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 Formulary Chapter 7: Obstetrics, Gynaecology, and urinary-tract disorders - Full Chapter
Notes:

Prescribing Guidance

Please see our Prescribing Guidelines page for all prescribing guidance relating to this chapter.

Shared Care Agreements

Please see our Shared Care Agreements page for all shared care agreements (SCAs) relating to this chapter.

 

 

 Details...
07.03  Expand sub section  Contraceptives
 note 

MHRA guidance: Medicines with teratogenic potential: what is effective contraception? Mar 2019

UKMi Q&A - Is there a lactose-free oral contraceptive?

07.03.01  Expand sub section  Combined hormonal contraceptives
 note 

FSRH Clinical Guidance - Combined Hormonal Contraception January 2019

MHRA general advice on combined hormonal contraceptives March 2014

Choosing a Combined Oral Contraceptive (COC): Prescribe COCs by brand name, the exception is co-cyprindiol. Co-cyprindiol contains the anti-androgen, cyproterone acetate, in combination with ethinyloestadiol. It is not licensed as a COC - see section 13.6.2.

A monophasic COC containing 30 micrograms of ethinylestradiol with norethisterone or levonorgestrel is a suitable first pill. 

Local consensus on prescribing the COC
Never used COC: Start with Rigevidon
Used COC in past and no new contraindications: (check BP, BMI, age, smoking and new medical conditions) Return to previously tolerated COC, if unknown follow ‘never used COC' above. 

 

No problems, continue current COC

↓ 

Relative progestogen excess: Depression, Sustained weight gain, Loss of libido with mood change, Acne, hirsutism, Vaginal dryness, Breast tenderness.  Relative oestrogen excess: Nausea, Bloating, Some cases of breast tenderness, Cyclical weight gain, Vaginal discharge, no infection, Some cases of loss of libido, no mood change, Benign breast disease, fibroids, endometriosis 

Less progestogenic COC:

  • Brevinor      Or

Oestrogen dominant COC:

  • Cilique
  • Gedarel 30/150 
  • Millinette 30/75
  • Lucette (3rd LINE)

Lower dose oestrogen COC:

  • Gedarel 20/150      Or

Progestogen dominant COC:

  • Norimin
Ethinylestradiol 30mcg / levonorgestrel 150mcg
(Rigevidon, Microgynon 30, Levest)
View adult BNF View SPC online
First Choice
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  • Tablets containing ethinylestradiol 30 micrograms and levonorgestrel 150 micrograms (21 days)
  • Rigevidon® Most cost effective choice 3 x 21 £1.89 v Microgynon 30, 3 x 21 £2.82 December 2018. Microgynon 30® existing patients only OR if Rigevidon® unavailable.

 

 
Ethinylestradiol 20mcg / gestodene 75 mcg
(Millinette 20/75, Femodette)
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Second Choice
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  • Tablets containing ethinylestradiol 20 micrograms and gestodene 75 micrograms.
 
 
Ethinylestradiol 30mcg / desogestrel 150mcg
(Gedarel, Marvelon)
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Second Choice
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  • Tablets containing ethinylestradiol 30 micrograms and desogestrel 150micrograms.
  • Note: Useful for patients with acne which hasn't improved with Rigevidon.

 

 
 
Ethinylestradiol 35 mcg / norgestimate 250 mcg
(Cilique)
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Second Choice
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  • Tablets containing ethinylestradiol 35 micrograms and norgestimate 250 micrograms
  • Cilique most cost effective £4.65 x 63 tablets (NB Cilest was discontinued in July 2019)
  • Note: Useful for irregular bleeding with Rigevidon

 

 
 
Ethinylestradiol 30 mcg / drospirenone 3 mg
(Yasmin, Lucette)
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Third Choice
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  • Tablets containing ethinyloestradiol 30 micrograms and drospirenone 3mg
  • Lucette most cost effective 3 x 21 £9.35 December 2018. Yasmin only for existing patients 3 x 21 £14.70 December 2018.
  • Note: Only for women with mild to moderate acne or symptoms of PMS when first and second choice have failed.
 
Link  MHRA DSU Dec 2014: Yasmin: risk of venous thromboembolism higher than levonorgestrel-containing pills
 
Ethinylestradiol 20 mcg / drospirenone 3 mg
(Eloine)
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Third Choice
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  • Tablets containing ethinyloestradiol 20 micrograms and drospirenone 3mg
  • Note: third line option where women have struggles with side effects on first and second line combined pills.
 
 
Combined Hormonal Contraceptives
(Logynon ED)
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Formulary
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  • Multiphasic pills containing ethinylestradiol 30 micrograms, levonorgestrel 50 micrograms;  ethinylestradiol 40 micrograms, levonorgestrel 75 micrograms; ethinylestradiol 30 micrograms, levonorgestrel 125 micrograms; 7 inactive lactose tablets. 3 x 28 tablets.
 
