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BNSSG Adult Joint Formulary

7.3 Contraception

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Last edited: 10-06-2024

First line drugs

Second line drugs

Specialist drugs

Secondary care drugs

7.3.1 Contraception, combined oestrogen and progesterone

For assessment of venous thromboembolism risk see Statement published by Faculty of Sexual & Reproductive Health

Combined Oestrogen and Progesterone Oral Contraception

Dianette^® (co-cyprindiol) is not considered a contraceptive

Type of preparation	Oestrogen content	Progestogen content	Alternative brand (TLS Blue)	Recommended Formulary brand (TLS Green)
Monophasic low strength (21-day preparations)	Ethinylestradiol 20micrograms	Desogestrel 150micrograms Gestodene 75micrograms N.B. 3rd generation COCs have a higher VTE risk	Mercilon^® Millinette 20/75^®	Bimizza Gedarel^® 20/150
Monophasic standard strength (21-day preparations)	Ethinylestradiol 30micrograms	Desogestrel 150micrograms	Marvelon^®	Gedarel^® 30/150
	Ethinylestradiol 30micrograms	Levonorgestrel 150micrograms Drospirenone 3mg N.B. 3rd generation COCs have a higher VTE risk. Gestodene 75micrograms N.B. 3rd generation COCs have a higher VTE risk	Microgynon 30^® Ovranette^® Yacella^® Dretine^® Millinette 30/75^®	Rigevidon^® Levest^®
	Ethinylestradiol 35micrograms	Norgestimate 250micrograms	Cilique^® Lizinna^®	N/A
	Ethinylestradiol 35 micrograms	Norethisterone 500micrograms	N/A	Brevinor
	Ethinylestradiol 35 micrograms	Norethisterone 1000micrograms	N/A	Norimin
Monophasic everyday (28 day preparation) For use where the inactive tablets may add benefit to support compliance only	Ethinylestradiol 30 micrograms	Levonorgestrel 150 micrograms Gestodene 75micrograms N.B. 3rd generation COCs have a higher VTE risk	Microgynon ED Femodene ED	N/A

Combined Contraception – other formulations

Specific indication:

Ethinylestradiol / Norelgestromin patch (Evra^®) (TLS Blue)

For patients where compliance is a problem. Refer to Evra prescribing guidance for further information here

Qlaira^® (estradiol valerate / dienogest) (TLS Amber Specialist Recommended)

As an option for patients with premature ovarian insufficiency requiring contraception and HRT cover where standard oral contraceptives are not suitable and patients have completed puberty
Non-formulary as standard contraception for other patients outside of this cohort

Uterine Fibroids

Relugolix-estradiol-norethisterone acetate (Ryeqo^®) (TLS Amber Specialist Initiated)

NICE TA832 Relugolix–estradiol–norethisterone acetate for treating moderate to severe symptoms of uterine fibroids
Local agreement that Secondary Care will complete the DEXA at 12 months

7.3.2 Contraception, oral progesterone-only

Progesterone Only Oral Contraception

Type of preparation

Progesterone content

Alternative brand

(TLS Blue)

Recommended Formulary brand

(TLS Green)

Progestogen-only contraceptives

Levonorgestrel 30micrograms

Desogestrel 75micrograms

Drospirenone 4mg

Norgeston^®

Cerazette^®

Cerelle^®

Slynd^®

Or prescribe generically

Zelleta

7.3.3 Emergency Contraception

Emergency Contraception

For advice see Clinical Guideline from the Faculty of Sexual and Reproductive Health

Intrauterine device (copper) (TLS Green)

Levonorgestrel 1500 micrograms (Levonelle^® 1500) (TLS Green)

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 - see link to updated guidance above

Ulipristal acetate (EllaOne^®) (TLS Green)

As per Faculty of Sexual and Reproductive Healthcare guidelines

7.3.4 Contraception, parenteral progestogen-only

Depo-Provera^® (Medroxyprogesterone 150mg vial) (TLS Green)

Sayana Press^® (Medroxyprogesterone 104mg single dose injector device) (TLS Green)

Nexplanon^® (Etonogestrel 68mg per rod) (TLS Green)

The CSM has advised that:

In adolescents, medroxyprogesterone acetate (Depo-Provera^®) be used only when other methods of contraception are inappropriate
In all women, benefits of using medroxyprogesterone acetate beyond 2 years should be evaluated against risks
In women with risk factors for osteoporosis an alternative method of contraception instead of medroxyprogesterone acetate should be considered

Intrauterine progestogen-only device

Levosert^® (Levonorgestrel intrauterine device) (TLS Green)

In line with licensed indications, for contraception and management of heavy menstrual bleeding, but not for endometrial protection during oestrogen replacement therapy

Mirena^® (Levonorgestrel intrauterine device) (TLS Green)

Kyleena^® (Levonorgestrel intrauterine device) (TLS Green)

Jaydess^® (Levonorgestrel intrauterine device) (TLS blue)

7.3.5 Progesterone Receptor Modulators

Ulipristal acetate (Esmya^®) (TLS Red)

MHRA Alert – indication restricted due to risk of serious liver injury and liver failure

For the intermittent treatment of moderate to severe symptoms of uterine fibroids, if not eligible for surgical treatment

Misoprostol (TLS Red)

Mifepristone (oral) (TLS Red)

For medical management of miscarriage, followed by Misoprostol

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7.3 Contraception

7.3.1 Contraception, combined oestrogen and progesterone

Combined Oestrogen and Progesterone Oral Contraception

Combined Contraception – other formulations

Ethinylestradiol / Norelgestromin patch (Evra®) (TLS Blue)

Qlaira® (estradiol valerate / dienogest) (TLS Amber Specialist Recommended)

Uterine Fibroids

Relugolix-estradiol-norethisterone acetate (Ryeqo®) (TLS Amber Specialist Initiated)