reasonably certain woman is not pregnant, first course can
be started on any day of cycle—if starting on day 6 of cycle
or later, additional precautions (barrier methods)
necessary during first 7 days. Every day (ED) combined
preparations, 1 active tablet daily for 21 days, followed by 1
inactive tablet daily for 7 days; subsequent courses
repeated without interval (withdrawal bleeding occurs
when inactive tablets being taken); if reasonably certain
woman is not pregnant, first course can be started on any
day of cycle—if starting on day 6 of cycle or later,
additional precautions (barrier methods) necessary during
Changing to combined preparation containing different
progestogen If previous contraceptive used correctly, or
pregnancy can reasonably be excluded, start the first active
tablet of new brand immediately. See individual
monographs for requirements of specific preparations.
Changing from progestogen-only tablet If previous
contraceptive used correctly, or pregnancy can reasonably
be excluded, start new brand immediately, additional
precautions (barrier methods) necessary for first 7 days.
Secondary amenorrhoea (exclude pregnancy) Start any day,
additional precautions (barrier methods) necessary during
first 7 days (9 days for Qlaira ®).
After childbirth (not breast-feeding) Start 3 weeks after birth
(increased risk of thrombosis if started earlier); later than
3 weeks postpartum additional precautions (barrier
methods) necessary for first 7 days (9 days for Qlaira ®).
After abortion or miscarriage Start same day.
Travel Women taking oral contraceptives or using the
patch or vaginal ring are at an increased risk of deep vein
thrombosis during travel involving long periods of
immobility (over 3 hours). The risk may be reduced by
appropriate exercise during the journey and possibly by
wearing graduated compression hosiery.
Diarrhoea and vomiting Vomiting and severe diarrhoea can
interfere with the absorption of combined oral
contraceptives. The FSRH advises following the
instructions for missed pills if vomiting occurs within
3 hours of taking a combined oral contraceptive or severe
diarrhoea occurs for more than 24 hours. Use of non-oral
contraception should be considered if diarrhoea or
Missed doses The critical time for loss of contraceptive
protection is when a pill is omitted at the beginning or end
of a cycle (which lengthens the pill-free interval).
If a woman forgets to take a pill, it should be taken as
soon as she remembers, and the next one taken at the
normal time (even if this means taking 2 pills together). A
missed pill is one that is 24 or more hours late. If a woman
misses only one pill, she should take an active pill as soon
as she remembers and then resume normal pill-taking. No
additional precautions are necessary.
If a woman misses 2 or more pills (especially from the
first 7 in a packet), she may not be protected. She should
take an active pill as soon as she remembers and then
resume normal pill-taking. In addition, she must either
abstain from sex or use an additional method of
contraception such as a condom for the next 7 days. If
these 7 days run beyond the end of the packet, the next
packet should be started at once, omitting the pill-free
interval (or, in the case of everyday (ED) pills, omitting the
Emergency contraception is recommended if 2 or more
combined oral contraceptive tablets are missed from the
first 7 tablets in a packet and unprotected intercourse has
occurred since finishing the last packet.
Dienogest with estradiol valerate
Contraception with 28-day combined preparations |
Menstrual symptoms with 28-day combined
▶ Females of childbearing potential: 1 active tablet daily for
26 days, followed by 1 inactive tablet daily for 2 days, to
be started on day 1 of cycle with first active tablet
(withdrawal bleeding may occur during the 2-day
interval of inactive tablets); subsequent courses
l INTERACTIONS → Appendix 1: combined hormonal
fallopian tube disorders . painful sexual intercourse . pelvic
disorders . sexual dysfunction . skin reactions . sleep
disorders . uterine cramps . vomiting . vulvovaginal
▶ Rare or very rare Aggression . anxiety . arterial
thromboembolism . asthma . chest pain . cholecystitis
chronic . concentration impaired . constipation . contact
lens intolerance . dry eye . dry mouth . dyspnoea . eye
swelling .fever. galactorrhoea . gastrooesophageal reflux
tract pain . vascular disorders . vertigo
l DIRECTIONS FOR ADMINISTRATION
Changing to Qlaira® Start the first active Qlaira ® tablet on
the day after taking the last active tablet of the previous
Diarrhoea and vomiting In cases of persistent vomiting or
severe diarrhoea lasting more than 12 hours in women
taking Qlaira ®, refer to product literature.
