Combined Hormonal Contraception

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.

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.

FSRH CEU new product review: Drovelis® estetrol/drospirenone combined oral contraceptive (October 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.