What are the considerations for switching from combined hormonal contraception to a progestogen-only method?

When switching from combined hormonal contraception (CHC) to a progestogen-only method (POP), several considerations are important to ensure effective contraception and safety.

Timing and additional precautions: If the woman has been using CHC consistently and correctly (at least seven consecutive days of active pills, patch, or ring), no additional contraception is required when switching to most POPs. However, if switching to the drospirenone-only pill, advise the woman to abstain from sex or use a barrier method (such as condoms) for 7 days after starting the new method.

If switching from drospirenone POP during the hormone-free interval (HFI) or days 1–7 after HFI and there has been no unprotected sexual intercourse (UPSI), the new POP can be started immediately with advice to use barrier contraception for 7 days. If UPSI has occurred, continue drospirenone until 7 consecutive pills have been taken before switching.

Switching from progestogen-only implants: If the implant has been in situ for up to 3 years, it can be removed and the POP started immediately without additional precautions. For implants in place longer than 3 years, a pregnancy test is recommended before removal and starting POP. Depending on the timing of UPSI and the type of POP chosen (drospirenone vs other POPs), additional barrier contraception for 7 or 2 days is advised, and pregnancy testing may be required 3 weeks after the last UPSI.

General advice: Ensure the woman understands the importance of correct and consistent use of the new method. Discuss any individual contraindications or risk factors, such as cardiovascular risks, which may influence contraceptive choice. Provide tailored advice and support to facilitate adherence and address any concerns.