Missed doses A missed pill for a patient taking Qlaira ® is
one that is 12 hours or more late; for information on how
to manage missed pills in women taking Qlaira ®, refer to
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Qlaira tablets | 84 tablet P £25.18
▶ Females of childbearing potential: 1 active tablet daily for
24 days, followed by 1 inactive tablet daily for 4 days, to
be started on day 1 of cycle with first active tablet
(withdrawal bleeding occurs when inactive tablets
being taken); subsequent courses repeated without
BNF 78 Contraception, combined 797
l INTERACTIONS → Appendix 1: combined hormonal
l PREGNANCY Toxicity in animal studies.
l DIRECTIONS FOR ADMINISTRATION Zoely ® (every day (ED)
combined (monophasic) preparation), 1 active tablet daily
for 24 days, followed by 1 inactive tablet daily for 4 days,
starting on day 1 of cycle with first active tablet;
subsequent courses repeated without interval (withdrawal
bleeding occurs when inactive tablets being taken).
Changing to Zoely® Start the first active Zoely ® tablet on the
day after taking the last active tablet of the previous brand
or, at the latest, the day after the tablet-free or inactive
tablet interval of the previous brand.
Diarrhoea and vomiting In cases of persistent vomiting or
severe diarrhoea lasting more than 12 hours in women
taking Zoely ®, refer to product literature.
Missed doses A missed pill for a patient taking Zoely ® is
one that is 12 hours or more late; for information on how
to manage missed pills in women taking Zoely ®, refer to
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Zoely (Merck Sharp & Dohme Ltd) A
Estradiol (as Estradiol hemihydrate) 1.5 mg, Nomegestrol acetate
2.5 mg Zoely 2.5mg/1.5mg tablets | 84 tablet P £19.80 DT =
Ethinylestradiol with desogestrel
Contraception with 21-day combined preparations |
Menstrual symptoms with 21-day combined
▶ Females of childbearing potential: 1 tablet once daily for
21 days; subsequent courses repeated after 7-day
interval, withdrawal bleeding occurs during the 7-day
interval, if reasonably certain woman is not pregnant,
first course can be started on any day of cycle—if
starting on day 6 of cycle or later, additional
precautions (barrier methods) necessary during first
7 days, tablets should be taken at approximately the
l INTERACTIONS → Appendix 1: combined hormonal
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Ethinylestradiol 30 microgram, Desogestrel
150 microgram Alenvona 150microgram/30microgram tablets | 63 tablet P £6.13 DT = £4.19
▶ Bimizza (Morningside Healthcare Ltd)
Ethinylestradiol 20 microgram, Desogestrel
150 microgram Bimizza 150microgram/20microgram tablets | 63 tablet P £5.04 DT = £5.08
▶ Cimizt (Morningside Healthcare Ltd)
Ethinylestradiol 30 microgram, Desogestrel
150 microgram Cimizt 30microgram/150microgram tablets | 63 tablet P £3.80 DT = £4.19
▶ Gedarel (Consilient Health Ltd)
Ethinylestradiol 20 microgram, Desogestrel
150 microgram Gedarel 20microgram/150microgram tablets | 63 tablet P £5.08 DT = £5.08
Ethinylestradiol 30 microgram, Desogestrel
150 microgram Gedarel 30microgram/150microgram tablets |
▶ Marvelon (Merck Sharp & Dohme Ltd)
Ethinylestradiol 30 microgram, Desogestrel
150 microgram Marvelon tablets | 63 tablet P £7.10 DT = £4.19
▶ Mercilon (Merck Sharp & Dohme Ltd)
Ethinylestradiol 20 microgram, Desogestrel
150 microgram Mercilon 150microgram/20microgram tablets | 63 tablet P £8.44 DT = £5.08
▶ Munalea (Lupin Healthcare (UK) Ltd)
Ethinylestradiol 20 microgram, Desogestrel
150 microgram Munalea 150microgram/20microgram tablets | 63 tablet P £5.07 DT = £5.08
