Related resources:
Long-acting reversible contraception Clinical guideline (NICE CG30 October 2005, updated July 2019)
- Long-acting reversible contraceptive (LARC), intrauterine devices (IUD), intrauterine system (IUS), injectable contraceptives and implants are more cost effective than the combined oral contraceptive pill. They are also the most reliable method of contraception.
Scenario: Combined oral contraceptive (NICE CKS updated September 2022)
Which method of contraception suits me? -Your contraception guide (nhs.uk)
Emergency contraception – Your contraception guide (nhs.uk)
- No additional contraceptive precaution is required during use of an antibiotic unless the antibiotic is an enzyme inducer or the antibiotic (and/or the illness being treated) causes vomiting or diarrhoea.
- Enzyme-inducing drugs could reduce contraceptive effectiveness of all combined hormonal contraception, all progestogen-only pills, the etonogestrel implant and oral emergency contraception. Individuals using an enzyme-inducing drug should be offered a reliable contraceptive method that is unaffected by the enzyme inducer. Intrauterine contraception and depot medroxyprogesterone acetate (either intramuscular or subcutaneous) are appropriate options.
- Individuals using an enzyme-inducing drug who require emergency contraception should be advised that effectiveness of oral emergency contraception could be reduced. They should be offered a copper IUD if indicated. If a copper IUD is unacceptable, unsuitable or unavailable, a double dose (3mg) of levonorgestrel oral emergency contraception or a single dose (30mg) of ulipristal acetate oral emergency contraception can be offered if indicated, with advice that effectiveness is unknown.
- Short-term users (<2 months) of an enzyme inducer may wish to consider continuing their existing method of contraception and using condoms reliably in addition during use of the enzyme inducer and for 28 days after it has been stopped (this is not recommended during use of a teratogen).
- Patients who have a BMI >26 or are greater than 70kg may require more than the standard 1.5mg dose of levonorgestrel. Consider double dose (3mg) or CI-IUD or ulipristal.
- Women who have had bariatric surgery should be advised that the effectiveness of COC could be reduced and should consider a non-oral contraception.
- Women who have had bariatric surgery should be advised that there is insufficient evidence to inform whether contraceptive effectiveness of POPs is affected by bariatric surgery and may therefore wish to consider non-oral contraception.
Using contraception with enzyme-inducing medicines (SPS February 2023)
NHS Somerset Contraception webpage
| Therapeutic Area | Formulary Choices | Cost for 28 (unless otherwise stated) | Rationale for decision / comments |
|---|---|---|---|
| Contraception, combined | |||
| Oestogens combined with progestogens | |||
| Ethinylestradiol with desogestrel | as Bimizza® | 20 and 150mcg tablet: £5.04 (63) Low strength | Monophasic. One tablet is taken daily for 21 consecutive days. Every subsequent blister pack is started after a 7 day tablet-free interval. Contains desogestrel, associated with a higher risk of VTE. |
| as Gedarel® | 20 and 150mcg tablet: £5.98 (63) Low strength |
||
| as Cimizt® | 30 and 150mcg tablet: £3.80 (63) | ||
| as Gedarel® | 30 and 150mcg tablet: £4.93 (63) | ||
| Ethinylestradiol with drospirenone | as Eloine® | 20mcg and 3mg tablet: £14.70 (84) Low strength | Monophasic. One tablet is taken daily for 21 consecutive days. Every subsequent blister pack is started after a 7 day tablet-free interval. Contains drospirenone, associated with a higher risk of VTE. |
| as Yacella® | 30mcg and 3mg tablet: £8.30 (63) | ||
| as Lucette® | 30mcg and 3mg tablet: £11.00 (63) | ||
| as Dretine® | 30mcg and 3mg tablet: £8.34 (63) | ||
| as Yasmin® | 30mcg and 3mg tablet: £14.70 (63) | ||
| Ethinylestradiol with gestodene | as Millinette® | 20 and 75mcg tablet: £6.37 (63) Low strength | Monophasic. One tablet is taken daily for 21 consecutive days. Every subsequent blister pack is started after a 7 day tablet-free interval. Contains gestodene, associated with a higher risk of VTE. |
| 30 and 75mcg tablet: £4.85 (63) | |||
| Ethinylestradiol with levonorgestrel | as Levest® | 30 and 150mcg tablet: £1.80 (63) | Monophasic. One tablet is taken daily for 21 consecutive days. Every subsequent blister pack is started after a 7 day tablet-free interval. |
| as Maexeni® | 30 and 150mcg tablet: £1.88 (63) | ||
