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Intrauterine Contraception

FSRH Clinical Guideline: Intrauterine contraception (March 2023, Amended July 2023)

17 July 2023

The guideline provides evidence-based recommendations and good practice points to enable clinicians to support individuals to make informed decisions about choosing and using IUC. It includes information on assessing suitability of IUC use for contraception, the risks and benefits of IUC and guidance for IUC procedures, complications and follow-up. Published March 2023.

Please read this guidance document in conjunction with any relevant clinical statements for this topic:

FSRH CEU Statement: Mirena 8 years contraception (Jan 2024)

FSRH CEU Statement: Response to new study by Meaidi et al (2023) Venous thromboembolism with use of hormonal contraception and non-steroidal anti-inflammatory drugs (September 2023)

FSRH Response to new study on use of CHC and POC and breast cancer risk (March 2023)

FSRH CEU Response to published study: Maternal use of hormonal contraception and risk of childhood leukemia: a nationwide, populate-based cohort study (September 2018)

FSRH CEU Statement to published systematic review: The relationship between progestin hormonal contraception and depression: a systematic review (March 2018)

FSRH CEU Statement: Response to Study Contemporary Hormonal Contraception and the Risk of Breast Cancer (December 2017)

FSRH CEU Statement: Response to Study: Intrauterine Contraception Use and Cervical Cancer Risk (January 2018)

FSRH CEU Statement: Contraception and Weight Gain (August 2019)


The digital version can be accessed from the BMJ SRH website: FSRH Guideline (March 2023) Intrauterine contraception BMJ Sexual & Reproductive Health 2023;49:1-142. 

You are welcome to download our freely available Guideline documents by clicking on the document title above.

This document is up-to-date

FSRH Clinical Guideline: Intrauterine contraception (March 2023, Amended July 2023) (Evidence relocated)

17 July 2023

The guideline provides evidence-based recommendations and good practice points to enable clinicians to support individuals to make informed decisions about choosing and using IUC. It includes information on assessing suitability of IUC use for contraception, the risks and benefits of IUC and guidance for IUC procedures, complications and follow-up. It is intended for any health care professional or health service providing contraceptive care in the UK.

In this version of the IUC Guideline, the supporting evidence for the recommendations has been removed from the main text and located in an appendix for ease of reading.

This resource is available to members/candidates of FSRH.

This document is up-to-date

FSRH CEU Guidance: Intrauterine Contraception Quick Reference Summary (April 2023)

18 April 2023

This summary has been written as a quick reference guide to help busy clinicians to give clear, safe advice on intrauterine contraception. Please refer to the full 2023 FSRH Intrauterine Contraception Clinical Guideline for further information and evidence for this advice.

This resource is available to members/candidates of FSRH.

This document is up-to-date

FSRH Guideline-related resources: Intrauterine Contraception (March 2023)

20 April 2023

Additional resources supporting FSRH Guideline: Intrauterine Contraception

This resource is available to members/candidates of FSRH.

This document is up-to-date

FSRH Guideline-related CPD Q&A: Intrauterine Contraception (March 2023)

31 March 2023

Login to view this document. 1 CPD credit can be claimed for reading the guidance. 1 CPD credit can be claimed for answering the questions.

This resource is available to members/candidates of FSRH.

This document is up-to-date

FSRH CEU Statement: Mirena 8 years contraception (Jan 2024)

11 January 2024

This CEU statement notes that the Mirena® 52mg LNG-IUD has now been licensed for 8 years for contraception. There has not been an extension to the licensed duration of use when being used for the management of heavy menstrual bleeding, or for endometrial protection as part of hormone replacement therapy. 
 
This supersedes the current advice in the Intrauterine Contraception Guideline.

You are welcome to download our freely available Guideline documents by clicking on the document title above.

This document is up-to-date

FSRH New Product Review: Intrauterine Ball (IUBTM) Ballerine® MIDI (February 2019) (Updated April 2023)

11 April 2023

Manufactured by OCON Medical Ltd, the Intrauterine Ball (IUB™) SCu300B MIDI is a copper intrauterine device (Cu-IUD) comprised of copper beads with a total exposed copper surface of 300mm² strung on a flexible Nitinol (nickel/titanium alloy), PET-coated frame. Once the IUB is released from the 3.2mm diameter insertion tube into the uterus it coils into a spherical shape measuring 15mm in diameter. Download the product review in full here.

