Standard and tailored regimens for use of CHC

*NB: Tailored CHC regimens are off-label use but supported by the Faculty of Sexual and Reproductive Healthcare (FSRH)

See Contraception Guidance for advice on

• Missed pill
• Risk factors
• Counselling advice
• Drug interactions
• Practical advice
• Emergency contraception

In the absence of any other clinical reason, the product of lower acquisition cost should be chosen.

Evidence suggests that CHCs containing the 'third generation' progestogens gestodene or desogestrel are associated with an increased risk of venous thromboembolism (VTE) when compared with those containing the 'second generation' progestogens levonorgestrel or norethisterone.

CHC containing a 3rd generation progestogen may be suitable for women who experience unacceptable side-effects from other progestogens. It is important that the woman is aware of the possible increased risk of venous thromboembolism, backed up with an up-to-date leaflet. The Family Planning Association produce a suitable leaflet (The Combined Pill).

Monophasic low strength (21 day)

Gedarel 20/150

(Ethinylestradiol with desogestrel)

• Tablets 20micrograms/150micrograms (£5.98 = 63 tablets)

Notes

1. Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)

Millinette 20/75

(Ethinylestradiol with gestodene)

• Tablets 20micrograms/75micrograms (£6.37 = 63 tablets)

Notes

1. Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)

Monophasic standard strength (21 day)

Levest

(Ethinylestradiol with levonorgestrel)

• Tablets 30micrograms/150micrograms (£1.80 = 63 tablets)

Notes

1. Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)

Rigevidon

(Ethinylestradiol with levonorgestrel)

• Tablets 30micrograms/150micrograms (£1.89 = 63 tablets)

Notes

1. Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)

Brevinor

(Ethinylestradiol with norethisterone)

• Tablets 35micrograms/500micrograms (£1.99 = 63 tablets)

Notes

1. Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)

Millinette 30/75

(Ethinylestradiol with gestodene)

• Tablets 30micrograms/75micrograms (£4.85 = 63 tablets)

Notes

1. Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)

Gedarel 30/150

(Ethinylestradiol with desogestrel)

• Tablets 30micrograms/150micrograms (£4.93 = 63 tablets)

Notes

1. Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)

Cilique 250/35

(Ethinylestradiol with norgestimate)

• Tablets 35micrograms/250micrograms (£4.65 = 63 tablets)

Notes

1. Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)
2. Cilique tablets are currently unavailable; anticipated re-supply date is 4th April 2025

Lizinna

(Ethinylestradiol with norgestimate)

• Tablets 35micrograms/250micrograms (£4.64 = 63 tablets)

Notes

1. Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)

Marvelon

(Ethinylestradiol with desogestrel)

• Tablets 30micrograms/150micrograms (£7.10 = 63 tablets)

Notes

1. Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)

Transdermal (standard strength)

EVRA

(Ethinylestradiol with norelgestromin)

• Transdermal patches 33.9micrograms/203micrograms/24 hours (£19.51 = 9 patches)

Indications and dose

• Contraception in women aged 18 to 45 years
  • Standard regimen: apply 1 patch on the same day each week for 3 consecutive weeks (days 1, 8, and 15), have a patch-free interval on week 4 (days 22–28), unless using a tailored regimen, then start a new cycle.
  • “Quick starting” at any time in the cycle is also supported (although outside the product licence). Refer to the FSRH guideline on quick starting contraception for more information
  • If cycle 1 therapy starts after first day of the menstrual cycle, a non-hormonal contraceptive should be used concurrently for the first 7 consecutive days of the first treatment cycle only
  • Tailored regimen: see table above
  • Refer to SmPC for information regarding delayed patch change days
  • Refer to FSRH guidance on CHC for information regarding switching from alternative methods of hormonal contraception, or starting after childbirth, miscarriage or abortion

Notes

1. Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)
2. Only to be prescribed to women wanting combined hormonal contraception who decline Long-Acting Reversible Contraceptive (LARC) and where oral CHC are not tolerated or not suitable
3. Arrange follow up 3 months after the first prescription, and annually thereafter:
   1. Check blood pressure, BMI, and assess for any new risk factors which may mean the combined transdermal patch is no longer suitable
4. Only one transdermal patch is to be worn at a time
5. Evra should be applied to clean, dry, hairless, intact healthy skin on the buttock, abdomen, upper outer arm or upper torso, in a place where it will not be rubbed by tight clothing.

Vaginal (low strength)

SyreniRing

(Ethinylestradiol with etonogestrel)

• Vaginal ring 15micrograms/120micrograms/24 hours (£23.76 = 3 rings)

Indications and dose

• Contraception in women aged 18 to 40 years
  • Standard regimen: Insert one ring high into the vagina for 3 weeks of continuous use per cycle starting on day 1 of the cycle if the patient was not previously receiving a hormonal contraceptive. Remove the ring after 3 weeks of use on the same day of the week as the ring was inserted. A new ring should be inserted after a 7-day ring-free break, which then starts a new cycle.
  • “Quick starting” at any time in the cycle is also supported (although outside the product licence). Refer to the FSRH guideline on quick starting contraception for more information
  • A barrier method is recommended in addition to SyreniRing for 7 days if starting on days 2 to 5 of the first cycle (see note 5 below)
  • Tailored regimen: see table above
  • Refer to Patient Information Leaflet for information regarding delayed ring change days
  • Refer to FSRH guidance on CHC for information regarding switching from alternative methods of hormonal contraception, or starting after childbirth, miscarriage or abortion

Notes

1. Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)
2. Only to be prescribed to women wanting combined hormonal contraception (CHC) who decline Long-Acting Reversible Contraceptive (LARC) and where oral or transdermal CHC are not tolerated or not suitable
3. Arrange follow up no longer than 3 months after the first prescription, and annually thereafter:
   1. Check blood pressure, BMI, and assess for any new risk factors which may mean the contraceptive vaginal ring is no longer suitable
4. To insert the ring, the woman should find a comfortable position (standing with one leg up, squatting, or lying down) (Patient Information Leaflet available here)
   1. The ring should be compressed and inserted into the vagina until it feels comfortable — the exact position is not critical for the ring to provide effective contraception
   2. Advise women to regularly check for the presence of the ring in the vagina (for example, before and after intercourse)
5. SyreniRing may interfere with the correct placement and position of certain female barrier methods, such as a diaphragm, cervical cap, or female condom. These contraceptive methods should not be used as back-up methods with SyreniRing.