7.3 Contraceptives

7.3 Contraceptives

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)

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)

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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