Contraceptives

Combined Hormonal Contraceptives

Combined oral contraceptives containing a fixed amount of an oestrogen and a progestogen in each active tablet are termed ‘monophasic’; those with varying amounts of the two hormones according to the stage of the cycle are termed ‘biphasic’ and ‘triphasic’. A transdermal patch containing an oestrogen with a progestogen is also available. The oestrogen content of combined oral contraceptives ranges from 20 to 40 micrograms. Generally a preparation with the lowest oestrogen and progestogen content which gives good cycle control and minimal side-effects in the individual woman is chosen. Combined hormonal contraceptives or hormone replacement therapy (HRT) should be stopped if any of the following occur:

sudden severe chest pain, sudden breathlessness, unexplained swelling or severe pain in calf of one leg, severe stomach pain, serious neurological effects including unusual severe, prolonged headache, hepatitis, jaundice, liver enlargement, blood pressure above systolic 160 mmHg and diastolic 100 mmHg, prolonged immobility after surgery or leg injury or detection of a risk factor which contra-indicates treatment.

Ethinylestradiol with Desogestrel:

Indications: contraception; menstrual symptoms

Contraindications: personal history of venous or arterial thrombosis, severe or multiple risk factors for arterial disease or for venous thromboembolism, heart disease associated with pulmonary hypertension or risk of embolus; sclerosing treatment for varicose veins; migraine, pregnancy, transient cerebral ischaemic attacks without headaches; liver disease including disorders of hepatic excretion.

Dose and Administration: 1 tablet daily for 21 days; subsequent courses repeated after 7-day tablet-free interval (during which withdrawal bleeding occurs)

Ethinylestradiol with Gestodene:

Indications: contraception; menstrual symptoms

Contraindications: personal history of venous or arterial thrombosis, severe or multiple risk factors for arterial disease or for venous thromboembolism, heart disease associated with pulmonary hypertension or risk of embolus; sclerosing treatment for varicose veins; migraine, pregnancy, transient cerebral ischaemic attacks without headaches; liver disease including disorders of hepatic excretion.

Dose and Administration: 1 tablet daily for 21 days; subsequent courses repeated after 7-day tablet-free interval (during which withdrawal bleeding occurs)

Ethinylestradiol with Norelgestromin:

Indications: contraception; menstrual symptoms

Contraindications: personal history of venous or arterial thrombosis, severe or multiple risk factors for arterial disease or for venous thromboembolism, heart disease associated with pulmonary hypertension or risk of embolus; sclerosing treatment for varicose veins; migraine, pregnancy, transient cerebral ischaemic attacks without headaches; liver disease including disorders of hepatic excretion.

Dose and Administration: 1 patch to be applied once weekly for three weeks, followed by a 7-day patch-free interval; subsequent courses repeated after 7-day patch-free interval (during which withdrawal bleeding occurs).

Ethinylestradiol with Levonorgestrel:

Indications: contraception; menstrual symptoms

Contraindications: personal history of venous or arterial thrombosis, severe or multiple risk factors for arterial disease or for venous thromboembolism, heart disease associated with pulmonary hypertension or risk of embolus; sclerosing treatment for varicose veins; migraine, pregnancy, transient cerebral ischaemic attacks without headaches; liver disease including disorders of hepatic excretion.

Dose and Administration: 1 tablet daily for 21 days, starting with light brown tablet marked 1 on day 1 of cycle; repeat after 7-day tablet-free interval.

Ethinylestradiol with Norgestimate:

Indications: contraception; menstrual symptoms

Contraindications: personal history of venous or arterial thrombosis, severe or multiple risk factors for arterial disease or for venous thromboembolism, heart disease associated with pulmonary hypertension or risk of embolus; sclerosing treatment for varicose veins; migraine, pregnancy, transient cerebral ischaemic attacks without headaches; liver disease including disorders of hepatic excretion.

Dose and Administration: 1 tablet daily for 21 days, starting with light brown tablet marked 1 on day 1 of cycle; repeat after 7-day tablet-free interval.

Ethinylestradiol with Drospirenone:

Indications: contraception; menstrual symptoms

Contraindications: personal history of venous or arterial thrombosis, severe or multiple risk factors for arterial disease or for venous thromboembolism, heart disease associated with pulmonary hypertension or risk of embolus; sclerosing treatment for varicose veins; migraine, pregnancy, transient cerebral ischaemic attacks without headaches; liver disease including disorders of hepatic excretion.

Dose and Administration: 1 tablet daily for 21 days, starting with light brown tablet marked 1 on day 1 of cycle; repeat after 7-day tablet-free interval.

Progestogen-only Contraceptives 

Desogestrel:

Indications: contraception.

Contraindications: pregnancy; undiagnosed vaginal bleeding; severe arterial disease; liver tumour; acute porphyria; history of breast cancer but can be used after 5 years if no evidence of disease and non-hormonal contraceptive methods unacceptable

Dose and Administration: 1 tablet daily at same time each day, starting on day 1 of cycle then continuously.

Norethisterone:

Indications: contraception.

Contraindications: pregnancy; undiagnosed vaginal bleeding; severe arterial disease; liver tumour; acute porphyria; history of breast cancer but can be used after 5 years if no evidence of disease and non-hormonal contraceptive methods unacceptable

Dose and Administration: 1 tablet daily at same time each day, starting on day 1 of cycle then continuously.

Medroxyprogesterone Acetate:

Indications: contraception.

Contraindications: pregnancy; undiagnosed vaginal bleeding; severe arterial disease; liver tumour; acute porphyria; history of breast cancer but can be used after 5 years if no evidence of disease and non-hormonal contraceptive methods unacceptable

Dose and Administration: By deep intramuscular injection, 150 mg within first 5 days of cycle or within first 5 days after parturition (delay until 6 weeks after parturition if breast-feeding); for long-term contraception, repeated every 12 weeks (if interval greater than 12 weeks and 5 days, rule out pregnancy before next injection and advise patient to use additional contraceptive measures (e.g. barrier) for 14 days after the injection)