

No changes in product availability since 1 June 2026.

Goals and outcome measures

Goals

To support primary healthcare professionals to: 

  • Assess women requesting contraception.
  • Support women to find a method of contraception that is appropriate.

Outcome measures

No outcome measures were found during the review of this topic.

Audit criteria

No audit criteria were found during the review of this topic.

QOF indicators

No QOF indicators were found during the review of this topic.

QIPP – options for local implementation

No QIPP criteria were found during the review of this topic.

NICE quality standards

Contraception

  • Women asking for contraception from contraceptive services are given information about, and offered a choice of, all methods including long-acting reversible contraception.
  • Women asking for emergency contraception are told that an intrauterine device is more effective than an oral method.
  • Women who request an abortion discuss contraception with a healthcare practitioner and are offered a choice of all methods when they are assessed for abortion and before discharge.
  • Women who give birth are given information about, and offered a choice of, all contraceptive methods by their midwife.

[NICE, 2021]

Background information

Which methods of contraception are available in the UK?

  • The following methods of contraception are available in the UK:
    • Combined hormonal contraception (CHC) — combined oral contraception (COC) pill, combined transdermal patch, and combined vaginal ring.
    • Progestogen-only contraception — progestogen-only pill (POP), progestogen-only implant, and progestogen-only injectable.
    • Intrauterine contraception — copper intrauterine device (Cu-IUD) and levonorgestrel intrauterine device (LNG-IUD).
    • Barrier methods — male condom, female condom, and diaphragm or cap (plus spermicide).
    • Sterilization methods — male sterilization (vasectomy) and female sterilization (tubal occlusion).
    • Natural family planning methods — fertility awareness methods and the lactational amenorrhoea method.
  • Long-acting reversible contraceptives (LARCs) are contraceptive methods that require administration less than once per cycle or month [NICE, 2020].
    • LARC methods, which include the progestogen-only injectable, progestogen-only implant, the Cu-IUD, and the LNG-IUD, are highly reliable because their effectiveness does not depend on daily concordance. 
  • Emergency contraception (EC) is an intervention aimed at preventing unintended pregnancy after unprotected sexual intercourse or contraceptive failure [CoSRH, 2020].
    • The methods of EC currently available in the UK are oral levonorgestrel, oral ulipristal acetate, and the Cu-IUD.
    • See the CKS topic on Contraception - emergency for more information.
  • Bridging contraception can be offered if a woman’s choice of contraceptive method is not available or is not appropriate at the time of presentation [CoSRH, 2017]. 
    • The methods of contraception that can be quick started as bridging contraception include CHC (excluding co-cyprindiol), the POP, the progestogen-only implant, and the progestogen-only injectable (if other methods are not appropriate or acceptable). See the section on Excluding pregnancy for more information.
    • Quick starting is outside the product license for many contraceptive methods. However, the College of Sexual and Reproductive Healthcare (CoSRH) supports quick starting of contraceptive methods as described in the CoSRH guideline Quick Starting Contraception.

How effective are the available contraceptive methods?

Table 1. Summary of the efficacy of different contraceptive methods available in the UK.

 Percentage of women experiencing an unintended pregnancy within the first year of use
MethodTypical usePerfect use*
No method85%85%
Fertility awareness methods2—23%0.4—5%
Female diaphragm with spermicide17%16%
Male condom13%2%
Combined hormonal contraception (CHC)7%0.3%
Progestogen-only pill (POP)7%0.3%
Progestogen-only injectable4%0.2%
Copper intrauterine device (Cu-IUD)0.8%0.6%
Levonorgestrel intrauterine device (LNG-IUD)0.1—0.4%0.3%
Progestogen-only implant0.1%0.1%
Female sterilization0.5%0.5%
Vasectomy0.15%0.10%
* Used consistently and correctly
Data from: [CoSRH, 2025a]

Management

Scenario: Assessment for contraception

From age 13 years to 60 years (Female).

What issues should I consider and discuss when a woman requests contraception?

  • Discuss her needs and personal circumstances, including:
    • Her preferred method of contraception.
    • Her future plans for having children.
    • Her personal beliefs and views about contraception.
    • The attitudes of her partner and family towards contraception (if relevant/appropriate).
  • Provide information on all contraceptive methods, including long-acting reversible contraception (LARC) methods, to help her make an informed choice.
    • The information should be presented using language and formats that can be easily accessible and understood, and should at least include:
      • The relative efficacy of the methods.
      • How the methods work.
      • Common adverse effects.
      • Possible drug interactions.
      • Health risks and benefits of the methods.
      • Information on return to fertility after discontinuation.
    • Information on contraception is available from the NHS Website (www.nhs.uk).
  • Offer the method of contraception that is most acceptable to the woman, unless it is contraindicated.

Basis for recommendation

These recommendations are based on the National Institute for Health and Care Excellence (NICE) guideline Long-acting reversible contraception  [NICE, 2020] the World Health Organization (WHO) Decision-making tool for family planning clients and providers [WHO, 2005] and the Faculty for Sexual and Reproductive Health Intrauterine contraception [CoSRH, 2025b].

How should I assess a woman requesting contraception?

  • Exclude pregnancy. 
  • Assess her suitability for the different contraceptive methods.
    • Take a history and perform a clinical examination to identify factors that can affect the choice of contraception, such as comorbidities (for example, hypertension and migraine), allergies (including to latex or anaesthetics), lifestyle factors (for example, smoking), reproductive history (postpartum/breastfeeding), drug treatments (including liver enzyme-inducing drugs), and age (approaching menopause or under 18 years of age). 
    • If the woman is considering combined hormonal contraception, progestogen-only contraception, or intrauterine contraception, check the UK Medical Eligibility Criteria for Contraceptive Use (UKMEC) to ensure that the woman can safely use these methods. 
    • If the woman is considering barrier methods, sterilization, or natural family planning, check the World Health Organization Medical Eligibility Criteria for Contraceptive Use, as these methods are not covered by the UKMEC.
    • Additional assessments may be required depending on the method of contraception being considered. 
  • Assess her risk of sexually transmitted infections (STIs) and, when appropriate, advise testing, promote safer sex, and/or refer for sexual health counselling.
    • Raise the subject sensitively — many STIs can be asymptomatic, but when symptoms are present, the person may not link them to an STI.
    • Take into consideration the local prevalence of STIs as well as the person's age and sexual activity.
    • Ask about their current circumstances, including current and recent sexual partners, age of onset of sexual activity, type of sexual activity, and use of alcohol and other substances.
    • Key groups at risk of STIs include:
      • Young people under 25 years of age.
      • People who frequently change sexual partners.
      • People involved in prostitution.
      • Men who have sex with men.
      • People who have come from, or who have visited, areas of high HIV prevalence and have been sexually active there.
  • Carry out a risk assessment for sexual abuse, rape, and non-consensual sex, particularly if the woman is considered to be vulnerable (that is, younger than 16 years of age; is from a disadvantaged background; is in, or is leaving, care; has low educational attainment).
    • The legal age of consent to sexual activity is 16 years in the UK.
      • Sexual activity under the age of consent is an offence, even if consensual.
      • Offences are considered more serious (statutory rape) when the person is younger than 13 years of age.
    • If non-consensual sex or sexual abuse is suspected, see the CKS topics on Domestic violence and abuse and Child maltreatment - recognition and management for more information.
  • Consider other relevant legal and ethical issues, for example:
    • If a girl younger than 16 years of age requests contraception without parental consent, assess her competency to independently consent to treatment and document in her case notes whether she meets (or does not meet) the Fraser Criteria.
      • If the Fraser Criteria are not met, consider breaching confidentiality and seeking parental consent. 
    • If a woman with learning and/or physical disabilities requests contraception: 
      • Support her to make her own decisions about contraception.
      • Assess her competence to consent to treatment by her ability to understand the information provided, weigh up the risks and benefits, and express her own wishes.
      • If the woman cannot understand or take responsibility for decisions about contraception, carers and other involved parties should meet to address issues around the woman's contraceptive needs and to establish a care plan.
      • See the Reference guide to consent for examination or treatment published by the Department of Health for more information.

How can I be reasonably certain that a woman is not pregnant?