Ethinylestradiol 30 microgram, Desogestrel
150 microgram Munalea 150microgram/30microgram tablets | 63 tablet P £4.18 DT = £4.19
Ethinylestradiol with drospirenone
Contraception with 21-day combined preparations |
Menstrual symptoms with 21-day combined
▶ Females of childbearing potential: 1 tablet once daily for
21 days; subsequent courses repeated after 7-day
interval, withdrawal bleeding occurs during the 7-day
l INTERACTIONS → Appendix 1: combined hormonal
▶ Common or very common Breast abnormalities . depressed
mood . increased risk of infection . menstrual disorder. vaginal discharge
▶ Rare or very rare Arterial thromboembolism . asthma . erythema nodosum . hearing impairment
Pill-free interval Withdrawal bleeding can occur during the
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Dretine (Theramex HQ UK Ltd)
Ethinylestradiol 30 microgram, Drospirenone 3 mg Dretine
0.03mg/3mg tablets | 63 tablet P £8.34 DT = £14.70
Ethinylestradiol 20 microgram, Drospirenone 3 mg Eloine
0.02mg/3mg tablets | 84 tablet P £14.70 DT = £14.70
▶ Lucette (Consilient Health Ltd)
Ethinylestradiol 30 microgram, Drospirenone 3 mg Lucette
0.03mg/3mg tablets | 63 tablet P £9.35 DT = £14.70
▶ Yacella (Morningside Healthcare Ltd)
Ethinylestradiol 30 microgram, Drospirenone 3 mg Yacella
0.03mg/3mg tablets | 63 tablet P £8.30 DT = £14.70
Ethinylestradiol 30 microgram, Drospirenone 3 mg Yasmin
tablets | 63 tablet P £14.70 DT = £14.70
▶ Yiznell (Lupin Healthcare (UK) Ltd)
Ethinylestradiol 30 microgram, Drospirenone 3 mg Yiznell
0.03mg/3mg tablets | 63 tablet P £8.30 DT = £14.70
Ethinylestradiol with etonogestrel
Contraception | Menstrual symptoms
▶ Females of childbearing potential: 1 unit, insert the ring
into the vagina on day 1 of cycle and leave in for
3 weeks; remove ring on day 22; subsequent courses
repeated after 7-day ring free interval (during which
l INTERACTIONS → Appendix 1: combined hormonal
l DIRECTIONS FOR ADMINISTRATION
Changing method of contraception to vaginal ring
Changing from combined hormonal contraception Insert ring at
the latest on the day after the usual tablet-free, patch-free,
or inactive-tablet interval. If previous contraceptive used
correctly, or pregnancy can reasonably be excluded, can
switch to ring on any day of cycle.
Changing from progestogen-only method From an implant or
intra-uterine progestogen-only device, insert ring on the
day implant or intra-uterine progestogen-only device
removed; from an injection, insert ring when next
injection due; from oral preparation, first ring may be
inserted on any day after stopping pill. For all methods
additional precautions (barrier methods) should be used
concurrently for first 7 days.
l PATIENT AND CARER ADVICE Patients or carers should be
given advice on how to administer vaginal ring.
Counselling The presence of the ring should be checked
Expulsion, delayed insertion or removal, or broken vaginal
ring If the vaginal ring is expelled for less than 3 hours,
rinse the ring with cool water and reinsert immediately; no
additional contraception is needed.
If the ring remains outside the vagina for more than
3 hours or if the user does not know when the ring was
expelled, contraceptive protection may be reduced:
. If ring expelled during week 1 or 2 of cycle, rinse ring
with cool water and reinsert; use additional precautions
(barrier methods) for next 7 days;
. If ring expelled during week 3 of cycle, either insert a
new ring to start a new cycle or allow a withdrawal bleed
and insert a new ring no later than 7 days after ring was
expelled; latter option only available if ring was used
continuously for at least 7 days before expulsion.
