Questionnaire/history:

Requested method?

Previous method?

Since when?

Side effects?

Menstrual periods:

- Duration?

- Heaviness?

- Timing?

- LMP?

IMB or PCB?

Breast aware/self-examination?

Last cervical screening?

Result?

Pregnancy excluded?

Risk of STIs?

Risk for sexual abuse, rape and non-consensual sex?

Past medical history?

- Smoking?

- Obesity?

- Hypertension?

- Diabetes?

- Venous thromboembolism?

- Headache or migraine?

- Menorrhagia, fibroids or previous ectopic pregnancy?

- Epilepsy?

- STI or pelvic inflammatory disease?

Reproductive history?

Current medication?

- Liver enzyme inducing drugs?

Comorbidities and special personal characteristics?

Significant risk factors for osteoporosis?

Drug allergies?

Examination:

Blood pressure?

Height?

Weight?

BMI?

Management:

UK Medical Eligibility Criteria for Contraception (UKMEC) considered?

Advised:

- Relative efficacy of the method

- How the method work

- Common adverse effects

- Possible drug interactions

- Health risks and benefits of the methods

- Information on infertility after discontinuing the methods

- To read information at www.nhs.uk and www.sexwise.org.uk

Resource(s):

FSRH: UK Medical Eligibility Criteria for Contraception (UKMEC)

NICE CKS: Progestogen injectables

Information for patient:

NHS Health A to Z: The contraceptive injection

Sexwise: Contraceptive injections