Excluding pregnancy
  • Health professionals can be ‘reasonably certain’ that a woman is not currently pregnant if any one or more of the following criteria are met and there are no symptoms or signs of pregnancy:
    • She has not had intercourse since the start of her last normal (natural) menstrual period, since childbirth, abortion, miscarriage, ectopic pregnancy, or uterine evacuation for gestational trophoblastic disease.
    • She has been correctly and consistently using a reliable method of contraception.
      • For the purposes of being reasonably certain that a woman is not currently pregnant, barrier methods of contraception can be considered reliable provided they have been used consistently and correctly for every episode of intercourse.
    • She is within the first 5 days of the onset of a normal (natural) menstrual period.
    • She is less than 21 days postpartum (non-breastfeeding women).
    • She is fully breastfeeding, amenorrhoeic, and less than 6 months postpartum.
    • She is within the first 5 days after abortion, miscarriage, ectopic pregnancy, or uterine evacuation for gestational trophoblastic disease.
    • She has not had intercourse for more than 21 days and has a negative high-sensitivity urine pregnancy test (able to detect human chorionic gonadotrophin [hCG] levels around 20 mIU/ml).
Unable to exclude pregnancy 
  • If pregnancy cannot be reasonably excluded, assess the need for emergency contraception (EC) and prescribe if necessary. See the CKS topic on Contraception - emergency for more information.
  • If pregnancy cannot be reasonably excluded and the woman is likely to continue to be at risk of pregnancy or has expressed a preference to begin contraception as soon as possible:
    • Consider quick starting combined hormonal contraception (CHC [excluding co-cyprindiol]), the progestogen-only pill (POP), or the progestogen-only implant, provided there are no contraindications.
      • The progestogen-only injectable (depot medroxyprogesterone acetate [DMPA]) is less preferred as a quick starting or bridging method because it cannot be removed or stopped if pregnancy is diagnosed, and evidence relating to fetal exposure to DMPA is limited. However, it can be considered if other methods are not appropriate or acceptable.
    • Advise the woman on what is known about the use of hormonal contraception during very early pregnancy. If the progestogen-only injectable is being considered, explain that there is a lack of evidence for use in early pregnancy.
    • See the CKS topics on Contraception - combined hormonal methods and Contraception - progestogen-only methods for information on how to quick start these methods of contraception.

What are the Fraser criteria?

  • In the UK, people 16 years of age and older are presumed to be competent to consent to medical treatment. In contrast, competence to consent to medical treatment must be demonstrated in children younger than 16 years of age.
    • In England and Wales, it is lawful to provide contraceptive advice and treatment to young people without parental consent, provided that the practitioner is satisfied that the Fraser criteria for competence are met. The criteria are that:
      • The young person understands the practitioner's advice.
      • The young person cannot be persuaded to inform their parents, or will not allow the practitioner to inform the parents, that contraceptive advice has been sought.
      • The young person is likely to begin or to continue having intercourse with or without contraceptive treatment.
      • Unless he or she receives contraceptive advice or treatment, the young person's physical or mental health (or both) are likely to suffer.
      • The young person's best interest requires the practitioner to give contraceptive advice or treatment (or both) without parental consent.
    • In Scotland, the Fraser guidelines do not apply; however, the Age of Legal Capacity Act 1991 applies similar criteria. Competence is demonstrated if the young person is able to:
      • Understand the treatment, its purpose and nature, and why it is being proposed.
      • Understand its benefits, risks, and alternatives.
      • Understand in broader terms what the consequences of the treatment will be.
      • Retain the information for long enough to use it and weigh it up in order to arrive at a decision.

Basis for recommendation

Excluding pregnancy
  • This information is based on the College of Sexual and Reproductive Healthcare (CoSRH) guidelines Quick starting contraception [CoSRH, 2017] and Intrauterine contraception [CoSRH, 2025b].
Unable to exclude pregnancy
  • This information is based on the CoSRH guidelines Quick starting contraception [CoSRH, 2017] and Progestogen-only injectables [CoSRH, 2023a].
The UK Medical Eligibility Criteria for Contraceptive Use (UKMEC) 
  • The UKMEC offers guidance on the use of combined hormonal contraception (CHC), progestogen-only contraception, and intrauterine contraception in women with particular medical conditions or medically relevant physiological or personal characteristics [CoSRH, 2025a].
    • For each medical condition or personal characteristic, contraceptive methods are placed into Category 1, 2, 3, or 4, depending on the safety/suitability of the method. When applied in a clinical setting:
      • UKMEC Category 1 indicates that there is no restriction for use.
      • UKMEC Category 2 indicates that the method can generally be used, but more careful follow up may be required. The advantages of using the method generally outweigh the theoretical or proven risks.
      • UKMEC Category 3 indicates that the method can be used; however, it may require expert clinical judgement and/or referral to a specialist contraception provider since use is not usually recommended unless other methods are not available or acceptable. The theoretical or proven risks usually outweigh the advantages of using the method.
      • UKMEC Category 4 indicates that use in that condition poses an unacceptable health risk, so the method should not be used. 
    • The UKMEC does not cover barrier methods, male or female sterilization, or natural family planning methods.
The World Health Organization Medical Eligibility Criteria for Contraceptive Use (WHOMEC)
  • The UKMEC is adapted from the WHOMEC.
  • CKS recommends consulting the WHOMEC for guidance on barrier methods, sterilization, and natural family planning methods [WHO, 2025].
    • For barrier methods, the WHOMEC uses the 1–4 recommendation categories.
    • For the sterilization and natural family planning methods, the WHOMEC states that in general, these methods can be provided without concern for health effects to people who choose them; therefore, the 1–4 recommendation categories do not apply. However, the A, C, D, and S recommendation categories have been used. When applied in a clinical setting:
      • WHOMEC Category A (accept) means there is no medical reason to deny sterilization to a person with this condition.
      • WHOMEC Category C (caution) means the procedure should normally be conducted in a routine setting, but with extra preparation and precautions.
      • WHOMEC Category D (delay) means the procedure should be delayed until the condition is evaluated and/or corrected. Alternative temporary methods of contraception should be provided.
      • WHOMEC Category S (special) means the procedure should be undertaken in a setting with an experienced surgeon and staff, equipment needed to provide general anaesthesia, and other backup medical support. For these conditions, the capacity to decide on the most appropriate procedure and anaesthesia regimen is also needed. Alternative temporary methods of contraception should be provided if a referral is required or there is otherwise any delay.
Assessing the risk of sexually transmitted infections
  • These recommendations are based on the CoSRH guideline Emergency contraception [CoSRH, 2026a], the National Institute for Health and Care Excellence (NICE) guideline Reducing sexually transmitted infections [NICE, 2022], and expert opinion in the Family Planning Association Handbook of sexual health in primary care [Belfield, 2011].
Ethical and legal issues
  • These recommendations are based on the CoSRH guideline Contraceptive choices for young people [CoSRH, 2026b] and the NICE guidelines Child maltreatment: when to suspect maltreatment in under 18s [NICE, 2026] and Long-acting reversible contraception [NICE, 2020].
Fraser criteria not met
  • The recommendation to consider breaking confidentiality and seek parental consent if the girl does not meet all of the Fraser criteria is based on what CKS considers to be good clinical practice.

Scenario: Comorbidities and personal characteristics

From age 13 years to 60 years (Female).

What methods of contraception are suitable for women with comorbidities?

What methods of contraception are suitable for women with epilepsy?

What methods of contraception are suitable for women with menorrhagia, fibroids, or previous ectopic pregnancy?

This section covers the UK Medical Eligibility Criteria (UKMEC) for hormonal and intrauterine methods of contraception.

See the sections on Natural family planning, Barrier methods, and Sterilization for information on these methods of contraception. See the section on Assessment for contraception for information on general assessment for all women requesting contraception.