If insertion of a new ring at the start of a new cycle is
delayed, contraceptive protection is lost. A new ring
should be inserted as soon as possible; additional
precautions (barrier methods) should be used for the first
7 days of the new cycle. If intercourse occurred during the
extended ring-free interval, pregnancy should be
No additional contraception is required if removal of the
ring is delayed by up to 1 week (4 weeks of continuous
use). The 7-day ring-free interval should be observed and
subsequently a new ring should be inserted. Contraceptive
protection may be reduced with continuous use of the ring
for more than 4 weeks—pregnancy should be ruled out
If the ring breaks during use, remove it and insert a new
ring immediately; additional precautions (barrier
methods) should be used for the first 7 days of the new
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ NuvaRing (Merck Sharp & Dohme Ltd)
Ethinylestradiol 2.7 mg, Etonogestrel 11.7 mg NuvaRing
0.12mg/0.015mg per day vaginal delivery system | 3 system P £29.70 DT = £29.70
▶ SyreniRing (Crescent Pharma Ltd)
Ethinylestradiol 2.7 mg, Etonogestrel 11.7 mg SyreniRing
0.12mg/0.015mg per day vaginal delivery system | 3 system P £23.76 DT = £29.70
Ethinylestradiol with gestodene
Contraception with 21-day combined preparations |
Menstrual symptoms with 21-day combined
▶ Females of childbearing potential: 1 tablet once daily for
21 days; subsequent courses repeated after 7-day
interval, withdrawal bleeding occurs during the 7-day
interval, if reasonably certain woman is not pregnant,
first course can be started on any day of cycle—if
starting on day 6 of cycle or later, additional
precautions (barrier methods) necessary during first
7 days, tablets should be taken at approximately the
Contraception with 28-day combined preparations |
Menstrual symptoms with 28-day combined
▶ Females of childbearing potential: 1 active tablet once
daily for 21 days, followed by 1 inactive tablet daily for
7 days; subsequent courses repeated without interval,
withdrawal bleeding occurs during the 7-day interval of
inactive tablets being taken, if reasonably certain
woman is not pregnant, first course can be started on
any day of cycle—if starting on day 6 of cycle or later,
additional precautions (barrier methods) necessary
during first 7 days, tablets should be taken at
approximately the same time each day
l INTERACTIONS → Appendix 1: combined hormonal
▶ Common or very common Abdominal pain . breast
abnormalities . depression . dizziness . increased risk of
infection . menstrual cycle irregularities . mood swings . nervousness . vaginal discharge
▶ Rare or very rare Angioedema . chorea exacerbated . ear
disorders . haemolytic uraemic syndrome . hepatic
erythematosus exacerbated . varicose veins exacerbated . weight decreased
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Ethinylestradiol with gestodene (Non-proprietary)
Ethinylestradiol 30 microgram, Gestodene
50 microgram Ethinylestradiol 30microgram / Gestodene
50microgram tablets | 18 tablet P s
Ethinylestradiol 40 microgram, Gestodene
70 microgram Ethinylestradiol 40microgram / Gestodene
70microgram tablets | 15 tablet P s
BNF 78 Contraception, combined 799
Ethinylestradiol 30 microgram, Gestodene
100 microgram Ethinylestradiol 30microgram / Gestodene
100microgram tablets | 30 tablet P s
▶ Aidulan (Lupin Healthcare (UK) Ltd)
Ethinylestradiol 30 microgram, Gestodene 75 microgram Aidulan
30microgram/75microgram tablets | 63 tablet P £4.11 DT = £6.73
Ethinylestradiol 20 microgram, Gestodene 75 microgram Aidulan
20microgram/75microgram tablets | 63 tablet P £5.40 DT = £8.85
Ethinylestradiol 30 microgram, Gestodene
75 microgram Femodene tablets | 63 tablet P £6.73 DT = £6.73
Ethinylestradiol 20 microgram, Gestodene
75 microgram Femodette tablets | 63 tablet P £8.85 DT = £8.85
Ethinylestradiol 20 microgram, Gestodene
75 microgram Juliperla 75microgram/20microgram tablets | 63 tablet P £5.41 DT = £8.85
Ethinylestradiol 30 microgram, Gestodene 75 microgram Katya
30/75 tablets | 63 tablet P £5.03 DT = £6.73
▶ Millinette (Consilient Health Ltd)
Ethinylestradiol 30 microgram, Gestodene
75 microgram Millinette 30microgram/75microgram tablets | 63 tablet P £4.12 DT = £6.73
Ethinylestradiol 20 microgram, Gestodene
75 microgram Millinette 20microgram/75microgram tablets |
Ethinylestradiol 30 microgram, Gestodene
75 microgram Sofiperla 75microgram/30microgram tablets | 63 tablet P £4.12 DT = £6.73
Ethinylestradiol 20 microgram, Gestodene 75 microgram Sunya
20/75 tablets | 63 tablet P £6.62 DT = £8.85
Ethinylestradiol with levonorgestrel
Contraception with 21-day combined preparations |
Menstrual symptoms with 21-day combined
▶ Females of childbearing potential: 1 tablet once daily for
21 days; subsequent courses repeated after 7-day
interval, withdrawal bleeding occurs during the 7-day
interval, if reasonably certain woman is not pregnant,
first course can be started on any day of cycle—if
starting on day 6 of cycle or later, additional
precautions (barrier methods) necessary during first
7 days, tablets should be taken at approximately the
Contraception with 28-day combined preparations |
Menstrual symptoms with 28-day combined
▶ Females of childbearing potential: 1 active tablet once
daily for 21 days, followed by 1 inactive tablet once
daily for 7 days, withdrawal bleeding occurs during the
7-day interval of inactive tablets being taken, if
reasonably certain woman is not pregnant, first course
can be started on any day of cycle—if starting on day 6
of cycle or later, additional precautions (barrier
methods) necessary during first 7 days, tablets should
be taken at approximately the same time each day.
