Containing ethinylestradiol 30micrograms
Containing ethinylestradiol 20micrograms
Prescribing Notes
- Combined contraceptive pills should be prescribed by brand name.
- Switching pills to a COC with a different progestogen component is an option for women experiencing progestogenic symptoms such as breast tenderness, low mood or acne. A different progestogen may result in fewer or different, side–effects.
- Gedarel® 20/150 contains a lower dose of oestrogen and may be associated with a better side–effect profile in women complaining of oestrogenic symptoms such as nausea, breast enlargement or mastalgia.
- Tailored regimens offer an acceptable alternative for many women as they can reduce the frequency of withdrawal bleeds and can reduce withdrawal symptoms associated with the hormone-free interval. The use of tailored regimens is off label but is supported by the FRSH, see FSRH.
- COCs containing an ethinylestradiol 30micrograms/drospirenone 3mg combination, e.g. Yasmin®, are not formulary choice COCS. They have similar contraceptive effectiveness to other COCs, no significant advantages in adverse event profile and cost significantly more. If this combination is deemed necessary, prescribe a less costly brand, e.g. Dretine® or Yacella®.
- Triphasic and biphasic COCs have no real benefits and are more complicated to use.
- It is recommended that COCs are not continued beyond 50 years of age since more suitable alternatives exist, see UKMEC
- FSRH produce eligibility criteria for contraceptive use, see UKMEC.
- Drug interactions, including enzyme-inducing drugs, should be considered when prescribing contraceptives, see FSRH.
- For missed or late pill guidance, see FSRH.
- Patients aged 16 years and over can order contraception including COCs and POPs via SH:24. Repeat issues of the contraceptive injectable Sayana Press can also be obtained. This is a free HSC funded service where medical eligibility is assessed by HCPs and contraception supplied via post. There are some requirements such as a blood pressure check before COC.
Treatment of Acne
- Oral contraceptives are not first line for acne treatment, see section 13.6.1 for management choices.
- If a person receiving treatment for acne wishes to use hormonal contraception, a COC is preferred over a progestogen-only pill.
- COCs (if not contraindicated) in combination with topical agents can be considered as an alternative to systemic antibiotics in women.
- Co-cyprindiol (e.g Dianette®) or other ethinylestradiol/cyproterone acetate-containing products can only be considered in severe acne where other treatments have failed. Careful discussion of the risks and benefits with the patient is required. Use should be discontinued 3 months after acne has been controlled and prescription guided by the UKMEC for Contraceptive Use and the SPC for the individual product. See MHRA alerts regarding risk of meningioma and information on risk of VTE.
Caution
- The absolute risk of blood clots with all low-dose CHCs is small – there is good evidence that the risk of venous thromboembolism (VTE) may vary between products, depending on the progestogen – CHCs that contain levonorgestrel, norethisterone, or norgestimate have the lowest risk of VTE – the benefits of any CHC far outweigh the risk of serious side effects – prescribers and women should be aware of the major risk factors for thromboembolism, and of the key signs and symptoms. For full information see MHRA.