Please note that the examples of brands listed below include the most cost-effective at the time of publication of this chapter (May 2017) and the current most cost-effective brand for primary or secondary care should be prescribed where possible.

The first line combined hormonal contraceptive for all women requiring CHC.

First line

• Levonorgestrel 150micrograms with ethinylestradiol 30micrograms - brand names include Rigevidon and Microgynon 30

(Note: In County Durham the Sexual Health Service choice is Maexeni 150/30)

Second line (alternative progesterone)

• Norethisterone 1.5mg with ethinylestradiol 30micrograms - Loestrin 30

Third line (slightly higher oestrogen content therefore helpful if vaginal dryness is affecting libido)

• Norethisterone 500micrograms with ethinylestradiol 35micrograms – Brevinor
• Norgestimate containing products are relatively expensive but are a benefit for those with progestagenic side effects (mood changes, skin problems):

Norgestimate 250micrograms with ethinylestradiol 35micrograms – Lizinna

(Note: In County Durham the Sexual Health Service choice is Cilest)

Fourth line (these oral preparations contain the third generation progesterones gestodene, desogestrel and drosperidone and therefore carry an increased risk of VTE compared to second generation progesterones. They should be reserved for women who are intolerant of other CHCs. These products are usually reserved for women who have progestogenic side effects on a first line pill and so need a more oestrogen-dominant pill. Due to the increased VTE risk the patient must be made aware before prescribing)

• Gestodene 75micrograms with ethinylestradiol 30micrograms (gives better cycle control if less progestogenic activity is required) – Millinette

(Note: In County Durham the Sexual Health Service choice is Aidulan 30/75)

• Desogestrel 150micrograms with ethinylestradiol 30micrograms (less progestogenic and more 'skin friendly') – Gedarel 30/150

(Note: In County Durham the Sexual Health Service choice is Munalea 150/30)

• Drosperinione 3mg with ethinylestradiol 30micrograms (beneficial if woman has acne plus hirsutism; plus a lower risk of VTE compared to Co-cyprindiol and should therefore be considered instead of Co-cyprindiol) – Lucette  

(Note: In County Durham the Sexual Health Service choice is Yiznell)

Please note that the examples of brands listed below include the most cost-effective at the time of publication of this chapter (May 2017) and the current most cost-effective brand for primary or secondary care should be prescribed where possible.

Low dose oestrogen content (consider switching to a product with a lower oestrogen component if there is significant nausea / vomiting. Be aware that these products may be less effective at inhibiting ovulation compared to products with a higher oestrogen component and are also more likely to have breakthrough bleeding)

• Norethisterone 1mg with ethinylestradiol 20micrograms - Loestrin 20

The following low dose oestrogren oral preparations contain third generation progesterones and therefore carry an increased risk of VTE. They should be reserved for women who are intolerant of other CHCs:

• Gestodene 75micrograms with ethinylestradiol 20micrograms - Millinette

(Note: In County Durham the Sexual Health Service choice is Aidulan 20/75)

• Desogestrel 150micrograms with ethinylestradiol 20micrograms – Gedarel 20/150

(Note: In County Durham the Sexual Health Service choice is Munalea 20/150)

For patients at risk of 'missed pills' and for those with persistent breakthrough bleeding (where other causes have been excluded). These products contain ethinylestridiol and levonorgestrel in varying amounts to correspond with each “phase”

• Logynon or TriRegol (same ingredients)

For use by a small number of women with gastrointestinal absorption problems or with compliance issues. The contraindications for CHC are the same for oral and transdermal preparations.

Evra patch is approximately 7x the cost of the first line oral ethinylestradiol 30micrograms / levonogestrel 150micrograms preparations.

Prescribe generically in most cases. N.B. Consider prescribing by brand in patients with soya or nut allergy as some generics may contain ingredients unsuitable for soya or nut allergy sufferers - check individual SPC.

First line (preferred due to 12 hour window to take a missed pill, compared to 3 hours with alternative progesterones)

• Desogestrel 75micrograms - brand names include Cerazette and Cerelle

 (Note: In County Durham the Sexual Health Service choice is Feanolla)

 Alternative progesterones

• Levonorgestel 30micrograms – Norgeston
• Norethisterone 350micrograms - Noriday

• Etonogestrel - Nexplanon

Replaced Implanon and differs in that it is impregnated with radio opaque material.

 Medroxyprogesterone

• Intramuscular preparation - Depo-Provera 150mg
• Subcutaneous preparation (consider this preparation when unsure if needle will reach the muscle, or if there is very little muscle) - Sayana Press 104mg

Prescribe by brand to ensure correct replacement time period:

Levonorgestrel-releasing intrauterine systems: prescribe by brand name. Drug Safety Update January 2016. MHRA. www.gov.uk/drug-safety-update/levonorgestrel-releasing-intrauterine-systems-prescribe-by-brand-name)

• 5 year contraceptive protection - Mirena
• 4 year contraceptive protection – Levosert
• 3 year contraceptive protection – Jaydess