NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Prescribing
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7 Obstetrics, gynaecology 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

Preferred list
LOESTRIN 20

Prescribing Notes:

Monophasic low strength 21-day preparation containing ethinylestradiol 20 micrograms and norethisterone acetate 1mg

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/34563.htm

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®.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/207460.htm#_207460

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®.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/207461.htm#_207461

7.3.1.2 Monophasic standard-strenth combined oral contraceptives

Preferred list
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®

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/207463.htm#_207463

Total Formulary
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®.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/207470.htm#_207470

MICROGYNON 30

Prescribing Notes:

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

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/34579.htm#_34579

OVRANETTE

Prescribing Notes:

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

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/34586.htm#_34586

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

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/61010.htm#_61010

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®.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/207464.htm#_207464

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

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/34691.htm#_34691

7.3.1.6 Other combined contraceptives

Total Formulary
NUVARING (vaginal ring)

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 etonorgestrel over a 21-day period.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/202425.htm#_202425

7.3.2 Progestogen-only contraceptives

7.3.2.1 Oral progestogen-only contraceptives

Preferred list
NORIDAY

Prescribing Notes:

Progestogen-only contraceptive containing norethisterone 350 micrograms

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4579.htm

Total Formulary
NORGESTON

Prescribing Notes:

Progestogen-only contraceptive containing levonorgestrel 30 micrograms

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4578.htm

DESOGESTREL (CERELLE) (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.  Cerelle® may have advantages in women with a history of poor compliance with a traditional progestogen-only contraceptive; however, it is more expensive.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/PHP4955-cerazette.htm?q=desogestrel&t=search&ss=text&p=2#PHP4955-cerazette

CERAZETTE

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

Prescribing Notes:

Contains desogestrel 75 micrograms.  Cerazette® may have advantages in women with a history of poor compliance with a traditional progestogen-only contraceptive; however, it is significantly more expensive.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/119670.htm

7.3.2.2 Parenteral progestogen-only contraceptives

Preferred list
ETONORGESTREL (NEXPLANON) (implant)

Prescribing Notes:

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

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/213809.htm

MEDROXYPROGESTERONE ACETATE (injection)

Prescribing Notes:

Given by deep IM injection, typically every 12 weeks (though see product literature).  Brands include Depo-Provera® and Sayana Press®

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/13753.htm#_13753

7.3.2.3 Intra-uterine progestogen-only device

Preferred list
LEVONORGESTREL (MIRENA) (intra-uterine system)

Prescribing Notes:

Prescribe by brand name. Intra-uterine device which releases levonorgestrel and offers contraception for up to 5 years.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/31961.htm#_31961

Total Formulary
LEVONORGESTREL (JAYDESS) (intra-uterine system)

Prescribing Notes:

Prescribe by brand name. Intra-uterine device which releases levonorgestrel and offers contraception for up to 3 years.

LEVONORGESTREL (LEVOSERT) (intra-uterine delivery system)

Prescribing Notes:

Prescribe by brand name. This preparation may be particularly useful in women with heavy menstrual bleeding requiring (reversible) contraception.

7.3.3 Spermicidal contraceptives

7.3.4 Contraceptive devices

Preferred list
TT 380 SLIMLINE (Intra-uterine device)

Prescribing Notes:

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

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/129506.htm#_129506

NOVA-T 380® (intra-uterine device)

Prescribing Notes:

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

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/4601.htm

7.3.5 Emergency contraception

Preferred list
LEVONORGESTREL

Prescribing Notes:

Upostelle® is the first-choice oral emergency contraceptive preparation for women presenting within 72 hours after unprotected intercourse.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/83608.htm

Total Formulary
ULIPRISTAL ACETATE

Restrictions: Restricted to use only in women presenting 72-120 hours after unprotected intercourse for whom the insertion of an IUD is not acceptable. Levonorgestrel remains the oral treatment of choice for women presenting up to 72 hours after unprotected intercourse.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/204192.htm