Standard and tailored regimens for use of CHC
Type of regimen | Period of CHC use | Hormone free interval (HFI) |
Standard use | 21 days (21 active pills or 1 ring, or 3 patches) | 7 days |
Tailored use* | | |
Shortened HFI | 21 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 use | Continuous use (≥ 21 days) of active pills, patches or rings until breakthrough bleeding occurs for 3–4 days | 4 days |
Continuous use | Continuous use of active pills, patches or rings | None |
*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 20micrograms/150micrograms (£5.98 = 63 tablets)
Notes
- 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
- 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 20micrograms/150micrograms (£8.44 = 63 tablets)
Notes
- 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 20micrograms/75micrograms (£8.85 = 63 tablets)
Notes
- 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 30micrograms/150micrograms (£1.89 = 63 tablets)
Notes
- 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
- 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
- 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
- Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)
- 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
- 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 30micrograms/150micrograms (£2.82 = 63 tablets)
Notes
- 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 30micrograms/75micrograms (£6.73 = 63 tablets)
Notes
- 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
- 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 30micrograms/3mg (£11.00 = 63 tablets)
Notes
- Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)
- 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 30micrograms/3mg (£14.70 = 63 tablets)
Notes
- Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)
- 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 30micrograms/150micrograms (plus white placebo tablets) (£2.99 = 84 tablets)
Notes
- 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 (£3.82 = 63 tablets)
Notes
- Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)
- 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 33.9micrograms/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
- Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)
- 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
- Arrange follow up 3 months after the first prescription, and annually thereafter:
- Check blood pressure, BMI, and assess for any new risk factors which may mean the combined transdermal patch is no longer suitable
- Only one transdermal patch is to be worn at a time
- 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
- Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)
- 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
- Arrange follow up no longer than 3 months after the first prescription, and annually thereafter:
- Check blood pressure, BMI, and assess for any new risk factors which may mean the contraceptive vaginal ring is no longer suitable
- 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)
- 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
- Advise women to regularly check for the presence of the ring in the vagina (for example, before and after intercourse)
- 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.