You are welcome to download our freely available Guideline documents by clicking on the document title above.

This document is up-to-date

FSRH CEU statement Levosert 6 year license for contraception - Feb 2021

08 February 2021

This statement notes that the Levosert® 52mg LNG-IUS has been licensed for contraceptive use for 6 years. Levosert remains licensed for 5 years for management of heavy menstrual bleeding and is not licensed for endometrial protection as part of HRT.

You are welcome to download our freely available Guideline documents by clicking on the document title above.

This document is up-to-date

FSRH CEU Resource: New one-handed, reloadable 52mg levonorgestrel-releasing intrauterine system

10 November 2021

Benilexa® (Gedeon Richter) - a 52mg levonorgestrel-releasing intrauterine system (LNG-IUS) with a reloadable one-handed insertion device - is now available in the UK. Benilexa is licensed for 6 years of use for contraception. It is not licensed for endometrial protection as part of HRT. This FSRH CEU Resource provides a table which compares the product characteristics of LNG-IUS devices currently available in the UK, Benilexa®, Levosert®, Mirena®, Kyleena® and Jaydess®.

You are welcome to download our freely available Guideline documents by clicking on the document title above.

This document is up-to-date

FSRH Statement: Pain associated with insertion of intrauterine contraception - June 2021

30 June 2021

Recent media reports have highlighted cases of individuals who have experienced distressing intrauterine contraception (IUC) fitting. Read and download the FSRH statement on pain associated with intrauterine contraception.

You are welcome to download our freely available Guideline documents by clicking on the document title above.

This document is up-to-date

Progestogen-only Implants

FSRH Clinical Guideline: Progestogen-only Implant (February 2021, Amended July 2023)

17 July 2023

You are welcome to download our freely available Guideline documents by clicking on the document title above.

This document is up-to-date

FSRH CEU Guidance: Progestogen-only Implant Quick Reference Summary (February 2021, amended July 2023)

17 July 2023

This summary has been written as a quick reference guide to help busy clinicians to give clear, safe advice on Progestogen-only Implant. Please refer to the full FSRH Progestogen-only Implant Clinical Guideline for further information and evidence for this advice.

This resource is available to members/candidates of FSRH.

This document is up-to-date

FSRH Guideline-related CPD Q&A: Progestogen-only Implant (February 2021, amended July 2023)

17 July 2023

1 CPD credit can be claimed for reading the guidance and 1 CPD credit can be claimed for answering the questions.

This resource is available to members/candidates of FSRH.

This document is up-to-date

FSRH CEU Statement on Nexplanon® Insertion Site 15 January 2020

15 January 2020

This CEU Statement provides guidance to healthcare professionals in response to a letter circulated by MSD (manufacturer of Nexplanon®) to healthcare professionals in the UK about updated guidance regarding the recommended Nexplanon® insertion site.

You are welcome to download our freely available Guideline documents by clicking on the document title above.

This document is up-to-date

Progestogen-only Injectables

FSRH Clinical Guideline: Progestogen-only Injectable (December 2014, Amended July 2023)

17 July 2023

You are welcome to download our freely available Guideline documents by clicking on the document title above.

This document is up-to-date

FSRH CEU Statement: Self-Administration of Sayana Press® (September 2015)

01 September 2015

The CEU supports the self administration of Sayana Press® because of its potential benefits to women and services. It offers women greater choice and more autonomy over their contraception and fertility.

You are welcome to download our freely available Guideline documents by clicking on the document title above.

This document is up-to-date

FSRH New Product Review: Sayana Press® (June 2013)

01 June 2013

Injectable progestogen-only contraception is a popular and effective method of contraception and until now, in the UK has largely been administered as Depo-Provera®, an intramuscular (IM) injection of 150mg medroxyprogesterone acetate (DMPA).

You are welcome to download our freely available Guideline documents by clicking on the document title above.

This document is up-to-date

FSRH Guideline-related CPD Q&A: Progestogen-only Injectable Contraception (December 2014)

16 May 2016

1 CPD credit can be claimed for reading the guidance and 1 CPD credit can be claimed for answering the questions.

This resource is available to members/candidates of FSRH.

