The combined pill, progestogen-only pill, implant, injection, hormonal IUD (Mirena), copper IUD, patch, and vaginal ring are all available in the UK. The most effective methods are LARCs (long-acting reversible contraceptives): the implant and IUDs are over 99% effective because they remove the risk of user error. The right choice depends on your medical history, lifestyle, tolerance of hormonal side effects, and whether you want a method you can start and stop yourself. A clinician can help you choose based on the UK Medical Eligibility Criteria (UKMEC).

The most effective contraceptives are long-acting reversible contraceptives (LARCs): the contraceptive implant (Nexplanon) and intrauterine devices (both copper IUD and hormonal Mirena IUS), all of which are over 99.9% effective. They are more effective than the combined or progestogen-only pill, patch, or ring, because they remove the risk of user error. The combined pill is 99% effective with perfect use but closer to 91% with typical use due to missed pills. The contraceptive injection is also over 99% effective. Barrier methods alone (condoms) are around 85–98% effective depending on use.

After stopping most hormonal contraceptives, fertility returns rapidly — typically within 1–3 months. The only significant exception is the Depo-Provera injection, after which fertility may take up to 12–18 months to return, with an average of around 9 months. The implant, pill, patch, and ring do not cause delayed return of fertility. There is no evidence that long-term contraceptive use reduces overall fertility. If pregnancy does not occur within 12 months of stopping contraception (6 months if over 35), seek fertility investigation.

Missed or late pills are the most common cause of contraceptive failure. Whether a missed pill matters depends on the type of pill. For the combined pill: if one pill is missed (more than 24 hours late), take it as soon as you remember. If two or more consecutive pills are missed, use condoms for 7 days and take emergency contraception if you had unprotected sex. For the progestogen-only pill (POP): the rules differ by brand — traditional POPs allow a 3-hour window while desogestrel-containing POPs (e.g. Cerazette) allow 12 hours. Read the patient information leaflet for your specific pill.

Yes. Hypertension in pregnancy — particularly pre-eclampsia (hypertension with proteinuria after 20 weeks) — is a serious condition affecting 2–5% of pregnancies. It can cause maternal complications (seizures, stroke, organ failure) and fetal growth restriction or preterm birth. Safe antihypertensives in pregnancy include labetalol, nifedipine, and methyldopa. ACE inhibitors and ARBs must be avoided in pregnancy due to fetal toxicity. Women with pre-existing hypertension should have their medication reviewed before or at the start of pregnancy.

The most common causes of bilateral ankle swelling are venous insufficiency (varicose veins and poor venous return), medications (particularly calcium channel blockers such as amlodipine), and inactivity. Heart failure is an important cause that must be excluded, particularly if accompanied by breathlessness. Bilateral swelling is rarely DVT — DVT almost always affects one leg at a time. If both ankles swell consistently at the end of the day and improve overnight, venous insufficiency and medication side effects are the most likely explanations.

Post-thrombotic syndrome (PTS) is a complication affecting 20–50% of people after DVT, causing chronic pain, swelling, skin changes, and — in severe cases — venous ulceration in the affected leg. It results from valve damage in the deep veins caused by the clot. The most effective prevention is wearing correctly fitted class 2 graduated compression stockings for at least 2 years after DVT. Early ambulation after DVT (walking is safe and beneficial), adequate anticoagulation, and compression therapy all reduce the risk. Severe PTS may require specialist vascular assessment.

Lymphoedema is chronic, progressive swelling caused by damage to the lymphatic system. Unlike pitting oedema from venous causes, lymphoedema is typically non-pitting, affects the foot and toes (not just the ankle), and does not improve with overnight elevation. Common causes include cancer treatment (lymph node removal or radiotherapy), infection (particularly recurrent cellulitis), and primary lymphatic abnormalities. It is managed — not cured — with complex decongestive therapy (manual lymphatic drainage, compression garments, skin care, and exercise). Early specialist referral to a lymphoedema clinic is important.