“My periods have stopped on the mini-pill — is that normal, or am I pregnant?”

Absent or erratic periods on the desogestrel progestogen-only pill are common, acceptable and expected — about 1 in 5 users have infrequent or absent bleeding (desogestrel SPC) and others have more frequent or irregular bleeding, none of which is harmful or a sign the pill is failing — so accurate reassurance is appropriate, but only AFTER excluding pregnancy. The governing principle is "reassure, but test first": before reassuring, screen for missed or late pills (desogestrel has a 12-hour window), vomiting or diarrhoea around the time of a pill, interacting medications (enzyme inducers) and pregnancy symptoms, and arrange a pregnancy test wherever there is any doubt about adherence or any symptom (a home urine test reported back when the consultation is by video; reliable from 3 weeks after the last unprotected sex), because confident blind reassurance is the trap. Review correct use and reinforce the missed-pill rules (a pill more than 12 hours late is "missed" — take it, continue, and use condoms/abstain for 48 hours; vomiting soon after a pill (within the CoSRH POP time limit) or severe diarrhoea is treated as a possible missed pill; understand emergency contraception). Use the consultation for a wider sexual-health review (STI risk and testing, cervical screening status, and whether the method still suits her — considering LARC such as an implant or IUS if the bleeding pattern is bothersome), and address her actual concern, which is anxiety about an unknown pregnancy: once the test is negative and use correct, give clear, explained reassurance and state what would warrant rechecking. The hidden agenda is pregnancy anxiety, possibly with unspoken questions about method suitability or future fertility; take it seriously, resolve it with the test, and give informed reassurance plus a method review rather than waving it away.