| as Rigevidon® | 30 and 150mcg tablet: £1.89 (63) | ||
| as TriRegol® | 30 and 50mcg, 40 and 75mcg, 30 and 125mcg tablet: £2.87 (63) | Multiphasic. One tablet is taken daily for 21 consecutive days. Every subsequent blister pack is started after a 7 day tablet-free interval. |
|
| as Logynon® | 30 and 50mcg, 40 and 75mcg, 30 and 125mcg tablet: £3.82 (63) | ||
| as Logynon® ED | 30 and 50mcg, 40 and 75mcg, 30 and 125mcg tablet: £4.00 (84) | Multiphasic. 1 tablet daily for 28 days, starting on the first day of the menstrual cycle. 21 (small) active tablets are taken followed by 7 (larger) placebo tablets. |
|
| Ethinylestradiol with norethisterone | as Synphase ® | 35 and 500mcg, 35 and 1mg, 35 and 500mcg tablet: £1.20 (21) | Multiphasic. One tablet is taken daily for 21 consecutive days. Every subsequent blister pack is started after a 7 day tablet-free interval. |
| Ethinylestradiol with norgestimate | as Lizinna® | 35 and 250mcg tablet: £4.64 (63) | Monophasic. One tablet is taken daily for 21 consecutive days. Every subsequent blister pack is started after a 7 day tablet-free interval. |
| as Cilique® | 35 and 250mcg tablet: £4.65 (63) | ||
| Norethisterone and mestranol | as Norinyl-1® | 1mg and 50mcg tablet:£2.19 (63) | |
| Contraception, emergency |
|||
| Progestogen | |||
| Levonorgestrel | as Upostelle® | 1500mg tablet: £3.75 (1) | First line oral preparation for females presenting within 72 hours of unprotected intercourse or contraceptive failure. Available via PGD through many pharmacies across Somerset, free of charge if under 25 years. Available to purchase over the counter if over 16 years. Please do not prescribe the OTC preparation: Levonelle One Step® as not cost effective. If vomiting occurs within 3 hours of the tablet intake, another tablet should be taken. |
| Progesterone receptor modulator | |||
| Ulipristal acetate | as EllaOne® | 30mg tablet: £14.05 (1) | One tablet to be taken orally as soon as possible, but no later than 120 hours (5 days) after unprotected intercourse or contraceptive failure. Pregnancy should be excluded before the tablet is administered. EllaOne is excluded from the MHRA alert affecting ulipristal for uterine fibroid treatment. If vomiting occurs within 3 hours of the tablet intake, another tablet should be taken. |
| Contraception, progestogen-only | |||
| Progestogen | |||
| Desogestrel | 75mcg tablet: £5.25 (84) | Tablets must be taken every day, continuously, at about the same time so that the interval between two tablets always is 24 hours. If the user is less than 12 hours late in taking any tablet, the missed tablet should be taken as soon as it is remembered and the next tablet should be taken at the usual time. If she is more than 12 hours late, she should use an additional method of contraception for the next 7 days. |
|
| Norethisterone | as Noriday® | 350mcg tablet: £2.10 (84) | Take one pill every day without a break in medication. If a pill is missed within 3 hours of the correct dosage time then the missed pill should be taken as soon as possible; this will ensure that contraceptive protection is maintained. If a pill is taken 3 or more hours late it is recommended that the woman takes the last missed pill as soon as possible and then continues to take the rest of the pills in the normal manner. However, to provide continued contraceptive protection it is recommended that an alternative method of contraception, such as a condom, is used for the next 7 days. |
| Levonorgestrel | as Norgeston® | 30mcg tablet: £0.92 (35) | |
| Drospirenone | as Slynd® | 4mg tablet: £14.70 (84) | One active tablet once daily for 24 days, followed by one inactive tablet once daily for 4 days, to be started on day 1 of cycle with first active tablet (withdrawal bleeding may occur during the 4-day interval of inactive tablets); subsequent courses repeated without interval. If administration delayed for 24 hours or more it should be regarded as a ‘missed pill' and contraceptive protection may be reduced. Use of a barrier method such as a condom should be considered for the next 7 days. The missed tablet should be taken as soon as it is remembered, even if this means taking two tablets at the same time. She then continues to take tablets at her usual time. If tablets were missed in the first week after initiation and intercourse took place in the week before the tablets were missed, the possibility of a pregnancy should be considered. If tablets were missed in the third week of pill taking, the