7.3.1 Combined hormonal contraceptives |
CSM advice - provided that women are fully informed of the small risks of venous thromboembolism and do not have medical |
contraindications, it should be a matter of clinical judgement and personal choice which type of oral contraceptive should be |
prescribed. |
|
Group 1 - First line |
The cheapest and safest in terms of VTE risk |
GREEN Brevinor®/ Ovysmen®(ethinyloestradiol 35mcg/norethisterone 500mcg) |
GREEN Microgynon 30®/Ovranette® (ethinyloestradiol 30mcg/ levonorgestrel 150mcg) |
|
Group 2 - Second line |
May be useful if acne or other androgenic side effects are problematical with the first line choice of pill. | GREEN *Cilique®(ethinyloestradiol 35mcg/ norgestimate 250mcg) *[alternative to Cilest® - discontinued from July 2019] | |
GREEN Femodene® (ethinyloestradiol 30 mcg/ gestodene 75mcg) |
GREEN Marvelon®(ethinyloestradiol 30mcg/desogestrel 150mcg) |
|
Group 3 – Second line |
This pill with lower oestrogen content (20micrograms) may be useful if nausea, breast tenderness or general headache (not |
migraine) are problematical with the first line choice of pill. |
GREEN Mercilon® (ethinyloestradiol 20mcg/desogestrel 150mcg) |
|
Group 4 - Second line |
Useful alternatives for breakthrough bleeding when other causes excluded. |
GREEN Loestrin 30® (ethinyloestradiol 30mcg/ norethisterone 1.5mg) |
GREEN Norimin® tablets (ethinyloestradiol 35mcg/ norethisterone 1mg) |
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Note: Everyday pills (eg MicrogynonED®) (21 active tablets followed by 7 inactive tablets) may be useful for women who find |
it difficult to remember to restart after the pill free week. |
|
Group 5 - Third line |
For women with acne, not settling with two previously tried second line pills. |
GREEN Yiznell® tablets (ethinylestradiol 30mcg/ drospirenone 3mg) |
GREEN Lucette® tablets (ethinylestradiol 30mcg/ drospirenone 3mg) |
GREEN Yacella® tablets (ethinylestradiol 30mcg/ drospirenone 3mg) |
|
Interactions with liver enzyme inducing drugs |
Faculty advice relating to a long term course of an enzyme inducing drug in women unable to use an alternative method of |
contraception is to use two low dose COCs providing a total daily dose of 50-60 micrograms of ethinyloestradiol (for example |
two Microgynon 30® daily - unlicensed). Women are advised to use additional contraception, such as condoms during use of a |
liver enzyme inducing drug and for 28 days after the liver enzyme-inducer is stopped. |
|
Low Strength Transdermal |
Evra® is not recommended for routine use, but only for younger, or less compliant women, or those with GI disturbance |
whilst taking oral contraceptives. |
GREEN Evra® transdermal patch |
(ethinylestradiol 20micrograms/24hrs, norelgestromin 150micrograms/24hrs) |
|
Biphasic/triphasic pills have no advantage over monophasic pills and are not listed. |
|
7.3.2 Progestogen-only contraceptives |
These are useful for women in whom oestrogen is contraindicated or if breastfeeding. |
|
7.3.2.1 Oral progestogen-only contraceptives |
GREEN Micronor® / Noriday® (norethisterone 350mcg) |
GREEN Norgeston® (levonorgestrel 30mcg) |
GREEN Desogestrel 75 microgram |
|
Desogestrel should not routinely be used as an alternative to COCs but is reserved for women who have problems adhering |
to the 3 hour window for other oral progestogen only contraceptives. (Desogestrel can be taken up to 12 hours overdue) |
|
7.3.2.2 Parenteral progestogen-only contraceptives |
For IUS/IUD and Implanon fitting special training is required (primary care -see nGMS enhanced services contract for details |
and contact local CCG for further information as necessary). NICE guidance states that these methods together with Depo- |
Provera® arethe most cost effective option and that their use should be encouraged. |
|
The CSM have also advised that; |
> In adolescents, medroxyprogesterone acetate (Depo-Provera®) be used only when other methods of contraception |
are inappropriate |
> In all women, benefits of using medroxyprogesterone acetate beyond 2 years should be evaluated against risks; |
> In women with risk factors for osteoporosis an alternative method of contraception instead of medroxyprogesterone |
acetate should be considered |
|
GREEN Medroxyprogesterone depot injection 150mg/1ml (Depo-provera®) |
GREEN Medroxyprogesterone suspension for injection 104mg/0.65ml (Sayana® Press) |
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The following are to be implanted by specially trained individuals only: |
GREEN Etonogestrel 68mg implantable rod (Nexplanon®) |
|
7.3.2.3 Intra-uterine progesterone-only device |
To be implanted by specially trained individuals only |
GREEN Levonorgestrel 20micrograms/24hrs intra-uterine system (Mirena®) |
GREEN Levonorgestrel 13.5 mg intra-uterine system (Jaydess®▼) |
|
(contraceptive for up to 3 years, second line to Mirena®, only for women who want periods or if there are problems |
insterting Mirena®)
|
|
7.3.5 Emergency contraception |
GREEN Levonelle® (levonorgestrel 1500microgram) |
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