  • In women with idiopathic menorrhagia:
    • All hormonal and intrauterine methods of contraception can be used (UKMEC 1 or 2).
      • To help with symptom control, consider recommending the levonorgestrel intrauterine device (LNG-IUD) first line, the combined oral contraceptive (COC) pill second line, and the progestogen-only pill (POP) or progestogen-only injectables third line, provided there are no contraindications. See the CKS topic on Menorrhagia for more information.
  • In women with abnormal vaginal bleeding:
    • Additional investigations may be indicated prior to or at the same time as IUC insertion in individuals with abnormal uterine bleeding, or if an individual has risk factors for gynaecological disease. However, the device can be left in place if the woman already has one fitted, as the advantages generally outweigh the theoretical or proven risks (UKMEC 2).
    • The progestogen-only implant and progestogen-only injectable are not recommended as the risks of using outweigh the benefits (UKMEC 3).
    • All other hormonal methods of contraception can be used as the benefits generally outweigh the risks (UKMEC 2).
    • Note: all unexplained vaginal bleeding should be investigated to rule out any underlying conditions, such as pregnancy or malignancy. See the CKS topic on Gynaecological cancers - recognition and referral for more information on the recognition and referral for gynaecological cancers.
  • In women with a history of ectopic pregnancy:
    • All hormonal and intrauterine methods of contraception can be used without restriction (UKMEC 1).
  • In women with uterine fibroids:
    • If there is no distortion of the uterine cavity:
      • All hormonal and intrauterine methods of contraception can be used without restriction (UKMEC 1).
  • If there is a distortion of the uterine cavity:
    • For individuals with fibroids and known distortion of the uterine cavity, UKMEC indicates that the risk associated with the use of any IUC method generally outweighs the benefit (UKMEC3).
    • All other hormonal methods of contraception can be used without restriction (UKMEC 1).

What methods of contraception are suitable for women with a sexually transmitted infection or pelvic inflammatory disease?

This section covers the UK Medical Eligibility Criteria (UKMEC) for hormonal and intrauterine methods of contraception. 

See the sections on Natural family planning, Barrier methods, and Sterilization for information on these methods of contraception. See the section on Assessment for contraception for information on general assessment for all women requesting contraception.

  • In women with pelvic inflammatory disease (PID):
    • Past infection, assuming there are no current risk factors for sexually transmitted infections (STIs): 
      • All hormonal and intrauterine methods of contraception can be used without restriction (UKMEC 1).
    • Current infection:
      • Do not initiate the copper intrauterine device (Cu-IUD) or levonorgestrel intrauterine device (LNG-IUD) due to unacceptable health risks (UKMEC 4). However, the device can be left in place if the woman already has one fitted, as the advantages generally outweigh the theoretical or proven risks (UKMEC 2).  
      • All other hormonal methods of contraception can be used without restriction (UKMEC 1).
  • In women with chlamydial infection:
    • Current symptomatic infection:
      • Do not initiate the Cu-IUD or LNG-IUD, due to unacceptable health risks (UKMEC 4). However, the device can be left in place if the woman already has one fitted, as the advantages generally outweigh the theoretical or proven risks (UKMEC 2).  
      • All other hormonal methods of contraception can be used without restriction (UKMEC 1).
    • Current asymptomatic infection:
      • The Cu-IUD and the LNG-IUD are not recommended as the risks of using outweigh the benefits (UKMEC 3). However, the device can be left in place if the woman already has one fitted, as the advantages generally outweigh the theoretical or proven risks (UKMEC 2).  
      • All other hormonal methods of contraception can be used without restriction (UKMEC 1).
  • In women with current purulent cervicitis or gonorrhoea: 
    • Do not initiate the Cu-IUD or LNG-IUD, due to unacceptable health risks (UKMEC 4). However, the device can be left in place if the woman already has one fitted, as the advantages generally outweigh the theoretical or proven risks (UKMEC 2).  
    • All other hormonal methods of contraception can be used without restriction (UKMEC 1).
  • In women with vaginitis (including Trichomonas vaginalis and bacterial vaginosis), other current STIs (excluding HIV and hepatitis), or increased risks for STIs:
    •  All hormonal and intrauterine methods of contraception can be used (UKMEC 1 or 2).

What methods of contraception are suitable for women with diabetes mellitus?

This section covers the UK Medical Eligibility Criteria (UKMEC) for hormonal and intrauterine methods of contraception. 

See the sections on Natural family planning, Barrier methods, and Sterilization for information on these methods of contraception. See the section on Assessment for contraception for information on general assessment for all women requesting contraception.

  •  In women with diabetes mellitus and no vascular disease:
    • All hormonal and intrauterine methods of contraception can be used (UKMEC 1 or 2).
  • In women with diabetes mellitus and nephropathy, retinopathy, neuropathy, or other vascular disease:
    • Combined hormonal contraception (pill, transdermal patch, or vaginal ring) is not recommended as the risks of using outweigh the benefits (UKMEC 3).
    • All other hormonal and intrauterine methods of contraception can be used (UKMEC 1 or 2). 
  • In women with a history of gestational diabetes:
    • All hormonal and intrauterine methods of contraception can be used without restriction (UKMEC 1).

What methods of contraception are suitable for a woman with headache or migraine?

This section covers the UK Medical Eligibility Criteria (UKMEC) for hormonal and intrauterine methods of contraception. 

See the sections on Natural family planning, Barrier methods, and Sterilization for information on these methods of contraception. See the section on Assessment for contraception for information on general assessment for all women requesting contraception.

  • In women with non-migrainous headaches:
    • All hormonal and intrauterine methods of contraception can be used without restriction (UKMEC 1). 
  • In women with migraine without aura:
    • Combined hormonal contraception (CHC [pill, patch, and vaginal ring]) can be initiated (UKMEC 2). However, if a migraine without aura develops in a woman already using a CHC, an alternative form of contraception should be considered as the risks of using the CHC would outweigh the benefits (UKMEC 3).
    • All other hormonal and intrauterine methods of contraception can be used (UKMEC 1 or 2).
  • In women with migraine with aura:
    • Do not use CHC due to unacceptable health risks (UKMEC 4).
    • All other hormonal and intrauterine methods of contraception can be used (UKMEC 1 or 2).
  • In women with a past history (5 years or more) of migraine with aura:
    • CHC is not recommended as the risks outweigh the benefits (UKMEC 3).
    • All other hormonal and intrauterine methods of contraception can be used (UKMEC 1 or 2).

What methods of contraception are suitable for women with multiple risk factors for cardiovascular disease?

This section covers the UK Medical Eligibility Criteria (UKMEC) for hormonal and intrauterine methods of contraception. 

See the sections on Natural family planning, Barrier methods, and Sterilization for information on these methods of contraception. See the section on Assessment for contraception for information on general assessment for all women requesting contraception.

  • In women with multiple risk factors for cardiovascular disease (such as smoking, diabetes, hypertension, obesity, and dyslipidaemias):
    • The following methods are not recommended as the risks of using outweigh the benefits (UKMEC 3):
      • Combined hormonal contraception (CHC [pill, transdermal patch, or vaginal ring]).
      • The progestogen-only injectables.
    • All other hormonal and intrauterine methods of contraception can be used (UKMEC 1 or 2).

What methods of contraception are suitable for women who are obese?

This section covers the UK Medical Eligibility Criteria (UKMEC) for hormonal and intrauterine methods of contraception. 

See the sections on Natural family planning, Barrier methods, and Sterilization for information on these methods of contraception. See the section on Assessment for contraception for information on general assessment for all women requesting contraception.

  • In women with a body mass index (BMI) of 30 kg/m2 or more but less than 35 kg/m2:
    • All hormonal and intrauterine methods of contraception can be used (UKMEC 1 or 2).
  • In women with a BMI of 35 kg/m2 or more:
    • Combined hormonal contraception (CHC [pill, transdermal patch, or vaginal ring]) is not recommended as the risks of using outweigh the benefits (UKMEC 3).
    • All other hormonal and intrauterine methods of contraception can be used (UKMEC 1 or 2).
  • Note that:
    • The combined contraceptive patch should be avoided in women who weigh more than 90 kg if there are other suitable methods, as the efficacy may be reduced.
    • The progestogen-only injectable may cause weight gain.

What methods of contraception are suitable for women with hypertension?

This section covers the UK Medical Eligibility Criteria (UKMEC) for hormonal and intrauterine methods of contraception. 

See the sections on Natural family planning, Barrier methods, and Sterilization for information on these methods of contraception. See the section on Assessment for contraception for information on general assessment for all women requesting contraception.

  • In women with hypertension without vascular disease (coronary heart disease [angina], peripheral vascular disease [intermittent claudication], hypertensive retinopathy, and transient ischaemic attacks):
    • Do not use combined hormonal contraception (CHC [pill, transdermal patch, or vaginal ring]) in the following circumstances due to the unacceptable health risk (UKMEC 4):
      • Blood pressure consistently 160/100 mmHg or higher.
    • CHC is not recommended in the following circumstances as the risks of using outweigh the benefits (UKMEC 3):
      • Adequately controlled hypertension.
      • Systolic blood pressure more than 140–159 mmHg or diastolic blood pressure more than 90–99 mmHg.
    • All other hormonal and intrauterine methods of contraception can be used (UKMEC 1 or 2).
  • In women with hypertension and vascular disease: 
    • Do not use CHC due to the unacceptable health risk (UKMEC 4).
    • The progestogen-only injection is not recommended as the risks of using outweigh the benefits (UKMEC 3).
    • All other hormonal and intrauterine methods of contraception can be used (UKMEC 1 or 2).

