Hormonal, non-hormonal contraception and emergency contraception

It is Saturday night. A 27-year-old nulliparous woman presents at 22:00 with a request for emergency contraception after condom breakage approximately 14 hours ago. She is on no regular contraception, has BMI 28, no migraine, no smoking, regular periods (day 12 of cycle). She wants the most effective option. You also need to plan her ongoing contraception. Across the same evening, your colleague admits a 35-year-old smoker, 2 weeks postpartum, with a VTE on admission — her combined oral contraceptive script from her GP is the precipitating factor, and the registrar on call must decide about future contraception. This topic is the script for both encounters.^[6]

Overview and definition

The umbrella of "modern contraception" spans three broad families: combined hormonal contraception (oestrogen plus progestogen); progestin-only methods (pill, implant, injectables, LNG-IUS); and non-hormonal methods (Cu-IUD, barrier, fertility awareness). Each family has distinct mechanisms, eligibility, failure rates and bleeding patterns; choosing between them is the central applied skill of contraception counselling. ^[6][5]

• Combined hormonal contraception (CHC) contains oestrogen (ethinylestradiol in most formulations, or estradiol valerate / estradiol hemihydrate in newer formulations) plus a progestogen. Routes include the combined oral contraceptive (COC) pill, the combined transdermal patch and the combined vaginal ring. Typical-use failure rate is roughly 7 per 100 women in the first year. ^[6]
• Progestin-only pill (POP) contains only a progestogen — norethindrone, norgestrel or drospirenone (DRSP). Typical-use failure rate is also roughly 7 per 100 women in the first year, but the mechanism and adherence demand differ.^[6]
• Emergency contraception (EC) is the use of a contraceptive method after unprotected intercourse to prevent pregnancy. Options are the copper IUD (within 5 days, most effective), ulipristal acetate 30 mg orally (within 5 days), levonorgestrel 1.5 mg orally (within 3 to 5 days, less effective in the later window and in higher BMI). ^[1][4]

The method-class map: combined hormonal, progestin-only, non-hormonal — the WHO MEC framework (Category 1 to 4) is the universal crosswalk between medical history and method choice. ^[5]

References19ShowHide

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