When additional precautions are indicated to reduce risk of pregnancy if starting combined oral contraceptive (COC) pill

Starting combined hormonal contraception and requirement for additional contraceptive precautions

The FSRH have suggested different circumstances when starting combined hormonal contraception (CHC) when additional precautions are required.

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COC, combined oral contraception; Cu-IUD, copper-bearing intrauterine device; HSUPT, high-sensitivity urine pregnancy test; LNG-EC, levonorgestrel emergency contraception; UPA-EC, ulipristal acetate emergency contraception; UPSI, unprotected sexual intercourse; VTE, venous thromboembolism.
*Day 1 for estradiol valerate/dienogest pill.
†See FSRH Guideline Contraception After Pregnancy.
‡In the presence of other risk factors for VTE, such as immobility, transfusion at delivery, BMI ≥30 kg/m2, postpartum haemorrhage, immediately post-caesarean delivery, pre-eclampsia or smoking, use of combined hormonal contraception may pose an additional increased risk for VTE

Note that with respect to trophoblastic disease it has been stated that (2):

• the combined oral contraceptive (COC) can be started 1 month after no hCG is detected. The COC starting procedure is then as if taking the COC for the first time

Reference:

• FSRH (July 2019). Combined Hormonal Contraception
• Guillebaud J, Contraception - your questions answered, 2012