Subsequent courses repeated without interval
l INTERACTIONS → Appendix 1: combined hormonal
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Ethinylestradiol with levonorgestrel (Non-proprietary)
Ethinylestradiol 30 microgram, Levonorgestrel
50 microgram Ethinylestradiol 30microgram / Levonorgestrel
50microgram tablets | 6 tablet P s
Ethinylestradiol 40 microgram, Levonorgestrel
75 microgram Ethinylestradiol 40microgram / Levonorgestrel
75microgram tablets | 5 tablet P s
Ethinylestradiol 30 microgram, Levonorgestrel
125 microgram Ethinylestradiol 30microgram / Levonorgestrel
125microgram tablets | 10 tablet P s
Ethinylestradiol 30 microgram, Levonorgestrel
150 microgram Elevin 150microgram/30microgram tablets | 63 tablet P £29.25 DT = £2.82
▶ Leandra (Genesis Pharmaceuticals Ltd)
Ethinylestradiol 30 microgram, Levonorgestrel
150 microgram Leandra 30microgram/150microgram tablets | 63 tablet P £2.82 DT = £2.82
▶ Levest (Morningside Healthcare Ltd)
Ethinylestradiol 30 microgram, Levonorgestrel
150 microgram Levest 150/30 tablets | 21 tablet P £0.85
(Hospital only) | 63 tablet P £1.80 DT = £2.82
▶ Maexeni (Lupin Healthcare (UK) Ltd)
Ethinylestradiol 30 microgram, Levonorgestrel
150 microgram Maexeni 150microgram/30microgram tablets | 63 tablet P £1.88 DT = £2.82
Ethinylestradiol 30 microgram, Levonorgestrel
150 microgram Microgynon 30 tablets | 63 tablet P £2.82 DT =
Ethinylestradiol 30 microgram, Levonorgestrel
150 microgram Ovranette 150microgram/30microgram tablets | 63 tablet P £2.20 DT = £2.82
▶ Rigevidon (Consilient Health Ltd)
Ethinylestradiol 30 microgram, Levonorgestrel
150 microgram Rigevidon tablets | 63 tablet P £1.89 DT = £2.82
Ethinylestradiol with norelgestromin
Contraception | Menstrual symptoms
▶ Females of childbearing potential: Apply 1 patch once
weekly for 3 weeks, apply first patch on day 1 of cycle,
change patch on days 8 and 15; remove third patch on
day 22 and apply new patch after 7-day patch-free
interval to start subsequent contraceptive cycle,
subsequent courses repeated after a 7-day patch free
interval (during which withdrawal bleeding occurs)
l INTERACTIONS → Appendix 1: combined hormonal
irregularities . mood altered . muscle spasms . skin
reactions . uterine cramps . vaginal haemorrhage . vomiting . vulvovaginal disorders
▶ Rare or very rare Embolism and thrombosis . gallbladder
disorders . genital discharge . neoplasms . stroke . swelling
▶ Frequency not known Anger. angioedema . cervical
dysplasia . colitis . contact lens intolerance . erythema
nodosum . hepatic disorders . hyperglycaemia . intracranial
haemorrhage . myocardial infarction . pulmonary artery
l DIRECTIONS FOR ADMINISTRATION Adhesives or bandages
should not be used to hold patch in place. If no longer
sticky do not reapply but use a new patch.
Changing to a transdermal combined hormonal contraceptive
Changing from combined oral contraception Apply
patch on the first day of withdrawal bleeding; if no
withdrawal bleeding within 5 days of taking last active
tablet, rule out pregnancy before applying first patch.
Unless patch is applied on first day of withdrawal bleeding,
additional precautions (barrier methods) should be used
concurrently for first 7 days.
Changing from progestogen-only method
. from an implant, apply first patch on the day implant
. from an injection, apply first patch when next injection
. from oral progestogen, first patch may be applied on any
For all methods additional precautions (barrier methods)
should be used concurrently for first 7 days.
After childbirth (not breast-feeding) Start 4 weeks
after birth; if started later than 4 weeks after birth
additional precautions (barrier methods) should be used
After abortion or miscarriage Before 20 weeks’
gestation start immediately; no additional contraception
required if started immediately. After 20 weeks’ gestation
start on day 21 after abortion or on the first day of first
spontaneous menstruation; additional precautions (barrier
methods) should be used for first 7 days after applying the
l PATIENT AND CARER ADVICE Patients and carers should be
given advice on how to administer patches.
