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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...
07.03.02  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
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  • 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
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  • 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
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  • 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
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
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  • 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)
View adult BNF View SPC online
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
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  • Intra-uterine system containing 19.5mg levonorgestrel releasing 17.5micrograms per 24 hours
 
 
Intra-uterine Progestogen Only System
(Mirena)
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Formulary
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  • Intra-uterine system releasing 20 micrograms of levonorgestrel per 24 hours
 
 
Intra-uterine Progestogen Only System
(Levosert)
View adult BNF View SPC online
Formulary
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  • Intra-uterine system containing 52mg levonorgestrel releasing 20micrograms per 24 hours
 
 
 ....
 Non Formulary Items
Etonorgestrel
(Implanon)

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
 
  
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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