1. Purpose and scope

This document updates previous Faculty of Sexual & Reproductive Healthcare (FSRH) guidance and aims to summarise the available evidence and expert opinion on combined hormonal contraception (CHC). The guideline is intended for use by healthcare practitioners (HCPs) providing CHC.

2. Identification and assessment of the evidence

This guideline was developed in accordance with standard methodology for developing FSRH clinical guidelines. The recommendations made within this document are based on the best available evidence and the consensus opinion of experts and the guideline development group (GDG). The methodology used in developing this guideline and a list of GDG members and other contributors can be found in Appendix 1.

The recommendations included should be used to guide clinical practice but are not intended to serve alone as a standard of medical care or to replace clinical judgement in the management of individual cases.

3. Introduction

CHC has been used by women worldwide for almost 60 years, with significant changes in dosage and preparation over time. Millions of UK women choose to use CHC. The Natsal 3 survey1 carried out in 2010–2012 reported that more than a third of UK women aged 16–44 years had used oral contraception (OC) in the last year (no distinction was made between combined oral contraception (COC) and the progestogen-only pill (POP)), but data from the Office for National Statistics (2008/09)2 indicate that the majority of women using OC choose COC.2

HCPs should support women to make informed decisions about choosing and using CHC, ensuring that they are informed about contraceptive effectiveness (and how this compares to other contraceptive methods) as well as potential risks and benefits.

Extrapolation of COC data to inform recommendation on all CHC methods

Unless stated otherwise, the recommendations for COC in this guideline refer to low-dose COC containing ≤35 μg ethinylestradiol (EE) combined with a progestogen. Recommendations are …