Travel Women using patches are at an increased risk of
deep vein thrombosis during travel involving long periods
of immobility (over 3 hours). The risk may be reduced by
appropriate exercise during the journey and possibly by
wearing graduated compression hosiery.
Delayed application or detached patch If a patch is partly
detached for less than 24 hours, reapply to the same site or
replace with a new patch immediately; no additional
contraception is needed and the next patch should be
applied on the usual ‘change day’. If a patch remains
detached for more than 24 hours or if the user is not aware
when the patch became detached, then stop the current
contraceptive cycle and start a new cycle by applying a new
patch, giving a new ‘Day 1’; an additional non-hormonal
contraceptive must be used concurrently for the first
If application of a new patch at the start of a new cycle is
delayed, contraceptive protection is lost. A new patch
should be applied as soon as remembered giving a new
‘Day 1’; additional non-hormonal methods of
contraception should be used for the first 7 days of the new
cycle. If application of a patch in the middle of the cycle is
delayed (i.e. the patch is not changed on day 8 or day 15):
. for up to 48 hours, apply a new patch immediately; next
patch ‘change day’ remains the same and no additional
. for more than 48 hours, contraceptive protection may
have been lost. Stop the current cycle and start a new
4-week cycle immediately by applying a new patch
giving a new ‘Day 1’; additional non-hormonal
contraception should be used for the first 7 days of the
If the patch is not removed at the end of the cycle (day
22), remove it as soon as possible and start the next cycle
on the usual ‘change day’, the day after day 28; no
additional contraception is required.
l NATIONAL FUNDING/ACCESS DECISIONS
Scottish Medicines Consortium (SMC) decisions
The Scottish Medicines Consortium has advised (September
2003) that Evra ® patches should be restricted for use in
women who are likely to comply poorly with combined oral
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Ethinylestradiol 33.9 microgram per 24 hour, Norelgestromin
203 microgram per 24 hour Evra transdermal patches | 9 patch P £19.51 DT = £19.51
Ethinylestradiol with norethisterone
Contraception with 21-day combined preparations |
Menstrual symptoms with 21-day combined
▶ Females of childbearing potential: 1 tablet once daily for
21 days; subsequent courses repeated after 7-day
interval, withdrawal bleeding occurs during the 7-day
interval, if reasonably certain woman is not pregnant,
first course can be started on any day of cycle—if
starting on day 6 of cycle or later, additional
precautions (barrier methods) necessary during first
7 days, tablets should be taken at approximately the
l INTERACTIONS → Appendix 1: combined hormonal
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Ethinylestradiol with norethisterone (Non-proprietary)
Ethinylestradiol 35 microgram, Norethisterone
500 microgram Ethinylestradiol 35microgram / Norethisterone
500microgram tablets | 5 tablet P s
Ethinylestradiol 35 microgram, Norethisterone
750 microgram Ethinylestradiol 35microgram / Norethisterone
750microgram tablets | 21 tablet P s
Ethinylestradiol 35 microgram, Norethisterone
1 mg Ethinylestradiol 35microgram / Norethisterone 1mg tablets |
Ethinylestradiol 35 microgram, Norethisterone
500 microgram Brevinor 500microgram/35microgram tablets | 63 tablet P £1.99 DT = £1.99
Ethinylestradiol 20 microgram, Norethisterone acetate
1 mg Loestrin 20 tablets | 63 tablet P £2.70 DT = £2.70
Ethinylestradiol 30 microgram, Norethisterone acetate
1.5 mg Loestrin 30 tablets | 63 tablet P £3.90 DT = £3.90
Ethinylestradiol 35 microgram, Norethisterone 1 mg Norimin
1mg/35microgram tablets | 63 tablet P £2.28 DT = £2.28
Ethinylestradiol with norgestimate
Contraception with 21-day combined preparations |
Menstrual symptoms with 21-day combined
▶ Females of childbearing potential: 1 tablet once daily for
21 days; subsequent courses repeated after 7-day
interval, withdrawal bleeding occurs during continued→
BNF 78 Contraception, combined 801
the 7-day interval, if reasonably certain woman is not
pregnant, first course can be started on any day of
cycle—if starting on day 6 of cycle or later, additional
precautions (barrier methods) necessary during first
7 days, tablets should be taken at approximately the
l INTERACTIONS → Appendix 1: combined hormonal
complaints . oedema . pain . skin reactions . vomiting
▶ Frequency not known Angioedema . contact lens