What methods of contraception are suitable for women with venous thromboembolism or a history of venous thromboembolism?

This section covers the UK Medical Eligibility Criteria (UKMEC) for hormonal and intrauterine methods of contraception. 

See the sections on Natural family planning, Barrier methods, and Sterilization for information on these methods of contraception. See the section on Assessment for contraception for information on general assessment for all women requesting contraception.  

  • Do not use combined hormonal contraception (CHC [pill, transdermal patch, or vaginal ring]) in the following circumstances due to the unacceptable health risk (UKMEC 4):
    • History of VTE.
    • Current VTE (on anticoagulants).
    • Major surgery with prolonged immobilization.
    • Multiple risk factors for VTE (including cancer, high BMI, and thrombotic or inflammatory disorders).
  •  CHC is not recommended in the following circumstances as the risks of using outweigh the benefits (UKMEC 3):
    • Family history of VTE in a first-degree relative younger than 45 years of age.
    • Immobility unrelated to surgery (for example, wheelchair use or debilitating illness).
  • The progestogen-only injection is not recommended in the following circumstances as the risks of using outweigh the benefits (UKMEC 3):
    • History of VTE.
    • Current VTE (on anticoagulants).
    • Major surgery with prolonged immobilization.
    • Multiple risk factors for VTE (including cancer, high BMI, and thrombotic or inflammatory disorders)
  • All other hormonal and intrauterine methods of contraception can be used in women with venous thromboembolism or a history of venous thromboembolism (UKMEC 1 or 2).

What methods of contraception are suitable for women with chronic kidney disease (CKD)?

This section covers the UK Medical Eligibility Criteria (UKMEC) for hormonal and intrauterine methods of contraception. 

See the sections on Natural family planning, Barrier methods, and Sterilization for information on these methods of contraception. See the section on Assessment for contraception for information on general assessment for all women requesting contraception.  

  • For women with CKD with current nephrotic syndrome, and/or who are undergoing haemodialysis or peritoneal dialysis:
    • Do not use combined hormonal contraception (CHC [pill, transdermal patch, or vaginal ring]) due to the unacceptable health risk (UKMEC 4).
    • The progestogen-only injection is not recommended  as the risks of using outweigh the benefits (UKMEC 3) .
  • All other hormonal and intrauterine methods of contraception can be used in women with CKD (UKMEC 2), however, drospirenone (DRSP), which should not be used in women with severe renal insufficiency or acute renal failure and should be used with caution in women at risk of hyperkalaemia.

What methods of contraception are suitable for women with multiple sclerosis (MS)?

This section covers the UK Medical Eligibility Criteria (UKMEC) for hormonal and intrauterine methods of contraception. 

See the sections on Natural family planning, Barrier methods, and Sterilization for information on these methods of contraception. See the section on Assessment for contraception for information on general assessment for all women requesting contraception.  

  •  CHC is not recommended in women with MS with prolonged immobility as the risks of using outweigh the benefits (UKMEC 3).
  • All other hormonal and intrauterine methods of contraception can be used in women with MS (UKMEC 1 or 2).

What methods of contraception are suitable for women with anxiety and mood disorders?

This section covers the UK Medical Eligibility Criteria (UKMEC) for hormonal and intrauterine methods of contraception. 

See the sections on Natural family planning, Barrier methods, and Sterilization for information on these methods of contraception. See the section on Assessment for contraception for information on general assessment for all women requesting contraception.

  • The CoSRH states that there is no consistent evidence that hormonal contraceptives (HCs) worsen or improve anxiety or mood (affective) disorders in those with pre-existing conditions.
  • When starting hormonal contraception, clinicians should provide individualised counselling and advise patients to monitor their mood, seeking follow-up with their healthcare provider if they notice a deterioration.

What methods of contraception are suitable for women with sickle cell disease/trait?

This section covers the UK Medical Eligibility Criteria (UKMEC) for hormonal and intrauterine methods of contraception. 

See the sections on Natural family planning, Barrier methods, and Sterilization for information on these methods of contraception. See the section on Assessment for contraception for information on general assessment for all women requesting contraception.

  • All types of hormonal contraception can be used in women with sickle cell disease (UMEC 1 or 2)
  • The CoSRH states that there is insufficient evidence to give MEC ratings for sickle cell trait (SCT). There is a small increase in the risk of VTE with SCT, therefore alternatives to CHC should be prioritised.

What methods of contraception are suitable for women who smoke?

This section covers the UK Medical Eligibility Criteria (UKMEC) for hormonal and intrauterine methods of contraception. 

See the sections on Natural family planning, Barrier methods, and Sterilization for information on these methods of contraception. See the section on Assessment for contraception for information on general assessment for all women requesting contraception.

  • Do not use combined hormonal contraception (CHC [pill, transdermal patch, or vaginal ring]) in the following circumstances due to unacceptable health risks (UKMEC 4):
    • Age 35 years or older and smokes 15 cigarettes or more daily.
  • CHC is not recommended in the following circumstances as the risks of using outweigh the benefits (UKMEC 3):
    • Age 35 years of age or older and smokes less than 15 cigarettes a day.
    • Age 35 years of age or older and stopped smoking less than 1 year ago.
  • All other hormonal and intrauterine methods of contraception can be used (UKMEC 1 or 2).

What methods of contraception are suitable for women who use E cigarettes?

This section covers the UK Medical Eligibility Criteria (UKMEC) for hormonal and intrauterine methods of contraception. 

See the sections on Natural family planning, Barrier methods, and Sterilization for information on these methods of contraception. See the section on Assessment for contraception for information on general assessment for all women requesting contraception.

  • The CoSRH states that due to the unknown long-term cardiovascular risks with e-cigarettes, alternatives to CHC should be prioritised.

Basis for recommendation

These recommendations are largely based on the College of Sexual and Reproductive Healthcare (CoSRH) UK Medical Eligibility Criteria for Contraceptive Use [CoSRH, 2025a] and Intrauterine contraception [CoSRH, 2025b].

  • The UK Medical Eligibility Criteria for Contraceptive Use (UKMEC) offers guidance on the use of combined hormonal contraception (CHC), progestogen-only contraception, and intrauterine contraception in women with particular medical conditions or medically relevant physiological or personal characteristics.
  • For each medical condition or personal characteristic, contraceptive methods are placed into Category 1, 2, 3, or 4, depending on the safety/suitability of the method. When applied in a clinical setting:
    • UKMEC Category 1 indicates that there is no restriction for use.
    • UKMEC Category 2 indicates that the method can generally be used, but more careful follow-up may be required. The advantages of using the method generally outweigh the theoretical or proven risks.
    • UKMEC Category 3 indicates that the method can be used; however, it may require expert clinical judgement and/or referral to a specialist contraception provider since use is not usually recommended unless other methods are not available or acceptable. The theoretical or proven risks usually outweigh the advantages of using the method.
    • UKMEC Category 4 indicates that use in that condition poses an unacceptable health risk, so the method should not be used. 
  • The UKMEC does not cover barrier methods, male or female sterilization, or natural family planning methods.

What methods of contraception are suitable for postpartum/breastfeeding women?

What methods of contraception are suitable for postpartum women who are breastfeeding?

This section covers the UK Medical Eligibility Criteria (UKMEC) for hormonal and intrauterine methods of contraception.

See the sections on Natural family planning, Barrier methods, and Sterilization for information on these methods of contraception. See the section on Assessment for contraception for information on general assessment for all women requesting contraception.

