7.3.1 Combined hormonal contraceptives (CHC)

Standard and tailored regimens for use of CHC

Type of regimenPeriod of CHC useHormone free interval (HFI)
Standard use21 days (21 active pills or 1 ring, or 3 patches)7 days
Tailored use*
Shortened HFI21 days (21 active pills or 1 ring, or 3 patches)4 days
Extended use (tricycling)9 weeks (3 x 21 active pills or 3 rings, or 9 patches used consecutively)4 or 7 days
Flexible extended useContinuous use (≥ 21 days) of active pills, patches or rings until breakthrough bleeding occurs for 3–4 days4 days
Continuous useContinuous use of active pills, patches or ringsNone

*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

Monophasic low strength (21 day)

Gedarel® 20/150

(Ethinylestradiol with desogestrel)

  • Tablets 20 micrograms/150 micrograms (£1.69)

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 20 micrograms/75 micrograms (£1.80)

Notes

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

(Ethinylestradiol with desogestrel)

  • Tablets 20 micrograms/150 micrograms (£2.81)

Notes

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

(Ethinylestradiol with gestodene)

  • Tablets 20 micrograms/75 micrograms (£2.95)

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)

Rigevidon®

(Ethinylestradiol with levonorgestrel)

  • Tablets 30 micrograms/150 micrograms (£0.63)

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 30 micrograms/75 micrograms (£1.37)

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 30 micrograms/150 micrograms (£1.40)

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 35 micrograms/250 micrograms (£1.55)

Notes

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

(Ethinylestradiol with norgestimate)

  • Tablets 35 micrograms/250 micrograms (£1.55)

Notes

  1. Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)
Microgynon 30®

(Ethinylestradiol with levonorgestrel)

  • Tablets 30 micrograms/150 micrograms (£0.94)

Notes

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

(Ethinylestradiol with gestodene)

  • Tablets 30 micrograms/75 micrograms (£2.24)

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 30 micrograms/150 micrograms (£2.37)

Notes

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

(Ethinylestradiol with drospirenone)

  • Tablets 30 micrograms/3mg (£3.12)

Notes

  1. Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)
  2. The risk of VTE in association with drospirenone-containing pills is higher than that for levonorgestrel-containing 'second generation' pills and may be similar to the risk for 'third-generation' pills that contain desogestrel or gestodene
Yasmin®

(Ethinylestradiol with drospirenone)

  • Tablets 30 micrograms/3mg (£4.90)

Notes

  1. Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)
  2. The risk of VTE in association with drospirenone-containing pills is higher than that for levonorgestrel-containing 'second generation' pills and may be similar to the risk for 'third-generation' pills that contain desogestrel or gestodene

Monophasic standard strength (28 days)

Microgynon 30 ED®

(Ethinylestradiol with levonorgestrel)

  • Tablets 30 micrograms/150 micrograms (plus white placebo tablets) (£1.00)

Notes

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

Phasic standard strength (28 days)

Logynon®

(Ethinylestradiol with levonorgestrel)

  • Tablets (£1.27)

Notes

  1. Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)
  2. Phasic preparations should only be used where breakthrough bleeding is a problem. Headaches may be a problem with these preparations.

Transdermal (standard strength)

EVRA

(Ethinylestradiol with norelgestromin)

  • Transdermal patches 33.9 micrograms/203 micrograms/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 15 micrograms/120 micrograms/24 hours (£19.00 = 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 SmPC 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.

 

Home > Formulary > Chapters > 7. Obstetrics, gynaecology, and urinary-tract disorders > 7.3 Contraceptives > 7.3.1 Combined hormonal contraceptives (CHC)

 

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