This document is up-to-date

Progestogen-only Pills

FSRH Clinical Guideline: Progestogen-only Pills (August 2022, Amended July 2023)

17 July 2023

You are welcome to download our freely available Guideline documents by clicking on the document title above.

This document is up-to-date

FSRH Guideline: Progestogen-only Pills (August 2022, Amended July 2023) (Evidence relocated)

17 July 2023

This guideline provides evidence-based recommendations and good practice points for health professionals on the use of progestogen-only contraceptive pills. It is intended for any healthcare professional or health service providing contraceptive care in the UK. In this version of the POP Guideline, the supporting evidence for the recommendations has been removed from the main text and located in an appendix for ease of reading. This document is available to FSRH members and candidates only. 

This resource is available to members/candidates of FSRH.

This document is up-to-date

FSRH CEU Guidance: Progestogen-only Pills Quick Reference Summary (August 2022, updated July 2023)

17 July 2023

This summary has been written as a quick reference guide to help busy clinicians to give clear, safe advice on progestogen-only contraceptive pills. Please refer to the full 2022 FSRH Progestogen-only Pills Clinical Guideline for further information and supporting evidence for this advice. This document is written for FSRH members and requires you to log in to access it.

This resource is available to members/candidates of FSRH.

This document is up-to-date

FSRH Guideline-related CPD Q&A: Progestogen-only Pills (August 2022)

23 August 2022

Login to view this document. 1 CPD credit can be claimed for reading the guidance. 1 CPD credit can be claimed for answering the questions.

This resource is available to members/candidates of FSRH.

This document is up-to-date

FSRH CEU Statement: Drospirenone Progestogen-only Pill (DRSP POP) (Jan 24)

10 January 2024

This CEU statement provides a brief summary of key information on a new drospirenone progestogen-only pill (DRSP POP) Slynd® available now in the UK.

You are welcome to download our freely available Guideline documents by clicking on the document title above.

This document is up-to-date

FSRH Clinical Statement - DSG-POP as Pharmacy Medication

21 July 2021

This FSRH Statement reviews two desogestrel 75mcg progestogen-only pill (POP) available over-the-counter as Pharmacy Medicines.

You are welcome to download our freely available Guideline documents by clicking on the document title above.

This document is up-to-date

Combined Hormonal Contraception

FSRH Clinical Guideline: Combined Hormonal Contraception (January 2019, Amended October 2023)

13 July 2023

This guidance provides evidence-based recommendations and good practice points for health professionals on the use of combined hormonal contraceptives (i.e. the combined oral contraceptive pill, transdermal patch and combined vaginal ring) currently available in the UK. It is intended for any health care professional or health service providing contraception or conception advice in the UK.

Please read this guidance document in conjunction with any relevant clinical statements for this topic:

FSRH CEU Statement: Response to new study by Meaidi et al (2023) Venous thromboembolism with use of hormonal contraception and non-steroidal anti-inflammatory drugs (September 2023)

FSRH Response to new study on use of CHC and POC and breast cancer risk (March 2023)

FSRH CEU Statement: New manufacturer/MHRA advice regarding nomegestrol acetate – how does this affect prescribing of Zoely®? (April 2023)

FSRH CEU Statement : New advice from the MHRA regarding cyproterone acetate: how does this affect prescribing of Co-cyprindiol/Dianette® for acne/hirsutism? July 2020

FSRH CEU Response to published study: Maternal use of hormonal contraception and risk of childhood leukemia: a nationwide, populate-based cohort study (September 2018)

FSRH CEU Statement: Oral Contraceptives and Multiple Sclerosis (March 2014)

FSRH CEU Statement: Response to Study Contemporary Hormonal Contraception and the Risk of Breast Cancer (December 2017)

FSRH CEU Statement: Contraception and Weight Gain (August 2019)

FSRH CEU Statement: Response to new reports of link between COC and Glaucoma (November 2013)


The digital version can be accessed from the BMJ SRH website: FSRH Guideline (January 2019, amended November 2020) Combined Hormonal Contraception. BMJ Sexual & Reproductive Health 2019; 45:Suppl 1.

You are welcome to download our freely available Guideline documents by clicking on the document title above.