  • In women considering the copper intrauterine device (Cu-IUD) or levonorgestrel intrauterine device (LNG-IUD):
    • Less than 48 hours postpartum:
      • The Cu-IUD or LNG-IUD can be used freely without restrictions (UKMEC 1).
    • From 48 hours to less than 4 weeks postpartum:
      • The Cu-IUD or LNG-IUD is not recommended as the risks of using outweigh the benefits (UKMEC 3).
    • From 4 weeks postpartum:
      • The Cu-IUD or LNG-IUD can be used freely without restrictions (UKMEC 1).
    •  Postpartum sepsis:
      • Do not initiate the Cu-IUD or LNG-IUD due to unacceptable health risks (UKMEC 4).
  • In women considering other hormonal contraception:
    • Less than 6 weeks postpartum:
      • Do not use combined hormonal contraception (CHC [pill, transdermal patch, or vaginal ring]) due to unacceptable health risks (UKMEC 4).
      • All other hormonal methods of contraception can be used (UKMEC 1 or 2).
    • From 6 weeks to less than 6 months postpartum (primarily breastfeeding):
      • All hormonal methods of contraception can be used (UKMEC 1 or 2).
    • From 6 months postpartum:
      • All hormonal methods of contraception can be used freely without restrictions (UKMEC 1).

What methods of contraception are suitable for postpartum women who are not breastfeeding?

This section covers the UK Medical Eligibility Criteria (UKMEC) for hormonal and intrauterine methods of contraception.

See the sections on Natural family planning, Barrier methods, and Sterilization for information on these methods of contraception. See the section on Assessment for contraception for information on general assessment for all women requesting contraception.

  • In women considering the copper intrauterine device (Cu-IUD) or levonorgestrel intrauterine device (LNG-IUD):
    • Less than 48 hours postpartum:
      • The Cu-IUD or LNG-IUD can be used freely without restrictions (UKMEC 1).
    • From 48 hours to less than 4 weeks postpartum:
      • The Cu-IUD or LNG-IUD is not recommended as the risks outweigh the benefits (UKMEC 3).
    • From 4 weeks postpartum:
      • The Cu-IUD or LNG-IUD can be used freely without restrictions (UKMEC 1).
    • Postpartum sepsis:
      • Do not initiate the Cu-IUD or LNG-IUD due to unacceptable health risks (UKMEC 4).
  • In women considering other hormonal contraception:  
    • Less than 3 weeks postpartum with other risk factors for venous thromboembolism (VTE), such as immobility, transfusion at delivery, body mass index of more than 30 kg/m2, postpartum haemorrhage, immediately post caesarean delivery, pre-eclampsia, or smoking):
      • Do not use combined hormonal contraception (CHC [pill, transdermal patch, or vaginal ring]) due to unacceptable health risks (UKMEC 4).
      • Progestogen-only injectables are not recommended as the risks outweigh the benefits (UKMEC 3).
      • All other hormonal methods of contraception can be used (UKMEC 1 or 2).
    • Less than 3 weeks postpartum without other risk factors for VTE:
      • CHC is not recommended as the risks outweigh the benefits (UKMEC 3).
      • All other hormonal methods of contraception can be used (UKMEC 1 or 2).
    • From 3 weeks postpartum to less than 6 weeks postpartum with other risk factors for VTE:
      • CHC and progestogen-only injectables are not recommended as the risks outweigh the benefits (UKMEC 3).
      • All other hormonal methods of contraception can be used (UKMEC 1 or 2).
    • From 3 weeks postpartum to less than 6 weeks postpartum without other risk factors for VTE:
      • All hormonal methods of contraception can be used (UKMEC 1 or 2).
    • From 6 weeks postpartum:
      • All hormonal methods of contraception can be used freely without restrictions (UKMEC 1).

Basis for recommendation

These recommendations are largely based on the College of Sexual and Reproductive Healthcare (CoSRH) UK Medical Eligibility Criteria for Contraceptive Use [CoSRH, 2025a].

  • The UK Medical Eligibility Criteria for Contraceptive Use (UKMEC) offers guidance on the use of combined hormonal contraception (CHC), progestogen-only contraception, and intrauterine contraception in women with particular medical conditions or medically relevant physiological or personal characteristics.
  • For each medical condition or personal characteristic, contraceptive methods are placed into Category 1, 2, 3, or 4, depending on the safety/suitability of the method. When applied in a clinical setting:
    • UKMEC Category 1 indicates that there is no restriction for use.
    • UKMEC Category 2 indicates that the method can generally be used, but more careful follow-up may be required. The advantages of using the method generally outweigh the theoretical or proven risks.
    • UKMEC Category 3 indicates that the method can be used; however, it may require expert clinical judgement and/or referral to a specialist contraception provider since use is not usually recommended unless other methods are not available or acceptable. The theoretical or proven risks usually outweigh the advantages of using the method.
    • UKMEC Category 4 indicates that use in that condition poses an unacceptable health risk, so the method should not be used. 
  • The UKMEC no longer covers barrier methods, male or female sterilization, or natural family planning methods. The UKMEC guideline development group removed the sections on these methods as they were considered to be 'not particularly helpful'.

What methods of contraception are suitable for women taking drug treatments?

  • In women taking (or whose partners are taking) known teratogenic drugs or drugs with potential teratogenic effects (such as lithium and sodium valproate):
    • Advise that she must use a highly effective method of contraception, such as a long-acting reversible contraception (LARC) method, to reduce the risk of pregnancy.
      • LARC methods considered highly effective include the progestogen-only implant, the copper intrauterine device (Cu-IUD), and the levonorgestrel intrauterine device (LNG-IUD).
      • Additional contraceptive precautions (such as condoms or a second effective contraceptive method) are not required if a LARC is being used. However, the woman may choose to also use condoms to reduce the risk of unintended pregnancy even further and for protection against sexually transmitted infections (STIs).
      • The progestogen-only injectable can be considered highly effective if repeat injections are documented as having been administered on schedule by a healthcare professional.
      • Barrier methods, withdrawal, and fertility awareness methods alone are not recommended. 
      • Ensure that a pregnancy prevention plan is in place to ensure there is no risk of conception. Detailed information on teratogenic drugs is available from the UK Teratology Information Service (www.uktis.org).
    • If the woman wishes to use combined hormonal contraception (CHC [pill, patch, or vaginal ring]) or the progestogen-only pill (POP), advise that:
      • She should use additional contraceptive precautions (such as condoms) as these methods of contraception have a slightly higher failure rate than the LARCs.
      • She must not take any interacting drugs that could reduce contraceptive effectiveness.
  • In women taking liver enzyme-inducing drugs (such as rifampicin and carbamazepine):
    • Advise on the potential interaction with hormonal contraception.
    • Offer reliable methods of contraception that are unaffected by enzyme-inducers (Cu-IUD, LNG-IUD, and the progestogen-only injectable).
    • If the woman wishes to use CHC, the POP, or the progestogen-only implant, see the sections on drug interactions in the CKS topics on Contraception - combined hormonal methods and Contraception - progestogen-only methods for more information.
  • In women taking lamotrigine:
    • Advise that although lamotrigine is not thought to be an enzyme-inducing drug, it may interact with CHC and the POP.
    • Avoid CHC as the risks may outweigh the benefits.
      • CHC moderately reduces lamotrigine exposure, leading to decreased seizure control in the active hormone phase and increased lamotrigine exposure with a risk of toxicity in the hormone-free week. Desogestrel might increase lamotrigine levels and adverse effects. 
    • If the woman chooses to use a POP, advise that concurrent use may increase lamotrigine levels. Monitor for adverse effects of lamotrigine. No additional precautions are needed.
  • In women taking griseofulvin:
    • Advise that although griseofulvin is not thought to be an enzyme-inducing drug, the contraceptive efficacy of CHC, POP, and the progestogen-only implant may be reduced by concurrent use.
    • Do not use the POP or the progestogen-only implant.
    • Avoid CHC as the risks may outweigh the benefits.
      • If the woman chooses to use a CHC, see the section on drug interactions in the CKS topic on Contraception - combined hormonal methods for more information. As there is a theoretical risk of teratogenic effects with griseofulvin, the use of condoms during treatment and for 28 days after is also recommended.
  • In women who are taking other drugs that are not liver enzyme inducers:
    • All hormonal and intrauterine methods of contraception can be used, provided there are no contraindications.
  • In women taking drugs that cause severe diarrhoea or vomiting (such as orlistat):
    • Consider the Cu-IUD, LNG-IUD, progestogen-only implant, or the progestogen-only injectable, provided there are no contraindications. There is no need for extra precautions.
    • If the woman wishes to use CHC or the POP, advise that:
      • She should follow the missed pill rules if vomiting occurs within 3 hours of taking the pill or severe diarrhoea occurs for more than 24 hours. See the sections on missed pills in the CKS topics on Contraception - combined hormonal methods and Contraception - progestogen-only methods for more information.
      • She should use additional contraceptive precautions (such as condoms) during treatment with the drug.

