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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...
07.03.01  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)
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First Choice
traffic lightGreen
  • 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
traffic lightGreen
  • Tablets containing ethinylestradiol 20 micrograms and gestodene 75 micrograms.
 
 
Ethinylestradiol 30mcg / desogestrel 150mcg
(Gedarel, Marvelon)
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Second Choice
traffic lightGreen
  • 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
traffic lightGreen
  • 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
traffic lightGreen
  • 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
traffic lightGreen
  • 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
traffic lightGreen
  • 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)
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Formulary
traffic lightGreen
  • 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
traffic lightGreen
  • 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)
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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)
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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
 
 ....
 Non Formulary Items
Combined Hormonal Contraceptives
(BiNovum)

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Non Formulary
 
Combined Hormonal Contraceptives
(Minulet)

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Non Formulary
 
Combined Hormonal Contraceptives
(Norinyl-1)

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Non Formulary
 
Combined Hormonal Contraceptives
(Qlaira)

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Non Formulary
 
Combined Hormonal Contraceptives
(Synphase)

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Non Formulary
 
Combined Hormonal Contraceptives
(Triadene)

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Non Formulary
 
Combined Hormonal Contraceptives
(Tri-minulet)

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Non Formulary
 
Combined Hormonal Contraceptives
(Trinordiol)

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Non Formulary
 
Combined Hormonal Contraceptives
(TriNovum)

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Non Formulary
 
Ethinylestradiol 20 mcg / norethisterone 1mg
(Loestrin 20)

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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)

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Non Formulary
 
Ethinylestradiol 30 mcg / levonorgestrel 150 mcg
(Ovranette)

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Non Formulary
 
Ethinylestradiol 30 mcg /desogestrel 150 mcg
(Cimizt)

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Non Formulary
 
Ethinylestradiol 30mcg / norethisterone 1.5mg
(Loestrin 30)

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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.
 
nomegestrol acetate and beta estradiol
(Zoely)

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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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