This document is up-to-date

FSRH CEU Guidance: Combined Hormonal Contraception Quick Reference Summary (January 2019, updated October 2023)

15 June 2023

This summary has been written as a quick reference guide to help busy clinicians to give clear, safe advice on combined hormonal contraception (CHC). Please refer to the full 2018 FSRH CHC Clinical Guideline for further information and evidence for this advice. This document is written for FSRH members and requires you to log in to access it. 

This resource is available to members/candidates of FSRH.

This document is up-to-date

FSRH CEU Guidance: Recommended Actions after incorrect Use of Combined Hormonal Contraception (e.g. late or missed pills, ring and patch) (March 2020, amended July 2021)

16 March 2020

This document provides guidance on incorrect use of: combined oral contraceptive pills, the combined vaginal ring, and the combined transdermal patch. This guidance was developed with an international team of SRH experts. The panel used the limited relevant published evidence relating to risk of pregnancy associated with incorrect use of the combined pill, patch and ring to inform a set of rules that are overcautious, but are considered to be simple enough to make them usable in practice. The guidance was peer reviewed and went out to public consultation prior to final publication. The guidance is intended for use by health professionals working in SRH, general practice and obstetric and gynaecology settings, and can also be used by women using CHC. Download the document here.

You are welcome to download our freely available Guideline documents by clicking on the document title above.

This document is up-to-date

FSRH CEU Statement: Response to Heikinheimo 2022 (June 2022)

22 June 2022

This FSRH Statement responses to a recently published cohort study, which used information from Finnish databases, assessed incidence of confirmed venous thromboembolic (VTE) events in 2018/19 amongst the roughly 300,000 Finnish people aged 15-49 who were using hormonal contraception (HC) in 2017 (identified from the prescribing database) and age-matched controls who were not using hormonal contraception.

You are welcome to download our freely available Guideline documents by clicking on the document title above.

This document is up-to-date

FSRH CEU Statement: Strengthening of Warnings about use of Dianette and other brands of co-cyprindiol (June 2013)

01 June 2013

Following a recent safety review, a letter has been issued to healthcare professionals from the manufacturers of Dianette® and other cyproterone acetate 2 mg/ ethinylestradiol 35 mcg (co-cyprindiol) products. The review by the Pharmacovigilance Risk Assessment Committee (PRAC) of the European Medicines Agency (EMA) followed concerns about the risk of thrombosis associated with co-cyprindiol. With the agreement of the EMA and Medicines and Healthcare products Regulatory Authority (MHRA), a letter has been issued to raise awareness of the thrombosis risks and the outcome of the review.

You are welcome to download our freely available Guideline documents by clicking on the document title above.

This document is up-to-date

FSRH New Product Review: Eloine Daylette (November 2015)

01 November 2015

How effective is 20mcgEE/3mgDRSP as contraception? 20mcgEE/3mg DRSP is of comparable effectiveness to other combined oral contraceptives. [1,2,3] A large US observational study reports lower failure rates amongst users of a 24/4 EE/DRSP regimen than a 21/7 EE/DRSP regimen. The study also suggests greater contraceptive effectiveness of a 24/4 EE/DRSP regimen than with a 24/4 regimen containing EE in combination with norethisterone.

You are welcome to download our freely available Guideline documents by clicking on the document title above.

This document is up-to-date

FSRH CEU Statement: CVR availability and Dispensing - Jan 2022

11 January 2022

This FSRH Satement notes the availability and dispensive of the combined vaginal contraceptive rings in the UK.

You are welcome to download our freely available Guideline documents by clicking on the document title above.

This document is up-to-date

Barrier Methods

FSRH Clinical Guideline: Barrier Methods for Contraception and STI Prevention (August 2012, amended October 2015)

01 October 2015

This guidance provides evidence-based recommendations and good practice points for health professionals on the use of barrier methods for contraception and STI prevention. It is intended for any health care professional or health service providing contraception or conception advice in the UK.

You are welcome to download our freely available Guideline documents by clicking on the document title above.

Please read this guidance document in conjunction with any relevant clinical statements for this topic.

FSRH New Product Review: One size contraceptive diaphragm (Caya®) (August 2014)

01 August 2014

Diaphragms are non-hormonal barrier methods of contraception that protect women against pregnancy by preventing sperm reaching the cervix. A single size contraceptive cap, FemCap, has been available since 2004, but until recently diaphragm products have been made in a range of sizes and designs. As a result women may have been required to try several types of diaphragm during the fitting process.