Liver enzyme-inducing drugs

  • Antibiotics:
    • Rifampicin (potent inducer).
    • Rifabutin.
  • Antiepileptics:
    • Carbamazepine.
    • Eslicarbazepine.
    • Oxcarbazepine.
    • Phenytoin.
    • Phenobarbital.
    • Primidone.
    • Rufinamide.
    • Topiramate (weak inducer).
  • Antiretrovirals:
    • Protease inhibitors: ritonavir, atazanavir, darunavir, fosamprenavir, lopinavir, nelfinavir, saquinavir, and tipranavir.
    • Non-nucleoside reverse transcriptase inhibitors: efavirenz, nevirapine.
    • Always use the HIV Drug Interaction Checker to identify potential interactions.
  • Others:
    • Bosentan.
    • Modafinil.
    • Aprepitant.
    • St John's Wort.

Basis for recommendation

The recommendations are largely based on the College of Sexual and Reproductive Healthcare (CoSRH) guideline Drug interactions with hormonal contraception [CoSRH, 2022], the CoSRH Clinical Effectiveness Unit Statement Contraception for women using known teratogenic drugs or drugs with potential teratogenic effects [CoSRH, 2018], the Medicines & Healthcare products Regulatory Agency (MHRA) guidance Valproate – reproductive risks [MHRA, 2025], and the consensus statement Diagnosis and management of individuals with Fetal Valproate Spectrum Disorder from the European Reference Network for Congenital Malformations and Intellectual Disability, [Clayton-Smith, 2019].

What methods of contraception are suitable for women approaching menopause?

  • In perimenopausal women, all hormonal and intrauterine methods of contraception can be considered, provided there are no contraindications.
    • Combined hormonal contraception (CHC [pill, patch, and vaginal ring]) is not contraindicated by age alone in perimenopausal women; however, consider the UK Medical Eligibility Criteria (UKMEC) categories for the use of CHC if there are cardiovascular risk factors, such as:
      • Hypertension (controlled and uncontrolled).
      • Vascular disease.
      • Current and history of ischaemic heart disease.
      • Stroke (history of cerebrovascular accident, including transient ischaemic attack).
      • Body mass index of 35 kg/m2 or more.
      • Smoking (in women aged 35 years and older).
      • Multiple risk factors for cardiovascular disease.

Basis for recommendation

These recommendations are largely based on the College of Sexual and Reproductive Healthcare (CoSRH) Contraception for women aged over 40 years [CoSRH, 2025c].

What methods of contraception are suitable for females under 18 years of age?

  • In those aged younger than 18 years, all methods of contraception can be considered, provided there are no contraindications. However:
    • Avoid the use of regular hormonal contraception prior to menarche.
    • Recommend the use of condoms both as a contraceptive and to prevent sexually transmitted infections (STIs).
    • Consider the progestogen-only injectable (depot medroxyprogesterone acetate [DMPA]) only if all other methods of contraception are unsuitable or unacceptable. The use of the progestogen-only injectable is associated with a small loss of bone mineral density (BMD) with long-term use (more than 1 year). 
  • Advise about:
    • Correct and consistent use of condoms to reduce the risk of STIs.
    • The need for testing for STIs 2 weeks after unprotected sexual intercourse (UPSI) to detect any newly acquired infection, and also 12 weeks after UPSI as it may take time for antibodies for syphilis or HIV to be detectable.
    • Seeking follow-up within 3 months of starting hormonal contraception, or at any time if she develops problems with the contraception. This allows adverse effects or other concerns to be addressed and helps ensure the correct use of the method. 
  • Address any concerns on the possible risks and adverse effects with hormonal contraception, such as weight gain, mood changes, altered bleeding patterns, dysmenorrhoea, loss of BMD, venous thromboembolism, return of fertility, and risk of cancer.

Basis for recommendation

These recommendations are largely based on the College of Sexual and Reproductive Healthcare (CoSRH) guideline Contraceptive choices for young people [CoSRH, 2026b].

Scenario: Assessment for specific contraceptive methods

From age 13 years to 60 years (Female).

How should I assess a woman's suitability for combined hormonal contraception?

Basis for recommendation

These recommendations are based on the College of Sexual and Reproductive Healthcare (CoSRH) guideline Combined hormonal contraception [CoSRH, 2023b].

 

How should I assess a woman considering progestogen-only contraception?

How should I assess a woman considering taking the progestogen-only pill?

  • In addition to a general assessment: 
    • Check the woman's cervical screening history to ensure that she has attended routine screening appointments.
    • Check the additional considerations before prescribing drospirenone, as well as the UK Medical Eligibility Criteria (UKMEC) that relates to all progestogen-only pills.  
      • Drospirenone is contraindicated in severe renal insufficiency and acute renal failure.  
      • The CoSRH advises that it should be avoided in people with known hyperkalaemia or untreated hypoaldosteronism and people taking potassium-sparing diuretics or potassium supplements.
      • If drospirenone is used in people with mild/moderate renal insufficiency or with treated hypoaldosteronism, the CoSRH suggests that monitoring of urea and electrolytes and blood pressure may be required (in consultation with the individual’s renal physician/endocrinologist where appropriate).
      • The CoSRH also suggests that measurement of urea and electrolytes and blood pressure should be considered prior to prescribing drospirenone in people with significant risk factors for chronic kidney disease,  particularly if aged over 50 years.
  • If the progestogen-only pill is suitable and acceptable to the woman, see Scenario: Progestogen-only pill in the CKS topic on Contraception - progestogen-only methods for more information on this method of contraception.

How should I assess a woman considering using a progestogen-only implant?

How should I assess a woman considering taking the progestogen-only injectable?

  • In addition to a general assessment:
    • Check the woman's cervical screening history to ensure that she has attended routine screening appointments.
    • Assess her risk for osteoporosis.
      • For women with significant risk factors for osteoporosis, consider other methods of contraception. See the CKS topic on Osteoporosis - prevention of fragility fractures for more information.
      • In girls aged under 18 years of age, consider the depot medroxyprogesterone acetate (DMPA) injection only if all other methods of contraception are unsuitable or unacceptable.
      • Review the risks and benefits of DMPA injection at least every 2 years and decide whether treatment can be continued. See the section on risk factors in the CKS topic on Osteoporosis - prevention of fragility fractures for more information.
  • If the progestogen-only injectable is suitable and acceptable to the woman, see Scenario: Progestogen-only injectables in the CKS topic on Contraception - progestogen-only methods for more information on this method of contraception.

Basis for recommendation

These recommendations are based on the College of Sexual and Reproductive Healthcare (CoSRH) UK Medical Eligibility Criteria for Contraceptive Use [CoSRH, 2025a] and the CoSRH guidelines Progestogen-only pills [CoSRH, 2026c], Progestogen-only injectables [CoSRH, 2023a], and Progestogen-only implants [CoSRH, 2023c].

 

How should I assess a woman considering intrauterine contraception?

How should I assess a woman considering using the levonorgestrel-releasing intrauterine device?

  • In addition to a general assessment:
    • Perform a bimanual pelvic examination before inserting the levonorgestrel intrauterine device (LNG-IUD).
      • If a woman attends to discuss intrauterine contraception (IUC) in advance of the procedure, a pelvic examination is not required unless indicated by the clinical history.
      • Obtain valid consent from the woman before the pelvic examination (and IUC insertion).
      • Take a sexual history to assess the woman's risk of sexually transmitted infections (STIs). 
        • Offer STI testing and/or cervical screening as appropriate. 
  • If the woman has unexplained vaginal bleeding that suggests an underlying medical condition (such as bleeding between her periods or after sexual intercourse):
    • Do not insert the LNG-IUD until the cause of bleeding has been diagnosed.
    • Offer an alternative method of contraception.
  • In women with heavy menstrual bleeding:
    • Consider the need for additional investigations, such as full blood count, pelvic ultrasound scan, and endometrial biopsy, prior to or at the same time as LNG-IUD insertion, particularly if other treatments for heavy menstrual bleeding have not been effective or if a woman has risk factors for gynaecological disease.
  • If the LNG-IUD is suitable and acceptable to the woman, see Scenario: Levonorgestrel intrauterine device in the CKS topic on Contraception - IUC for more information on this method of contraception.

