NHS Greater Glasgow and Clyde Area Drug and Therapeutics Committee

Greater Glasgow and Clyde Medicines

Key to symbols

The medicine should be initiated by, or on the advice of a specialist, but is suitable for continuation by a GP

The medicine should only be used and prescribed by a specialist

Indicates the preferred choice within a class or group of medicines

7. Obstetrics, gynaecology, renal and urinary-tract disorders

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.org

7.3.1. 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

Total Formulary

GEDAREL 20/150

Prescribing Notes:

Monophasic 21-day preparation containing ethinylestradiol 20 micrograms and desogestrel 150 micrograms. The 20/150 strength is an equivalent preparation in terms of hormone content to Mercilon^®.

MILLINETTE 20/75

Prescribing Notes:

Monophasic 21-day preparation available in a low or standard strength containing ethinylestradiol 20 micrograms and gestodene 75 micrograms. The 20/75 strength is an equivalent preparation in terms of hormone content to Femodette^®.

7.3.1.2. Monophasic standard-strength combined oral contraceptives

Preferred List

Preferred List First Line

RIGEVIDON

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^®

Total Formulary

OVRANETTE

Prescribing Notes:

Monophasic standard strength 21-day preparation containing ethinylestradiol 30 micrograms and levonorgestrel 150 micrograms

MICROGYNON 30

Prescribing Notes:

Monophasic standard strength 21-day preparation containing ethinylestradiol 30 micrograms and levonorgestrel 150 micrograms.

MILLINETTE 30/75

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^®.

7.3.1.3. Monophasic "everyday" combined oral contraceptives

Total Formulary

MICROGYNON 30 ED

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

Total Formulary

TRIREGOL

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

Total Formulary

LOGYNON ED

Prescribing Notes:

Phasic standard-strength "everyday" preparation containing ethinylestradiol and levonorgestrel

7.3.1.6. Other combined contraceptives

Total Formulary

EVRA (transdermal patch)

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).

ETHINYLESTRADIOL, ETONORGESTREL (vaginal ring)

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

Preferred List

DESOGESTREL (tablets)

Restrictions:

Restricted to use in patients in whom oestrogen containing contraceptives are not tolerated or are contra-indicated.

Prescribing Notes:

Contains desogestrel 75 micrograms.

Total Formulary

NORIDAY

Prescribing Notes:

Progestogen-only contraceptive containing norethisterone 350 micrograms

NORGESTON

Prescribing Notes:

Progestogen-only contraceptive containing levonorgestrel 30 micrograms

7.3.2.2. Parenteral progestogen-only contraceptives

Preferred List

ETONOGESTREL (NEXPLANON) (implant)

Prescribing Notes:

Subdermal implant containing etonorgestrel 68mg which offers contraception for 3 years

MEDROXYPROGESTERONE ACETATE (injection)

Prescribing Notes:

Brands include Depo-Provera^® and Sayana Press^®.

7.3.2.3. Intra-uterine progestogen-only device

Preferred List

LEVONORGESTREL (LEVOSERT) (intra-uterine system)

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

LEVONORGESTREL (BENILEXA) (intra-uterine system)

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

Total Formulary

LEVONORGESTREL (KYLEENA) (intra-uterine system)

Prescribing Notes:

Prescribe by brand name. Intra-uterine system which releases levonorgestrel (19.5mg) and offers contraception for up to 5 years.

LEVONORGESTREL (MIRENA) (intra-uterine system)

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

Preferred List

Preferred List First Line

TT 380 SLIMLINE (Intra-uterine device)

Prescribing Notes:

First choice intra-uterine device which can be left in place for up to 10 years.

UT 380 Short / Standard (intra-uterine device)

NOVA-T 380® (intra-uterine device)

Prescribing Notes:

Intra-uterine device which can be left in place for up to 5 years

7.3.5. Emergency contraception

Preferred List

LEVONORGESTREL emergency contraception

Prescribing Notes:

Upostelle^® is the preferred levonorgestrel preparation for emergency contraception in NHSGGC.
Please follow the FSRH guidance for appropriate use.

ULIPRISTAL ACETATE 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.