intolerance . dyslipidaemia . erythema nodosum . neoplasms . seizure . suppressed lactation
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Ethinylestradiol 35 microgram, Norgestimate
250 microgram Cilest 35microgram/250microgram tablets |
63 tablet P £7.16 DT = £7.16 | 126 tablet P £14.32
▶ Cilique (Consilient Health Ltd)
Ethinylestradiol 35 microgram, Norgestimate
250 microgram Cilique 250microgram/35microgram tablets | 63 tablet P £4.65 DT = £7.16
▶ Lizinna (Morningside Healthcare Ltd)
Ethinylestradiol 35 microgram, Norgestimate
250 microgram Lizinna 250microgram/35microgram tablets | 63 tablet P £4.64 DT = £7.16
Contraception | Menstrual symptoms
▶ Females of childbearing potential: 1 tablet once daily for
21 days; subsequent courses repeated after 7-day
interval, withdrawal bleeding can occur during the
7-day interval, if reasonably certain woman is not
pregnant, first course can be started on any day of
cycle—if starting on day 6 of cycle or later, additional
precautions (barrier methods) necessary during first
7 days, tablets should be taken at the same time each
l INTERACTIONS → Appendix 1: combined hormonal
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Mestranol 50 microgram, Norethisterone 1 mg Norinyl-1 tablets | 63 tablet P £2.19 DT = £2.19
Other drugs used for Contraception, devices
Intra-uterine contraceptive devices
▶ BY INTRA-UTERINE ADMINISTRATION
▶ Females of childbearing potential: (consult product
MHRA/CHM ADVICE (JUNE 2015) INTRA-UTERINE
CONTRACEPTION: UTERINE PERFORATION—UPDATED
Uterine perforation most often occurs during insertion,
but might not be detected until sometime later. The risk
of uterine perforation is increased when the device is
inserted up to 36 weeks postpartum or in patients who
are breastfeeding. Before inserting an intra-uterine
contraceptive device, inform patients that perforation
occurs in approximately 1 in every 1000 insertions and
. severe pelvic pain after insertion (worse than period
. pain or increased bleeding after insertion which
continues for more than a few weeks;
Patients should be informed on how to check their
threads and to arrange a check-up if threads cannot be
felt, especially if they also have significant pain. Partial
perforation may occur even if the threads can be seen;
consider this if there is severe pain following insertion
l CONTRA-INDICATIONS Active trophoblastic disease (until
return to normal of urine and plasma-gonadotrophin
concentration). distorted uterine cavity . established or
marked immunosuppression . genital malignancy . medical
diathermy . pelvic inflammatory disease .recent sexually
transmitted infection (if not fully investigated and treated)
. severe anaemia . small uterine cavity . unexplained
uterine bleeding . Wilson’s disease
l CAUTIONS Anaemia . anticoagulant therapy (avoid if
possible). diabetes . disease-induced immunosuppression
involution . menorrhagia (progestogen intra-uterine
system might be preferable). nulliparity . severe cervical
stenosis . severe primary dysmenorrhoea . severely scarred
uterus (including after endometrial resection). young age
CAUTIONS, FURTHER INFORMATION The Faculty of Sexual
and Reproductive Healthcare advises if removal is after day
3 of the menstrual cycle, intercourse should be avoided or
another method of contraception used for at least 7 days
before removal of device—emergency contraception may
need to be considered if recent intercourse has occurred
and the intra-uterine device is removed after day 3 of the
▶ Risk of infection The main excess risk of infection occurs in
the first 20 days after insertion and is believed to be related
to existing carriage of a sexually transmitted infection.
Women are considered to be at a higher risk of sexually
. they are under 25 years old or
. they are over 25 years old and
. have had more than one partner in the past year or
. their regular partner has other partners.
In these women, pre-insertion screening (for chlamydia
and, depending on sexual history and local prevalence of
disease, Neisseria gonorrhoeae) should be performed. If
prophylactic antibacterial cover should be given. The
woman should be advised to attend as an emergency if she
experiences sustained pain during the next 20 days.
l SIDE-EFFECTS Device complications . epilepsy (on
alleviated by NSAID such as ibuprofen 30 minutes before
insertion). pelvic infection exacerbated . presyncope (on
SIDE-EFFECTS, FURTHER INFORMATION Advise the patient
to seek medical attention promptly in case of significant
symptoms—very small risk of uterine perforation, ectopic
pregnancy and pelvic inflammatory disease.