 
Combined Hormonal Contraceptives
(Microgynon 30 ED)
View adult BNF View SPC online
Formulary
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  • Tablets containing ethinylestradiol 30 micrograms and levonorgestrel 150 micrograms (21 beige tabs); lactose (7 white tabs) 3 x 28 £2.99 December 2018.
 
 
Combined Hormonal Contraceptives
(NuvaRing)
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Formulary
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  • Ethinylestradiol 15 micrograms/24 hours with Etonogestrel 120micrograms/24 hours. 3 ring pack. 1 ring to be inserted into the vagina, removed on day 22; subsequent courses after 7 day ring-free interval.
  • May be considered in women:
    • with GI disturbance /malabsorption.
    • getting persistent breakthrough bleeding with COCP (good cycle control).
    • who have difficulties swallowing pills, and are not keen on other methods of contraception.
    • getting hormonal side effects with COCP (relatively low oestrogen exposure).
 
 
Ethinylestradiol / levonorgestrel phased pill
(TriRegol, Logynon)
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Formulary
traffic lightGreen
  • Multiphasic tablets containing ethinylestradiol 30 micrograms, levonorgestrel 50 micrograms;  ethinylestradiol 40 micrograms, levonorgestrel 75 micrograms; ethinylestradiol 30 micrograms, levonorgestrel 125 micrograms. 3 x 21 tablets.
 
 
Ethinylestradiol 20mcg / desogestrel 150mcg
(Gedarel, Mercilon)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Tablets containing ethinylestradiol 20 micrograms and desogestrel 150 micrograms (21 days)
  • Gedarel 20/150 Most cost effective choice 3 x 21 £5.08, Mercilon 3 x 21 £8.44 December 2018. Mercilon for existing patients only OR if Gedarel 20/150 unavailable.

 

 
 
Ethinylestradiol 30mcg / gestodene 75 mcg
(Femodene ED)
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Formulary
traffic lightGreen
  • Each active tablet contains 75 micrograms gestodene and 30 micrograms ethinylestradiol. Each pack also contains seven placebo tablets which are larger.
 
 
Ethinylestradiol 30mcg / gestodene 75 mcg
(Millinette 30/75, Femodene,Sofiperla)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Tablets containing ethinylestradiol 30 micrograms and gestodene 75 micrograms.
 
 
Ethinylestradiol 35 mcg / noresthisterone 1mg
(Norimin)
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Formulary
traffic lightGreen
  • Tablets containing ethinylestradiol 35 micrograms & norethisterone 1mg micrograms
 
 
Ethinylestradiol 35 mcg / noresthisterone 500mcg
(Brevinor)
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Formulary
traffic lightGreen
  • Tablets containing ethinylestradiol 35 micrograms & norethisterone 500 micrograms x 21 tablets.
  • Note: Less progestogenic

 

 
 
Combined Hormonal Contraceptives
(Evra)
(Transdermal patch)
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Formulary
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  • Transdermal patch containing 6 mg norelgestromin and 600 micrograms ethinyl estradiol
  • Restricted for use in women who are likely to comply poorly with combined oral contraceptives
 
Link  BSW Evra Contraceptive Patch Prescribing Guidance
 
07.03.02  Expand sub section  Progestogen-only contraceptives
 note 

FSRH Clinical Guidance: Progestogen-only Injectable contraception - Updated April 2019

FSRH Clinical Guidance: Progestogen-only Pills - Updated April 2019

07.03.02.01  Expand sub section  Oral progestogen-only contraceptives
 note 

It is advisable to prescribe Progestogen-only pills (POPs) by brand name. POPs are also indicated during lactation.

 

Desogestrel (Cerelle)
(Oral progestrogen-only contraceptive )
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First Choice
traffic lightGreen
  • Tablets containing 75 microgram desogestrel
  • First line choice of oral progestogen-only contraceptive due to the 12 hour window to take the pill.
  • Cerelle is most cost effective generic brand (3 x 28 £3.50 December 2018). Cerazette is non-formulary as not cost effective (3 x 28 £8.68 December 2018) 

 

 
Norethisterone
(Noriday)
(Oral progestogen-only contraceptive)
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Second Choice
traffic lightGreen
  • Tablets containing norethisterone 350 micrograms
  • Recommended for patients previously on Micronor - discontinued 2017
  • Note: If administration is delayed for 3 hours or more it should be regarded as a ‘missed pill'.