risk of reduced reliability is imminent because of the forthcoming 4-day hormone-free interval. However, by adjusting the tablet-intake schedule, reduced contraceptive protection can still be prevented. The user should take the last missed tablet as soon as she remembers, even if this means taking two tablets at the same time. She then continues to take the active tablets at her usual time. The user is advised not to take the placebo pills and continue straight on to the next active blister pack. Missed (green) placebo tablets can be disregarded. However, they should be discarded to avoid unintentionally prolonging the interval between active tablet taking. If vomiting or diarrhea occurs within 3-4 hours after tablet taking, a new (replacement) tablet should be taken as soon as possible. The new tablet should be taken within 24 hours of the usual time of tablet-taking if possible. If more than 24 hours elapse, need to follow advice concerning missed tablets. |
| as Mirena® | 20micrograms/24hours intrauterine device: £88 (1) | T-shaped plastic frame. Mirena is effective for 8 years for contraception and should be removed no later than 8 years after insertion. Mirena is effective for 5 years in the indication idiopathic menorrhagia. For protection from endometrial hyperplasia during oestrogen replacement therapy, should be removed no later than 4 years after insertion. |
|
| as Jaydess® | 13.5mg intrauterine device: £69.22 (1) | Smaller frame and smaller reservoir. Approved for use in the CASH service where a coil is appropriate but Mirena is not suitable or not tolerated. Three year life license. Contraception only. | |
| as Levosert® | 20micrograms/24hours intrauterine device: £66.00 (1) | Smaller device. Licensed for 4 years. |
|
| Etonogestrel | as Nexplanon® | 68mg subdermal implant: £83.43 | Long-acting reversible contraception as per Traffic light guidance. A single implant is inserted subdermally and can be left in place for three years. Pregnancy should be excluded before insertion of Nexplanon. Only to be administered by doctors and other healthcare professionals who have documentary proof of completion Faculty of Family Planning and Reproductive Health Care recognised training and have been assessed as competent in the insertion and removal of Nexplanon® subdermal implants. |
| Amended advice on the insertion site for Nexplanon contraceptive implants following concerns regarding reports of neurovascular injury and implants migrating to the vasculature (including the pulmonary artery). See MHRA Drug Safety Update (February 2020) for Nexplanon (etonogestrel) contraceptive implants: new insertion site to reduce rare risk of neurovascular injury and implant migration. | |||
| Medroxyprogesterone acetate | as Provera® | 2.5mg tablet: £1.84 (30) | Dysfunctional (anovulatory) uterine bleeding: 2.5 - 10 mg daily for 5 - 10 days commencing on the assumed or calculated 16th - 21st day of the cycle. Treatment should be given for two consecutive cycles. When bleeding occurs from a poorly developed proliferative endometrium, conventional oestrogen therapy may be employed in conjunction with medroxyprogesterone acetate in doses of 5 - 10 mg for 10 days. Secondary amenorrhoea: 2.5 - 10 mg daily for 5 - 10 days beginning on the assumed or calculated 16th to 21st day of the cycle. Repeat the treatment for three consecutive cycles. In amenorrhoea associated with a poorly developed proliferative endometrium, conventional oestrogen therapy may be employed in conjunction with medroxyprogesterone acetate in doses of 5 - 10 mg for 10 days. Mild to moderate endometriosis: Beginning on the first day of the menstrual cycle, 10 mg three times a day for 90 consecutive days. Medroxyprogesterone may produce less androgenic adverse effects than norethisterone. |
| 5mg tablet: £1.23 (10) | |||
| 10mg tablet: £22.16 (90) | |||
| as Depo-Provera® | 150mg/1ml suspension for injection pre-filled syringes: £6.01 (1) | For long-acting reversible contraception as per Traffic light guidance. These should be injected intramuscularly at 12 week intervals, however, as long as the injection is given no later than five days after this time. |
|
| as Sayana Press® | 104mg/0.65ml suspension for injection pre-filled disposable devices: £6.90 (1) | For long-acting reversible contraception as per Traffic light guidance. Each subcutaneous injection prevents ovulation and provides contraception for at least 13 weeks (+/- 1 week). |
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