How should I assess a woman's suitability for the copper intrauterine device?

  • In addition to a general assessment:
    • Perform a bimanual pelvic examination before inserting the copper intrauterine device (Cu-IUD).
      • If a woman attends to discuss intrauterine contraception (IUC) in advance of the procedure, a pelvic examination is not required unless indicated by the clinical history.
      • Obtain valid consent from the woman before the pelvic examination (and IUC insertion).
  • If the woman is identified as being at risk of a sexually transmitted infection (STI):
      • Offer STI testing and/or cervical screening as appropriate. 
  • If the woman has unexplained vaginal bleeding that suggests an underlying medical condition (such as bleeding between her periods or after sexual intercourse):
    • Do not insert the Cu-IUD until the cause of bleeding has been diagnosed.
    • Offer an alternative method of contraception.
  • In women with heavy menstrual bleeding:
    • Consider the need for additional investigations, such as full blood count, pelvic ultrasound scan, and endometrial biopsy, prior to or at the same time as Cu-IUD insertion, particularly if other treatments for heavy menstrual bleeding have not been effective or if a woman has risk factors for gynaecological disease.
  • If the Cu-IUD is suitable and acceptable to the woman, see Scenario: Copper intrauterine device in the CKS topic on Contraception - IUC for more information on this method of contraception.

Basis for recommendation

These recommendations are based on the College of Sexual and Reproductive Healthcare (CoSRH) UK Medical Eligibility Criteria for Contraceptive Use [CoSRH, 2025a] and the CoSRH guideline Intrauterine contraception [CoSRH, 2025b].

 

How should I assess a woman considering the natural family planning method of contraception?

How should I assess a woman who is considering fertility awareness methods of contraception?

  • In addition to a general assessment:
    • Check whether the woman (or her partner) is taking a teratogenic drug or the woman has a condition that makes pregnancy an unacceptable health risk. If either or both of these apply:
      • Advise that the reliance on fertility indicators for the prevention of pregnancy is not recommended.
      • Discuss suitable alternative contraceptive options with the woman and, where necessary, with specialists involved in the management of her condition. 
    •  Advise the woman that in general, fertility awareness methods (FAM) are not recommended due to reduced efficacy compared with other methods of contraception.
  • Be aware that certain situations may affect FAM.
  • The World Health Organization Medical Eligibility Criteria for Contraceptive Use outlines certain situations where FAM is more unreliable and should therefore be delayed or used with caution, such as:
    • Following cessation of hormonal contraception or other drugs that can affect cycle regularity, hormones, and/or fertility signs, women should not rely on fertility indicators until regular menstrual cycles have been re-established and they have had a minimum of 3 cycles after stopping these medications.
    • Conditions that can make the use of FAM more complex, such as irregular vaginal bleeding or vaginal discharge. 
  • If FAM are suitable and acceptable to the woman, see Scenario: Fertility awareness methods in the CKS topic on Contraception - natural family planning for more information on these methods of contraception.

How should I assess a woman who is considering using the lactational amenorrhoea method of contraception?

  • In addition to a general assessment: 
    • Check that the criteria for the lactational amenorrhoea method (LAM) are met. The following conditions must all be met before LAM can be used:
      • Complete amenorrhoea.
      • Fully or nearly fully breastfeeding (that is, the baby is getting 85% or more of its feeds as breast milk).
      • Less than 6 months postpartum.
    • Check whether the woman is taking a teratogenic drug or has a health condition that makes pregnancy an unacceptable risk. If either or both of these apply:
      • Advise that the LAM is not a reliable enough method of contraception if pregnancy must be strictly avoided.
      • Discuss alternative contraceptive options with the woman and, where necessary, with specialists involved in the management of her condition. 
  • Be aware that some medical conditions in the newborn that can affect breastfeeding may also affect the duration of amenorrhoea, making the LAM a less useful choice for family planning purposes. These conditions are outlined in the World Health Organization Medical Eligibility Criteria for Contraceptive Use and include certain metabolic disorders and congenital deformities of the mouth, jaw, or palate. Separation from a newborn who requires neonatal care can also affect breastfeeding. 
  • If the LAM is suitable and acceptable to the woman, see Scenario: Lactational amenorrhea method in the CKS topic on Contraception - natural family planning for more information on this method of contraception.

Basis for recommendation

These recommendations are based on the College of Sexual and Reproductive Healthcare (CoSRH) guideline Fertility awareness methods [CoSRH, 2015a] and the World Health Organization Medical Eligibility Criteria for Contraceptive Use [WHO, 2025].

How should I assess a woman who is considering using a barrier method of contraception?

  • In addition to a general assessment:
    • Check whether the woman (or her partner) is taking a teratogenic drug or the woman has a condition that makes pregnancy an unacceptable health risk. If either or both of these apply:
      • Advise that barrier methods of contraception may not be appropriate for those who cannot use them consistently and correctly because of their relatively higher typical-use failure rates.
      • Discuss alternative contraceptive options with the woman and, where necessary, with specialists involved in the management of her condition. 
    • For diaphragms and caps, perform a vaginal examination to ensure. Diaphragms and caps are not appropriate for women who:
      • Have very poor vaginal muscle tone (this may be a contraindication for the diaphragm).
      • Have a shallow pubic ledge (this applies to the diaphragm only).
      • Have an abnormality of the vagina.
      • Have a cervix in a markedly distorted cervical anatomy (applies to the cervical cap).
      • Cannot touch their genital area with comfort.
  • Note that:
    • Severe obesity may make diaphragm and cap placement difficult.
    • There is a higher risk of cervical cap failure in parous women than in nulliparous women.
    • The risk of urinary tract infection with the diaphragm may increase in a woman with subacute bacterial endocarditis.
    • Diaphragms and caps are not appropriate for women who are less than 6 weeks postpartum or 6 weeks following second trimester termination of pregnancy. There is an increased risk of complications when the uterus has not fully involuted.
    • A different size of cap or diaphragm may be needed postpartum.
  • If a barrier method of contraception is suitable and acceptable to the woman, see the CKS topic on Contraception - barrier methods and spermicides for more information on this method of contraception.

Basis for recommendation

These recommendations are based on the College of Sexual and Reproductive Healthcare (CoSRH) UK guideline Barrier methods for contraception and STI prevention [CoSRH, 2015b] and the World Health Organization Medical Eligibility Criteria for Contraceptive Use [WHO, 2025].

 

How should I assess a person who is considering sterilization?

  • In addition to a general assessment, assess the woman's:
    • Mental capacity to make the decision.
      • If there is any doubt about her mental capacity, seek advice from appropriately experienced colleagues (such as a specialist in learning disabilities).
    • Level of understanding of the advantages, disadvantages, procedures involved, and relative failure rates of a vasectomy or tubal occlusion.
      • Offer alternative long-term reversible methods of contraception, such as hormonal methods (combined hormonal contraceptives, progestogen-only contraceptives) and intrauterine methods.
    • Risk for later regret. Take additional care when counselling women who are:
      • Younger than 30 years of age.
      • Without children.
      • Taking decisions during pregnancy.
      • Taking decisions in reaction to the end of a relationship.
      • Possibly at risk of coercion by their partner, family, or health or social welfare professionals.
    • Cultural, religious, psychosocial, psychosexual, and psychological issues/beliefs.
  • Also assess her partner's suitability for sterilization, as the couple's clinical history, present symptoms, or abnormal examination findings may influence which partner goes forward to have sterilization. For example:
    • Vasectomy for the man may be preferable if:
      • The woman has any contraindication to general anaesthesia.
      • The woman has had previous abdominal or pelvic surgery — this increases the relative risk of complications and the need for a laparotomy.
    • Tubal occlusion for the woman may be preferable:
      • If past history of genital or scrotal surgery in the man increases the risk of complications of vasectomy.
    • A hysterectomy may be an alternative if significant gynaecological pathology, such as large fibroids or a prolapse, is present.
    • For some women, an alternative form of contraception may be more suitable, such as the levonorgestrel intrauterine device (LNG-IUD), which is indicated for heavy menstrual bleeding, symptoms of endometriosis, and as a component of hormone replacement therapy.
  • Before tubal occlusion, a bimanual pelvic examination should be performed so that there are no unexpected findings during the procedure.
  • Before a vasectomy, a scrotal examination is necessary to exclude potential problems, such as a large varicocele or hydrocele that may make the vas deferens more difficult to palpate such that general anaesthesia is required.
  • If sterilization is suitable and acceptable to the woman and/or her partner, see the CKS topic on Contraception - sterilization for more information on this method of contraception.