 

 
 
Oral Progestogen Only Contraceptives
(Norgeston)
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Second Choice
traffic lightGreen
  • Tablets containing levonorgestrel 30 micrograms.
  • Note: If administration is delayed for 3 hours or more it should be regarded as a ‘missed pill'

 

 
 
07.03.02.02  Expand sub section  Parenteral progestogen-only contraceptives to top
Etonorgestrel
(Nexplanon)
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Formulary
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  • Implant containing 68 mg of etonogestrel
  • The practitioner fitting (or removing) must be fully trained in the technique.
  • Nexplanon is licensed for 3 years.

 

 
Link  Feb 2020 MHRA DSU - Nexplanon (etonogestrel) contraceptive implants: new insertion site to reduce rare risk of neurovascular injury and implant migration
 
Medroxyprogesterone Acetate
(Depo-Provera)
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Formulary
traffic lightGreen
  • 150mg in 1ml for administration as deep intramuscular injection every 12 weeks.
 
 
Medroxyprogesterone acetate
(Sayana Press)
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Formulary
  • Green Patients > 18 years
  • Amber Patients and adolescents (12-18 years), use of Sayana Press is only indicated when other contraceptive methods are considered unsuitable or unacceptable, due to unknown long-term effects of bone loss associated with Sayana Press during the critical period of bone accretion. Sayana Press has not been studied in women under the age of 18 years but data is available for intramuscular medroxyprogesterone acetate (MPA) in this population.
  • Single-dose container with 104 mg medroxyprogesterone acetate (MPA) in 0.65 mL suspension for injection.
  • Licensed for self-administration. Please note company provide sharps bins BUT patients must organise safe disposal of full sharps bins via their local council.
  • Dose (no hormonal contraceptive use in previous month) 104 mg within first 5 days of cycle or within 5 days postpartum (delay until 6 weeks postpartum if breast-feeding). For long-term contraception, repeat every 13 weeks (if interval greater than 13 weeks and 7 days, rule out pregnancy before next injection)
  • Especially effective in patients with a BMI > 30

 

 
Link  Sayana Press - Stock shortages until at least the end of 2019
 
Norethisterone enantate
(Noristerat)
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Formulary
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  • 200mg norethisterone enantate in 1ml oily solution
  • Noristerat® oily injection provides contraception for 8 weeks. Intended for short-term use when a high level of efficacy independent of possible errors by the patient is required. It has been licensed for short-term use by women whose partners undergo vasectomy, until the vasectomy is effective, and women immunised against rubella, to prevent pregnancy during the period of activity of the virus.
 
 
07.03.02.03  Expand sub section  Intra-uterine progestogen-only contraceptive
 note 

Please prescribe by BRAND name: 

See MHRA Drug Safety Update Jan 2016 Levonorgestrel-releasing intrauterine systems should always be prescribed by brand name because products have different indications, durations of use, and introducers. 

Also see this information on the risk of ectopic pregnancy in association with the use of Bayer levonorgestrel IUS (LNG-IUS). Also explains the differences between three approved LNG-IUS products (Jaydess, Kyleena, Mirena) to help reduce the risk of medication error.

See MHRA Drug Safety Update June 2015 for further information and advice on  risk of uterine perforation. 

Intra-uterine Progestogen Only System
(Jaydess)
(Contraception)
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Formulary
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  • Intra-uterine system containing 13.5mg of levonorgestrel
 
 
Intra-uterine Progestogen Only System
(Kyleena)
(Contraception)
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Formulary
traffic lightGreen
  • Intra-uterine system containing 19.5mg levonorgestrel releasing 17.5micrograms per 24 hours
 
 
Intra-uterine Progestogen Only System
(Mirena)
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Formulary
traffic lightGreen
  • Intra-uterine system releasing 20 micrograms of levonorgestrel per 24 hours
 
 
Intra-uterine Progestogen Only System
(Levosert)
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Formulary
traffic lightGreen
  • Intra-uterine system containing 52mg levonorgestrel releasing 20micrograms per 24 hours
 
 
07.03.03  Expand sub section  Spermicidal contraceptives
07.03.04  Expand sub section  Contraceptive devices
 note 

Intra-uterine devices and other contraceptive devices
Prescribe as per local practice.
 

07.03.05  Expand sub section  Emergency Contraception
07.03.05  Expand sub section  Hormonal methods to top
 note 

Useful decision making algorithms for choosing emergency contaceptive method (Cu-IUD vs oral EC and LNG-EC vs UPA-EC) can be found at The Faculty of Sexual & Reproductive Healthcare (FSRH) CEU Clinical Guidance: Emergency Contraception

MHRA September 2016: Emergency contraceptive affected by other medicines - regulator issues new guidance

UKMi Q&A - Emergency contraception and breastfeeding

 

Levonorgestrel
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Formulary
traffic lightGreen
  • Tablet contains 1.5 mg of levonorgestrel
  • Licensed to prevent pregnancy when taken within 72 hours of unprotected intercourse or failure of a contraceptive method. Emergency contraceptive pills do not prevent 100% of pregnancies and are more effective the sooner they are taken after unprotected sex.
  • Please be aware of the updated FSRH advice (2017) to provide a 3mg dose in patients women weighing >70 kg or with a BMI >26 kg/m2
  • FP10s for levonorgestrel should be written generically as levonorgestrel 1.5mg. Levonelle One Step, the pharmacy pack, is significantly more expensive.
  • Levonelle One Step pharmacy pack of levonorgestrel 1.5mg is available to purchase from Community Pharmacies. Pharmacist checklist and patient information leaflet here.
 
