Contraception

Get help straight away if

These are uncommon, but they need same-day care — go to an emergency department, do not wait for an appointment.

• Swelling or pain in one calf, sudden breathlessness, or chest pain worse on breathing inGo to an emergency department. These can be signs of a blood clot.
• Sudden weakness or numbness on one side, difficulty speaking, or sudden loss of visionCall 911.

Contact us promptly if

Not an emergency, but worth being seen sooner rather than waiting it out.

• Migraines with visual warning signs — flashing lights, zigzags or a blind spot before the headache — while taking a combined pill, patch or ringWorth contacting us promptly. This combination raises stroke risk, and there are other methods that suit you better.
• Bleeding that is new, heavy or persistent beyond the first few months of a method
• Missed pills or a method used incorrectly, with unprotected sex sinceEmergency contraception is most effective the sooner it is taken, and is available without a prescription from a pharmacy.

What usually happens

The pill is what most people picture, and it is not the most effective option. The methods that do not depend on remembering anything — the implant and the intrauterine devices — are far more effective in ordinary use, precisely because ordinary use includes forgetting.

There is a real difference between how well a method works when used perfectly and how well it works in practice. For methods needing daily action that gap is wide; for the long-acting ones it barely exists. It is worth asking about the practical figure rather than the ideal one.

Several methods do other useful things — lighter or less painful periods, better acne, fewer migraines around your period, less endometriosis pain. If one of those matters to you, say so, because it can decide between otherwise similar options.

The risk of a blood clot with combined methods is real and small, and it is smaller than the risk in pregnancy. What matters more is whether you have particular risk factors, which is why we ask about migraines, smoking, blood pressure and family history.

Changing your mind is normal and expected. Roughly half of people are not using the same method a year later, and coming back to try something different is the system working rather than failing.

At your appointment

A conversation about what matters to you — how effective, how permanent, effect on periods, whether you want to avoid hormones, and whether remembering something daily is realistic.

Blood pressure, weight and a history covering migraines, smoking, clots in the family and any other medications, since these narrow which methods are suitable.

Clear instructions on what to do about missed doses or late appointments, before you need them.

An offer of STI testing where relevant, since contraception and infection protection are separate things and only barrier methods do both.

Worth asking

• —Which methods suit me given my history?
• —How effective is this one in ordinary use, not perfect use?
• —What should I do if I miss one, or if it is late?
• —What are the side effects likely to be in the first few months?