GUIDELINES FOR INITIATION AND SWITCHING OF COMBINED ORAL CONTRACEPTION

FIRST CHOICE Microgynon 30 OR Microgynon 30 ED

Breakthrough bleeding

Nausea or headache (NOT migraine)

Acne, bloatedness, Breast tenderness

Weight gain

Reduction of sexual desire

Loss of sexual drive

Mood swings

Check compliance, pregnancy, poor absorption interacting medication, diahorrea, vomiting, infection e.g. Chlamydia, local causes e.g. cervical polyp, ectropion tumours (rare)

Exclude pregnancy, eye test. Try taking at different times or tri-cycle

3rd Generation of Combined Pill (Marvelon)

General advice e.g. diet, exercise and being healthy

Likely psychological if for example; less motivation, relationship issues

Likely to be hormonal

To take full history as for example; all the time or in relation to withdrawal bleed

Alternative 2nd Generation COC (Brevinor)

Lower the dose of oestrogen e.g. Loestrin 20

Refer to Doctor or change method

3rd Generation of Combined Pill (Marvelon)

Refer to Doctor or Psychosexual Service

Refer to Doctor or discussion

3rd Generation of Combined Pill (Marvelon)

Side effects Remember consider other causes history, examination and investigation if necessary Lower the dose of oestrogen (3rd generation COC) e.g. Mercilon Switching Pills {21 day to 21 day} Changing to combined preparation containing different progesterone (21 day combined preparations) continue current pack until last tablet and start first tablet of new brand the next day. If a seven day break is taken before starting new brand, additional precautions (barrier methods) should be used during the first 7 days of taking the new brand. Switching Pills {28 day to 21 day} When switching from an ED brand (28 tablets) all placebo tablets should be omitted and the new brand started without a break. If placebo tablets are taken continue to the end of the pack and then start new brand additional precautions (barrier methods) should be used during the first 7 days of taking the new brand.

3rd Generation of Combined Pill (Marvelon)

Triphasic COC

HP/T&W Medicines Management Team

November 2007

Choice of hormonal contraceptives Combined Oral Contraceptives

Oral contraceptive
FIRST LINE COC (2nd generation COC) SECOND LINE COC (2nd generation COC) Microgynon 30 or Microgynon 30 ED

Appropriate choice for

Clients requesting to commence or continue combined oral contraception who have no contra-indication to COCs Please refer to PGD for specific exclusion criteria

(levonorgestrel 150mcg, ethynylestradiol 30mcg)

Loestin 20

Low Strength
(2nd generation COC)

(norethisterone acetate 1mg, ethynylestradiol 20mcg)

Brevinor

Clients who experience nausea and vomiting on Microgynon 30

(Please refer to PGD for specific exclusion criteria)

Standard Strength
(2nd generation COC)

(norethisterone 500mcg, ethynylestradiol 35mcg)

Logynon or Logynon ED

Clients who experience breakthrough bleeding on Microgynon 30

(Please refer to PGD for specific exclusion criteria)

Phased COC

Clients in whom effective cycle control is not achieved with (6 x ethynylestradiol 30mcg, levonorgestrel 50mcg; Microgynon 30 or Brevinor 5 x ethynylestradiol 40mcg, levonorgestrel 75mcg; (Please refer to PGD for specific exclusion criteria) 10 ethinylestradiol 30mcg, levonorgestrel 125mcg)
Marvelon

(Fist line 3rd generation COC)

(desogestrel 150mcg, ethynylestradiol 30mcg)

Standard Strength

Clients who experience unacceptable side effects on Microgynon or any other second generation COC, do not have any contraindications to 3rd generation COCs and are willing to accept the increased risk of venous thromboembolism.
(Please refer to PGD for specific exclusion criteria)

(Second line 3rd generation COC)

Mercilon

(desogestrel 150mcg, ethynylestradiol 20mcg)

Low Strength

Clients who experience unacceptable side effects on Microgynon or any other second generation COC, do not have any contraindications to 3rd generation COCs and are willing to accept the increased risk of venous thromboembolism.
(Please refer to PGD for specific exclusion criteria)

HP/T&W Medicines Management Team

November 2007

Choice of hormonal contraceptives Progestogen Only Contraceptives

First line progestogen only oral contraceptive: Second line progestogen only oral contraceptive: Second line progestogen only oral contraceptive:

Noriday (Norethisterone 350mcg) Femulen (Etynodiol diacetate 500mcg) Cerazette (Desogestrel 75mg)

Clients requesting to commence or continue progestogen only oral contraception who have no contraindications to POPs
(Please refer to PGD for specific exclusion criteria)

Women who experience menstrual irregularities on Noriday

(Please refer to PGD for specific exclusion criteria)

Initiation in patients who experience difficulty in complying with stricter dosage regimen of other POPs (3 hour rule)
(Please refer to PGD for specific exclusion criteria)

POP Dosage: 1 tablet daily at the same time each day, starting on day 1 of the cycle then continuously. If administration is delayed for 3 hours (12 hours for Cerazette) or more it should be regarded as a missed pill Changing from a COC to a POP. Cerazette, Femulen, Micronor, Norgeston, and Noriday are started without a break on the day following the combined contraceptive. No additional contraception is necessary with Cerazette, Micronor, or Noriday, but additional contraception for the first 14 days after switching is recommended for Femulen and Norgeston.

HP/T&W Medicines Management Team

November 2007