There’s a dazzling array of choice.

At some point, most GPs will be asked to prescribe the oral contraceptive pill for a patient. It’s important to consider the pros and cons of each type of pill as well as the patient’s unique situation before deciding on which one is most suitable for them.

As reproductive health clinician Dr Deborah Bateson pointed out in a recent Women’s and Children’s health podcast, many women present with preconceived ideas about which pill is best based on their own experience or that of a family member or a friend. It is important to consider and manage these ideas and expectations regarding the pill as part of the pre-prescribing assessment.

When advising patients on the most appropriate pill for them, there are several factors to consider.

Firstly, do they need a combined pill or would the progesterone only pill be more suitable? The progestogen only pill tends to have fewer contraindications than the combined oral contraceptive pill and can be used in females who have migraines with aura and those that smoke over the age of 35.

The combined oral contraceptive can also be useful in managing acne and heavy menstruation in addition to its contraception use whereas the progestogen only pill carries with it a risk of irregular bleeding – so a woman’s lifestyle is an important consideration. A history of breast cancer often precludes the use of either form of hormonal contraception.

A thorough and comprehensive history is important to assess a patient’s risk factors prior to prescribing the pill, either progestogen only or the combination form.

Dr Bateson pointed to the UK Faculty of Sexual and Reproductive health MEC guide that is freely available online that can help guide that decision. It is useful in determining the appropriateness of contraceptive use via an easy grading system of 1-4 with 1 indicating no issues in using that form of contraceptive and 4 indicating an absolute contraindication.

Once, it has been determined that the combined oral contraceptive pill is suitable for a patient, the next decision will be which particular combination and dose should be recommended.

While certain formulations might be used for acne, for example, a good starting point is to use a pill with levonorgestrel and 30 micrograms of ethinyloestradiol as they tend to be the gold standard in terms of effectiveness, risk profile and affordability (as they are listed on the PBS).

Recommending a contraceptive pill to a patient might be daunting with regards to the number of options available but this podcast helps establish some guiding principles that take the patient’s unique factors into account.

This podcast collates information from a survey involving 1,000 GPs and answers the most common contraceptive pill-based questions.

An Oral Contraception Update will be provided by sexual health physician Prof Deborah Bateson at the upcoming Healthed webcast on 16 August. Don’t miss the next free fortnightly webcast, register here.