7.3.2 Progestogen-only contraceptives

7.3.2.1 Oral progestogen-only contraceptives

Norethisterone
  • Tablets containing norethisterone 350 micrograms (£0.70)

Indications

  • Oral contraception
Norgeston®
  • Tablets containing levonorgestrel 30 micrograms (£0.92)
Desogestrel
  • Tablets containing desogestrel 75 micrograms (£0.76)

Notes

  1. Desogestrel (DSG) pills may have potential benefits over traditional progestogen-only contraceptives because ovulation is inhibited in up to 97% of cycles and they have a 12-hour window for missed pills. They may have some benefits in management of dysmenorrhea.

7.3.2.2 Parenteral progestogen-only contraceptives

Please refer to: NICE CG30 Long-acting reversible contraception (Oct 2005)

Norethisterone enantate (Noristerat) has not been included in this formulary because it is only licensed for 2 injections and is thought to be more painful than Depo-Provera®.

Medroxyprogesterone acetate
  • Depo-Provera® 150mg in 1mL for deep intramuscular injection every 12 weeks (£6.01 = 1ml)
  • Sayana Press® 104mg in 0.65ml for subcutaneous injection every 13 weeks (£6.90 = 0.65ml)

Indications and dose

Etonogestrel
  • Nexplanon® implant 68mg in each flexible rod for subdermal implantation (£83.43 = implant)

Notes

  1. See Etonogestrel implant for further information

7.3.2.3 Intra-uterine progestogen-only device

MHRA Drug Safety Update (January 2016): Levonorgestrel-releasing intrauterine systems should always be prescribed by brand name because products have different indications, durations of use, and introducers.

For information on heavy and/or painful periods please refer to: NICE NG88 Heavy menstrual bleeding: assessment and management (March 2018)

Jaydess and Kyleena have physically smaller T-frame dimensions than Levosert or Mirena and the inserter tube used is slightly smaller, which might be more comfortable during insertion. LNG-IUS should not be considered as direct alternatives to each other; they should all be considered as distinct different options to discuss with women seeking contraceptive advice.

It has been suggested that a narrower introducer and a smaller device could be more suitable for women with a narrower cervical canal and/or smaller uterine cavity (such as nulliparous women or young women).

It is recommended that all LNG-IUS should only be inserted by physicians/healthcare professionals who are experienced in IUS insertions and/ or have undergone training on the individual products insertion procedures.

It is recognised that irregular bleeding and spotting are common with the use of IUS, but reduce with time; patients should be informed to seek medical advice if there is increased menstrual flow or unexpected bleeding.

Please see Levonorgestrel Intrauterine System (LNG-IUS) for further information

Jaydess®
  • Intrauterine system containing 13.5mg total dose levonorgestrel (£69.22 per device)
    • Initial release rate of levonorgestrel 14micrograms per 24 hours

Indications

  • Contraception for up to 3 years

Notes

  1. Jaydess is not recommended as a first choice for contraception in nulliparous women as clinical experience is limited
  2. Frame size (W x H) 28mm x 30mm, insertion tube diameter 3.8mm
  3. The routine commissioning of Jaydess® is accepted in Devon for the prevention of pregnancy (see Commissioning Policy for more details).
  4. The SPC indicates the failure rate was approximately 0.4% at 1 year and the cumulative failure rate was approximately 0.9% at 3 years
Levosert®
  • Intrauterine system containing 52mg total dose levonorgestrel (£66.00 per device)
    • Initial release rate of levonorgestrel 20micograms per 24 hours

Indications

  • Contraception for up to 5 years
  • Menorrhagia

Notes

  1. Levosert is suitable for nulliparous and parous women
  2. Frame size (W x H) 32mm x 32mm, insertion tube diameter 4.8mm
  3. The SPC indicates the failure rate was approximately 0.15% at 1 year and 0.2% at 5 years
Kyleena®
  • Intrauterine system containing 19.5mg total dose levonorgestrel (£76.00 per device)
    • Initial release rate of levonorgestrel 12micrograms per 24 hours

Indications

  • Contraception for up to 5 years

Notes

  1. Kyleena is suitable for nulliparous and parous women
  2. Frame size (W x H) 28mm x 30mm, insertion tube diameter 3.8mm
  3. The SPC indicates the failure rate was approximately 0.2% at 1 year and the cumulative failure rate was approximately 1.4% at 5 years
Mirena®
  • Intrauterine system containing 52mg total dose levonorgestrel (£88.00 per device)
    • Initial release rate of levonorgestrel 20micrograms per 24 hours

Indications

  • Contraception for up to 5 years
  • Menorrhagia
  • HRT-related endometrial hyperplasia

Notes

  1. Mirena is suitable for nulliparous and parous women
  2. Frame size (W x H) 32mm x 32mm, insertion tube diameter 4.4mm
  3. The SPC indicates the failure rate was approximately 0.2% at 1 year and the cumulative failure rate was approximately 0.7% at 5 years

MHRA Drug Safety Update (June 2015): Before inserting an intrauterine system (IUS) or intrauterine device (IUD), inform women that perforation occurs in less than 1 in 1,000 women and that the symptoms include:

  • severe pelvic pain after insertion (worse than period cramps)
  • pain or heavy bleeding after insertion which continues for more than a few weeks
  • sudden changes in periods
  • pain during sex
  • not being able to feel the threads

Explain to women how to check their threads and tell them to return for a check-up if they cannot feel them (especially if they also have significant pain). Partial perforation may have occurred even if the threads can still be seen; consider this if there is severe pain following insertion.

 

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