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. Also see NICE CG30 which offers guidance on prescribing long-acting reversible contraception. The College of Sexual & Reproductive Healthcare produce eligibility criteria for contraceptive use. The full guidance and a useful summary can be found at www.cosrh.org.
7.3.1. Combined hormonal contraceptives
Co-cyprindiol (brands include 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. 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 available in a low 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®.
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®.
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 micrograms. 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 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 ethinylestradiol (EE).
Restrictions:
Restricted to patients unable to use other methods of contraception and for prescribing by specialists in reproductive health.
Prescribing Notes:
Vaginal ring which releases ethinylestradiol and etonogestrel 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 etonogestrel 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 8 years.
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 for contraception and/or menorrhagia in women under 45 years old.
Prescribe by brand name. Intra-uterine system which releases levonorgestrel (52mg) and offers contraception for up to 8 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 8 years.
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 CoSRH guidance for appropriate use.