7.3. Contraceptives
Women requiring contraception should be given information about and offered a choice of methods, including long-acting reversible contraception (LARC) methods. See the NHSGGC Guideline for Contraceptive Prescribing in Primary Care for more detail (available by following the Clinical Guidelines link). Also see NICE CG30 which offers guidance on prescribing long-acting reversible contraception. The Faculty of Sexual and Reproductive Healthcare produce eligibility criteria for contraceptive use. The full guidance and a useful summary can be found at www.fsrh.org7.3.1. Combined hormonal contraceptives
Co-cyprindiol (Dianette®) is licensed for the treatment of severe acne and hirsutism, but not as a contraceptive. It is occasionally used as a contraceptive (unlicensed indication) when acne is present. CSM advice relating to co-cyprindiol and the risk of venous thromboembolism exists (see BNF). Formulary indications for co-cyprindiol can be found in section 13.6. For current advice about interactions between contraceptives and other medicines, refer to BNF.7.3.1.1. Monophasic low-strength combined oral contraceptives
Prescribing Notes:
Monophasic 21-day preparation containing ethinylestradiol 20 micrograms and desogestrel 150 micrograms. This is an equivalent preparation in
terms of hormone content to Gedarel® 20/150 and Mercilon®.
Prescribing Notes:
Monophasic 21-day preparation available in a low or standard strength containing ethinylestradiol 20 micrograms and gestodene 75 micrograms. This preparation is an equivalent preparation in terms of hormone content to Millinette® 20/75 and Femodette®.
7.3.1.2. Monophasic standard-strength combined oral contraceptives
Prescribing Notes:
- Monophasic standard strength 21-day preparation containing ethinylestradiol 30 micrograms and levonorgestrel 150 micrograms.
- Levest® is an equivalent preparation in terms of hormone content to Microgynon 30® but has a cost advantage.
- Levest® is a 2nd generation combined oral contraceptive.
Prescribing Notes:
Monophasic standard strength 21-day preparation containing ethinylestradiol 30 micrograms and levonorgestrel 150 mcrograms. Rigevidon® is an equivalent preparation in terms of hormone content to Microgynon 30® and Ovranette®
Prescribing Notes:
Monophasic standard strength 21-day preparation containing ethinylestradiol 30 micrograms and levonorgestrel 150 micrograms.
Prescribing Notes:
Monophasic 21-day preparation available in a low or standard strength containing ethinylestradiol 30 micrograms and gestodene 75 micrograms. The 30/75 strength is an equivalent preparation in terms of hormone content to Femodene®.
Prescribing Notes:
• Monophasic 21-day preparation available containing ethinylestradiol 30 micrograms and drospirenone 3mg.
• This could be an appropriate third-line choice for some patients, if preferred formulary options are not tolerated or contraindicated.
7.3.1.3. Monophasic "everyday" combined oral contraceptives
Prescribing Notes:
Monophasic standard strength "everyday" preparation containing ethinylestradiol 30 micrograms and levonorgestrel 150 micrograms
7.3.1.4. Phasic standard-strength combined oral contraceptives
Prescribing Notes:
A phasic standard-strength 21-day preparation containing ethinylestradiol and levonorgestrel. TriRegol® is an equivalent preparation in terms of hormone content to Logynon®.
7.3.1.5. Phasic "everyday" standard-strength combined oral contraceptives
Prescribing Notes:
Phasic standard-strength "everyday" preparation containing ethinylestradiol and levonorgestrel
7.3.1.6. Other combined contraceptives
Restrictions:
Restricted to women who have demonstrated-, or are deemed to be at-, substantial risk of poor compliance with combined oral contraceptives (COCs).
Prescribing Notes:
Each transdermal patch contains 6 mg norelgestromin (NGMN) and 600 micrograms ethinyl estradiol (EE).
Restrictions:
Restricted to patients unable to use other methods of contraception and for prescribing by specialists in reproductive health.
Prescribing Notes:
SyreniRing ® is currently the preferred brand in NHSGGC due to the favourable acquisition cost.
Vaginal ring which releases ethinylestradiol and etonorgestrel over a 21-day period.
7.3.2. Progestogen-only contraceptives
7.3.2.1. Oral progestogen-only contraceptives
7.3.2.2. Parenteral progestogen-only contraceptives
Prescribing Notes:
Subdermal implant containing etonorgestrel 68mg which offers contraception for 3 years
7.3.2.3. Intra-uterine progestogen-only device
Prescribing Notes:
Levosert® is the preferred levonorgestrel intra-uterine system
- for secondary care and Sandyford due to more complex insertion technique
- for contraception and/or menorrhagia in women under 45 years old.
This preparation may be particularly useful in women with heavy menstrual bleeding requiring (reversible) contraception.
Prescribe by brand name. Intra-uterine delivery system releases levonorgestrel (52mg) and offers contraception for up to 6 years (as per FSRH advice).
For preferred intra-uterine delivery system in endometrial hyperplasia and/or endometrial protection, please refer to section 6.4.1.2
Prescribing Notes:
Benilexa® is the preferred levonorgestrel intra-uterine system for
- primary care due to simpler insertion technique
Prescribe by brand name. Intra-uterine system which releases levonorgestrel (52mg) and offers contraception for up to 6 years.
For preferred intra-uterine delivery system in endometrial hyperplasia and/or endometrial protection, please refer to section 6.4.1.2
Prescribing Notes:
Prescribe by brand name. Intra-uterine system which releases levonorgestrel (19.5mg) and offers contraception for up to 5 years.
Prescribing Notes:
Prescribe by brand name. Intra-uterine system which releases levonorgestrel (52mg) and offers contraception for up to 6 years (as per FSRH advice).
For other indications, see section 6.4.1.2
7.3.3. Spermicidal contraceptives
7.3.4. Contraceptive devices
Prescribing Notes:
First choice intra-uterine device which can be left in place for up to 10 years.
7.3.5. Emergency contraception
Prescribing Notes:
- Ulipristal is licensed for use in women presenting up to 120 hours after unprotected intercourse for whom the insertion of an IUD is not acceptable.
- Please follow the FSRH guidance for appropriate use.