You are welcome to download our freely available Guideline documents by clicking on the document title above.

This document is up-to-date

Male and Female Sterilisation

FSRH Clinical Guideline: Male and Female Sterilisation (September 2014)

01 September 2014

This guidance provides evidence-based recommendations and good practice points for health professionals on elective male sterilisation (vasectomy) and female sterilisation (tubal occlusion) in the UK. It is intended for any health care professional or service that undertakes or refers individuals for either procedure. This guidance has been jointly developed with the Royal College of Obstetricians and Gynaecologists (RCOG).

You are welcome to download our freely available Guideline documents by clicking on the document title above.

Please read this guidance document in conjunction with any relevant clinical statements for this topic.

FSRH Clinical Guideline: Male and Female Sterilisation Summary of Recommendations (September 2014)

01 September 2014

This is a summary of the recommendations made in the FSRH Clinical Guidance Male and Female Sterilisation. This guidance has been jointly developed with the Royal College of Obstetricians and Gynaecologists (RCOG).

You are welcome to download our freely available Guideline documents by clicking on the document title above.

Please read this guidance document in conjunction with any relevant clinical statements for this topic.

FSRH CEU Statement: Response to the FDA Review of Essure® (October 2015)

01 October 2015

Essure® is a form of female sterilisation which involves the hysteroscopic insertion of flexible micro-inserts into the proximal section of the fallopian tubes and is undertaken without general anaesthesia.

You are welcome to download our freely available Guideline documents by clicking on the document title above.

This document is up-to-date

FSRH CEU Statement: Response to the BMJ paper by Mao et. al. (October 2015)

01 October 2015

A large observational study from the United States found that the risk of unintended pregnancy after Essure sterilisation was similar to that after surgical sterilisation. However just over 2% of women who had Essure sterilisation required a further operation related to the sterilisation procedure within a year.

You are welcome to download our freely available Guideline documents by clicking on the document title above.

This document is up-to-date

FSRH Guideline-related CPD Q&A: Male and Female Sterilisation (September 2014)

16 May 2016

1 CPD credit can be claimed for reading the guidance and 1 CPD credit can be claimed for answering the questions.

This resource is available to members/candidates of FSRH.

This document is up-to-date

Fertility Awareness Methods

FSRH Clinical Guideline: Fertility Awareness Methods (June 2015)

01 June 2015

This is a new guidance document that provides evidence-based recommendations and good practice points on the use of fertility awareness methods (FAM) for the purpose of preventing and/or spacing pregnancies. It is intended for any health care professional or health service providing contraception or conception advice in the UK.

You are welcome to download our freely available Guideline documents by clicking on the document title above.

Please read this guidance document in conjunction with any relevant clinical statements for this topic.

FSRH Guideline-related CPD Q&A: Fertility Awareness Methods (June 2015)

15 March 2016

1 CPD credit can be claimed for reading the guidance and 1 CPD credit can be claimed for answering the questions.

This resource is available to members/candidates of FSRH.

Please read this guidance document in conjunction with any relevant clinical statements for this topic.

Other

FSRH response to new study using a mathematical model to inform dose and regimen of exogenous hormones (April 2023)

13 April 2023

A new mathematical model suggests that effective suppression of ovulation for contraception could be achieved using lower doses of progestogen and estrogen than those currently used in hormonal contraceptives. A paper published today in PLOS Computational Biology describes the model and its findings. The authors highlight that lower exposure to exogenous hormones could reduce associated health risks and side effects. The model could be used to inform dose and regimen of exogenous hormones to be investigated by future clinical trials seeking to find new options for safe, effective and acceptable contraception. Clinical trials would be required to investigate what outcomes, with such regimens, were found in practice.

You are welcome to download our freely available Guideline documents by clicking on the document title above.

This document is up-to-date

FSRH CEU Statement regarding the decision of NICE not to update LARC guidelines (October 2017)

01 October 2017

The National Institute for Health and Care Excellence (NICE) has decided not to update their 2005 guidance on long-acting reversible contraception (LARC) at this time because changes to the current recommendations are not required.

You are welcome to download our freely available Guideline documents by clicking on the document title above.

This document is up-to-date