Basis for recommendation

These recommendations are based on the College of Sexual and Reproductive Healthcare (CoSRH) guideline Male and female sterilisation [CoSRH, 2014] and the World Health Organization Medical Eligibility Criteria for Contraceptive Use [WHO, 2025].

 

Supporting evidence

This CKS topic is largely based on the College of Sexual and Reproductive Healthcare (CoSRH) UK Medical Eligibility Criteria for Contraceptive Use (UKMEC) [CoSRH, 2025a] and other relevant CoSRH guidelines, and the World Health Organization Medical Eligibility Criteria for Contraceptive Use [WHO, 2025].

How this topic was developed

This section briefly describes the processes used in developing and updating this topic. Further details on the full process can be found in the About Us section and on the Clarity Informatics website.

Search strategy

A literature search was conducted for guidelines, systematic reviews and randomized controlled trials on primary care management of contraception - assessment.

Search dates

March 2021 - June 2026

Key search terms

Various combinations of searches were carried out. The terms listed below are the core search terms that were used for Medline.

  • Contraception/
  • Contraceptive Agents/tu [Therapeutic Use]
  • Contraception Behavior/
  • Counseling.kw.
  • Assessment.ti,ab.
  • *Switching.kw.
  • *Continuation.kw.
  • Choice Behaviour/

Sources of guidelines

Sources of systematic reviews and meta-analyses

  • The Cochrane Library:
    • Systematic reviews
    • Protocols
    • Database of Abstracts of Reviews of Effects
  • Medline (with systematic review filter)
  • EMBASE (with systematic review filter)

Sources of health technology assessments and economic appraisals

Sources of randomized controlled trials

  • The Cochrane Library:
    • Central Register of Controlled Trials
  • Medline (with randomized controlled trial filter)
  • EMBASE (with randomized controlled trial filter)

Sources of evidence based reviews and evidence summaries

Sources of national policy

Patient experiences

Sources of medicines information

The following sources are used by CKS pharmacists and are not necessarily searched by CKS information specialists for all topics. Some of these resources are not freely available and require subscriptions to access content.

Stakeholder engagement

Our policy

The external review process is an essential part of CKS topic development. Consultation with a wide range of stakeholders provides quality assurance of the topic in terms of:

  • Clinical accuracy.
  • Consistency with other providers of clinical knowledge for primary care.
  • Accuracy of implementation of national guidance (in particular NICE guidelines).
  • Usability.

Principles of the consultation process

  • The process is inclusive and any individual may participate.
  • To participate, an individual must declare whether they have any competing interests or not. If they do not declare whether or not they have competing interests, their comments will not be considered.
  • Comments received after the deadline will be considered, but they may not be acted upon before the clinical topic is issued onto the website.
  • Comments are accepted in any format that is convenient to the reviewer, although an electronic format is encouraged.
  • External reviewers are not paid for commenting on the draft topics.
  • Discussion with an individual or an organization about the CKS response to their comments is only undertaken in exceptional circumstances (at the discretion of the Clinical Editor or Editorial Steering Group).
  • All reviewers are thanked and offered a letter acknowledging their contribution for the purposes of appraisal/revalidation.
  • All reviewers are invited to be acknowledged on the website. All reviewers are given the opportunity to feedback about the external review process, enabling improvements to be made where appropriate.

Stakeholders

  • Key stakeholders identified by the CKS team are invited to comment on draft CKS topics. Individuals and organizations can also register an interest to feedback on a specific topic, or topics in a particular clinical area, through the Getting involved section of the Clarity Informatics website.
  • Stakeholders identified from the following groups are invited to review draft topics:
    • Experts in the topic area.
    • Professional organizations and societies (for example, Royal Colleges).
    • Patient organizations, Clarity has established close links with groups such as Age UK and the Alzheimer’s Society specifically for their input into new topic development, review of current topic content and advice on relevant areas of expert knowledge.
    • Guideline development groups where the topic is an implementation of a guideline.
    • The British National Formulary team.
    • The editorial team that develop MeReC Publications.
  • Reviewers are provided with clear instructions about what to review, what comments are particularly helpful, how to submit comments, and declaring interests.

Patient engagement

Clarity Informatics has enlisted the support and involvement of patients and lay persons at all stages in the process of creating the content which include:

  • Topic selection
  • Scoping of topic
  • Selection of clinical scenarios
  • First draft internal review
  • Second draft internal review
  • External review
  • Final draft and pre-publication

Our lay and patient involvement includes membership on the editorial steering group, contacting expert patient groups, organizations and individuals.

Evidence exclusion criteria

Our policy

Scoping a literature search, and reviewing the evidence for CKS is a methodical and systematic process that is carried out by the lead clinical author for each topic. Relevant evidence is gathered in order that the clinical author can make fully informed decisions and recommendations. It is important to note that some evidence may be excluded for a variety of reasons. These reasons may be applied across all CKS topics or may be specific to a given topic.

Studies identified during literature searches are reviewed to identify the most appropriate information to author a CKS topic, ensuring any recommendations are based on the best evidence. We use the principles of the GRADE and PICOT approaches to assess the quality of published research. We use the principles of AGREE II to assess the quality of published guidelines.

Standard exclusions for scoping literature:

  • Animal studies
  • Original research is not written in English

Possible exclusions for reviewed literature:

  • Sample size too small or study underpowered
  • Bias evident or promotional literature
  • Population not relevant
  • Intervention/treatment not relevant
  • Outcomes not relevant
  • Outcomes have no clear evidence of clinical effectiveness
  • Setting not relevant
  • Not relevant to UK
  • Incorrect study type
  • Review article
  • Duplicate reference

Organizational, behavioural and financial barriers

Our policy

The CKS literature searches take into consideration the following concepts, which are discussed at the initial scoping of the topic.

  • Feasibility
    • Studies are selected depending on whether the intervention under investigation is available in the NHS and can be practically and safely undertaken in primary care.
  • Organizational and Financial Impact Analysis
  • Studies are selected and evaluated on whether the intervention under investigations may have an impact on local clinical service provision or national impact on cost for the NHS. The principles of clinical budget impact analysis are adhered to, evaluated and recorded by the author. The following factors are considered when making this assessment and analysis.
    • Eligible population
    • Current interventions
    • Likely uptake of new intervention or recommendation
    • Cost of the current or new intervention mix
    • Impact on other costs
    • Condition-related costs
    • In-direct costs and service impacts
    • Time dependencies
  • Cost-effectiveness or cost-benefit analysis studies are identified where available. 

We also evaluate and include evidence from NICE accredited sources which provide economic evaluations of recommendations, such as NICE guidelines. When a recommended action may not be possible because of resource constraints, this is explicitly indicated to healthcare professionals by the wording of the CKS recommendation.

Declarations of interest

Our policy

Clarity Informatics requests that all those involved in the writing and reviewing of topics, and those involved in the external review process to declare any competing interests. Signed copies are securely held by Clarity Informatics and are available on request with the permission of the individual. A copy of the declaration of interest form which participants are asked to complete annually is also available on request. A brief outline of the declarations of interest policy is described here and full details of the policy is available on the Clarity Informatics website. Declarations of interests of the authors are not routinely published, however competing interests of all those involved in the topic update or development are listed below. Competing interests include:

  • Personal financial interests
  • Personal family interest
  • Personal non-financial interest
  • Non-personal financial gain or benefit

Although particular attention is given to interests that could result in financial gains or losses for the individual, competing interests may also arise from academic competition or for political, personal, religious, and reputational reasons. An individual is not obliged to seek out knowledge of work done for, or on behalf of, the healthcare industry within the departments for which they are responsible if they would not normally expect to be informed.

Who should declare competing interests?

Any individual (or organization) involved in developing, reviewing, or commenting on clinical content, particularly the recommendations should declare competing interests. This includes the authoring team members, expert advisers, external reviewers of draft topics, individuals providing feedback on published topics, and Editorial Steering Group members. Declarations of interest are completed annually for authoring team and editorial steering group members, and are completed at the start of the topic update and development process for external stakeholders.

Competing interests declared for this topic:

None.

References

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