l ALLERGY AND CROSS-SENSITIVITY Contra-indicated if
l PREGNANCY If an intra-uterine device fails and the woman
wishes to continue to full-term the device should be
removed in the first trimester if possible. Remove device; if
pregnancy occurs, increased likelihood that it may be
l BREAST FEEDING Not known to be harmful.
l MONITORING REQUIREMENTS Gynaecological examination
before insertion, 6–8 weeks after insertion, then annually.
l DIRECTIONS FOR ADMINISTRATION The timing and
technique of fitting an intra-uterine device are critical for
its subsequent performance. The healthcare professional
inserting (or removing) the device should be fully trained in
the technique and should provide full counselling backed,
where available, by the patient information leaflet. Devices
should not be fitted during the heavy days of the period;
they are best fitted after the end of menstruation and
before the calculated time of implantation.
l PRESCRIBING AND DISPENSING INFORMATION
TT380 ® SLIMLINE For uterine length 6.5–9 cm;
LOAD ® 375 For uterine length over 7 cm; replacement
NOVAPLUS T 380 ® AG ‘ Mini’ size for minimum uterine
length 5 cm; ‘ Normal’ size for uterine length 6.5–9 cm;
MULTILOAD ® CU375 For uterine length 6–9 cm;
GYNEFIX ® Suitable for all uterine sizes; replacement every
UT380 STANDARD ® For uterine length 6.5–9 cm;
UT380 SHORT ® For uterine length 5–7 cm; replacement
MULTI-SAFE ® 375 For uterine length 6–9 cm; replacement
ANCORA ® 375 CU For uterine length over 6.5 cm;
T-SAFE ® 380A QL For uterine length 6.5–9 cm;
NEO-SAFE ® T380 For uterine length 6.5–9 cm;
MINI TT380 ® SLIMLINE For minimum uterine length 5 cm;
COPPER T380 A ® For uterine length 6.5–9 cm;
NOVAPLUS T 380 ® CU ‘ Mini’ size for minimum uterine
length 5 cm; ‘ Normal’ size for uterine length 6.5–9 cm;
NOVA-T ® 380 For uterine length 6.5–9 cm; replacement
FLEXI-T ®+ 380 For uterine length over 6 cm; replacement
FLEXI-T ® 300 For uterine length over 5 cm; replacement
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Intra-uterine contraceptive device
▶ Intra-uterine contraceptive devices (R.F. Medical Supplies Ltd, Farla
Medical Ltd, Durbin Plc, Williams Medical Supplies Ltd, Bayer Plc,
Copper T380 A intra-uterine contraceptive device | 1 device £8.95
Steriload intra-uterine contraceptive device | 1 device £9.65
Load 375 intra-uterine contraceptive device | 1 device £8.52
Novaplus T 380 Ag intra-uterine contraceptive device mini | 1 device
T-Safe 380A QL intra-uterine contraceptive device | 1 device £10.55
UT380 Standard intra-uterine contraceptive device | 1 device £11.22
Nova-T 380 intra-uterine contraceptive device | 1 device £15.20
Flexi-T+ 380 intra-uterine contraceptive device | 1 device £10.06
Mini TT380 Slimline intra-uterine contraceptive device | 1 device
Flexi-T 300 intra-uterine contraceptive device | 1 device £9.47
Multi-Safe 375 intra-uterine contraceptive device | 1 device £8.96
Multiload Cu375 intra-uterine contraceptive device | 1 device £9.24
Optima TCu 380A intra-uterine contraceptive device | 1 device £9.65
Novaplus T 380 Ag intra-uterine contraceptive device normal | 1 device £12.50
GyneFix intra-uterine contraceptive device | 1 device £27.11
Novaplus T 380 Cu intra-uterine contraceptive device mini | 1 device
TT380 Slimline intra-uterine contraceptive device | 1 device £12.46
Ancora 375 Cu intra-uterine contraceptive device | 1 device £7.95
Novaplus T 380 Cu intra-uterine contraceptive device normal | 1 device £10.95
Neo-Safe T380 intra-uterine contraceptive device | 1 device £13.40
UT380 Short intra-uterine contraceptive device | 1 device £11.22
Silicone contraceptive pessaries
l SILICONE CONTRACEPTIVE PESSARIES
1 device . NHS indicative price = £15.29 . Drug Tariff (Part IXa)
1 device . NHS indicative price = £15.29 . Drug Tariff (Part IXa)
1 device . NHS indicative price = £15.29 . Drug Tariff (Part IXa)
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