 
Ulipristal (EllaOne)
(contraception)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Tablet containing 30 mg ulipristal acetate.
  • Licensed for prevention of pregnancy when taken within 120 hours (5 days) of unprotected sexual intercourse or contraceptive failure. Emergency contraceptive pills do not prevent 100% of pregnancies and are more effective the sooner they are taken after unprotected sex.
  • EllaOne is available to purchase from Community Pharmacies.
 
 
 ....
 Non Formulary Items
Combined Hormonal Contraceptives
(BiNovum)

View adult BNF View SPC online
Non Formulary
 
Combined Hormonal Contraceptives
(Minulet)

View adult BNF View SPC online
Non Formulary
 
Combined Hormonal Contraceptives
(Norinyl-1)

View adult BNF View SPC online
Non Formulary
 
Combined Hormonal Contraceptives
(Qlaira)

View adult BNF View SPC online
Non Formulary
 
Combined Hormonal Contraceptives
(Synphase)

View adult BNF View SPC online
Non Formulary
 
Combined Hormonal Contraceptives
(Triadene)

View adult BNF View SPC online
Non Formulary
 
Combined Hormonal Contraceptives
(Tri-minulet)

View adult BNF View SPC online
Non Formulary
 
Combined Hormonal Contraceptives
(Trinordiol)

View adult BNF View SPC online
Non Formulary
 
Combined Hormonal Contraceptives
(TriNovum)

View adult BNF View SPC online
Non Formulary
 
Ethinylestradiol 20 mcg / norethisterone 1mg
(Loestrin 20)

View adult BNF View SPC online
Notes Refer to Notes
Green

DISCONTINUED

  • Tablets containing ethinylestradiol 20 micrograms and norethisterone acetate 1mg.
  • Please note: Sept 2019 manufacturers confirmed this product is being discontinued with no further supplies of Loestrin 20 to the UK market.
 
Ethinylestradiol 20mcg / desogestrel 150mcg
(Alenini)

View adult BNF View SPC online
Non Formulary
 
Ethinylestradiol 30 mcg / levonorgestrel 150 mcg
(Ovranette)

View adult BNF View SPC online
Non Formulary
 
Ethinylestradiol 30 mcg /desogestrel 150 mcg
(Cimizt)

View adult BNF View SPC online
Non Formulary
 
Ethinylestradiol 30mcg / norethisterone 1.5mg
(Loestrin 30)

View adult BNF View SPC online
Notes Refer to Notes
Green

DISCONTINUED

  • Tablets containing ethinylestradiol 30 micrograms and norethisterone 1.5 mgs.
  • Please note: Sept 2019 manufacturers confirmed this product is being discontinued with no further supplies of Loestrin 30 to the UK market.
 
Etonorgestrel
(Implanon)

View adult BNF View SPC online
Non Formulary
 
nomegestrol acetate and beta estradiol
(Zoely)

View adult BNF View SPC online
Non Formulary
 
Oral Progestogen-Only Contraceptives
(Cerazette®)

View adult BNF View SPC online
Non Formulary
 
Oral Progestogen-Only Contraceptives
(Micronor®)

View adult BNF View SPC online
Non Formulary
 
Spremicidal Contraceptives
(Ortho-Creme®)

View adult BNF View SPC online
Non Formulary
 
Spremicidal Contraceptives
(Orthoforms®)

View adult BNF View SPC online
Non Formulary
 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG
Blueteq
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Traffic LightRed

RED - Hospital only to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment.  

Traffic LightAmber

Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.  

Traffic LightAmber with Shared Care

Shared Care - these medicines require specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.  

Traffic LightGreen

These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations.  

Traffic LightSelf

Suitable for patient to be directed to buy themselves  

Traffic LightGrey

Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review.   

Traffic LightBlack

(In use from Oct 2020) Used where a decision has been made by the BSW APC not to routinely commission this preparation for its licensed indications. Do not prescribe.   

Traffic LightRed Specialist Centre

Not currently used. We intend to include this TLS in future to highlight where this medicine and indication is ONLY available through a Specialist Centre according to a NICE Highly Specialised Technology or NHSE Specialised Commission Circular / Policy.  

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