Contraception

Combined Hormonal Contraception: Mechanism, Risks and Who Can't Take It

The combined pill is one of the most prescribed drugs on earth, and one of the most misunderstood. Students memorise "it stops ovulation" and stop there — but the exam, and the clinic, are almost never about how it works. They are about who should never take it. A tablet this safe for millions is genuinely dangerous for a few, and telling the two apart is a structured risk assessment done at the desk before a single pill is dispensed: do you smoke, are you over 35, do your headaches come with an aura, what is your blood pressure, how long since you gave birth? Get that conversation right and you have an elegant, reversible drug. Get it wrong and you can cause a stroke.

Progestogen-Only and Long-Acting Contraception

The combined pill is elegant, but it carries a passenger the body doesn't always tolerate: oestrogen, and with it the shadow of clots. For the woman who smokes past 35, the migraineur who sees aura, the mother nursing a newborn, oestrogen is off the table. What remains is a whole quieter family of methods — progestogen alone in a pill, an implant, an injection, a coil — and one non-hormonal outlier that works by nothing more than copper. The best of them ask almost nothing of the user, and that, more than any laboratory number, is why they so rarely fail.

Emergency Contraception: The Three Options and Their Timing

Emergency contraception is one of the few places in medicine where the clock is the drug. The same three options — a copper coil, one tablet, or another tablet — separate a routine morning from an unplanned pregnancy, and their effectiveness falls with every hour that passes. Yet almost everything students believe about them is slightly wrong: that the pill is a mini-abortion (it isn't), that any of them work once ovulation has happened (they don't), and that the tablet everyone reaches for first is the best one (it usually isn't). Get the mechanism right and the whole decision — which method, how soon, and what to start next — falls into place.