BACKGROUND Despite the general consensus that long-acting reversible contraceptives (LARCs) are the most appropriate choice of contraception for most women, there are special circumstances when the contraceptive and non-contraceptive needs of the patient are met by oral methods. OBJECTIVE By using case histories, we seek to demonstrate the medical and practical complexities in managing contraceptive needs that may result in oral contraception being the most appropriate choice. The cases also illustrate the resources available to enable evidence-based management. CONCLUSIONS Concurrent medical conditions and non-contraceptive benefits of oral contraceptive methods will see the continued use of these medications for a significant minority of women. A comprehensive knowledge of the rapidly developing evidence regarding medical eligibility and indications for usage is required. Reference to the already highly developed and easily accessible evidence bases ensures best practice for the women and families who seek advice.