Contraceptives and advice regarding Coils, Implants and Depo injections

MANAGING REPEAT PRESCRIPTIONS OF CONTRACEPTIVES AND ADVICE FOR USERS OF COILS;IMPLANTS AND DEPO INJECTIONS

 

We understand that many of you are concerned about your repeat prescriptions of Combined Oral Contraceptive pills (COC) and Progesterone Only Pills (POP).

You may also have concerns about long acting contraceptives (LARCs) approaching the end of their licensed active life, such as Depo injections, Nexplanon Implants, Non-hormonal copper coils [IUD] and hormonal coils such as the Mirena [IUS] or Jaydess.

If you are not already on the waiting list at the Practice, the following is a recommendation of what your options are during this pandemic.

 

Combined Oral Contraception (COC)

 

⇒ Combined pill/ patch

If you have had a contraceptive review in the last 6 months (BP, consultation, weight check) then we can issue a repeat prescription for 6 months. If you  had a review 12 months ago then we can issue a prescription for 3 months providing there are no; abnormal weight changes, any new medical problems including new migraine, thrombosis/blood clots, raised blood pressure or medication changes.

If there have been new changes since your last review it may be safer to change you to a POP, finish your last COC tablet and the start the new POP the following day.

 

Progesterone only pill  (POP)

 

Providing you have no new illnesses or new medications we can issue a repeat for 12 months.

 

 Coil Replacement due (IUD/IUS)

 

⇒ IUD – Non Hormonal Coils

IUDs have a 5 year or 10 year licence, please check on your patient information sheet or Patient card for this information. If the coil has reached the end of its licensed active life, then please take note of the following advice.

  • If the IUD is licensed for 5 years we can issue a 3 month supply of the Progesterone only pill to take daily without a break or use additional contraception such as condoms
  • If the IUD (such as T-Cu380A ) has a 10 year license then it will provide contraceptive cover for up to 12 years and no additional contraception is needed
  • If the IUD was inserted after you were aged 45 there is no need to change this at all, it can remain in place until you no longer require contraception

 

⇒ IUS-Hormonal Contraceptive Coils

Please check on your patient information card what sort of IUS was inserted, if you are uncertain, please feel free to ring the practice.

Mirena and Levosert are licensed for 5 years use for contraception, but there is evidence to support ongoing contraceptive cover for 6 years, so there is no need to change at the moment.

Jaydess has a 3 year license and should not be relied on after that time, we would prescribe 3 months of the POP to provide full contraception.

If you were aged over 45 when the Mirena was inserted this can be left (unless you are using this for part of your HRT) until you are aged 55.

If the Mirena or Levosert are used for heavy, menstrual bleeding ONLY it can be left for as long as it is still effective, so there is no need to change after 5 years. If you starts experiencing problematic bleeding you should contact the practice for advice.

If Mirena is inserted for the purpose of HRT, the recommendation is that it can stay in for 5 years (licensed for 4 years) with added oestrogen therapy but if is more than 5 years then you should consult the Surgery to arrange a change of HRT.

 

⇒ Implant – Nexplanon

If you are due for a change of contraceptive implant, there is evidence that the implant remains an active method of contraception for 4 years rather than 3 years. However if you are concerned; we could supply you with a prescription of the POP to be taken continuously as additional cover (the hormone is very similar to that in the implant).

 

⇒ Depo-Injections

Depo Provera continues to have a contraceptive effect for 14 weeks and no extra precautions are required if the repeat injection is delayed until then. After 14 weeks we can prescribe a POP such as Cerelle to be taken continuously until the next depo injection is given and also continuing until 7 days after the next depo is given.

If you are already using Sayana Press we can re-prescribe it as a repeat injection as you are giving it yourselves.

If Depo Provera is used ONLY for menstrual problems then the absence of periods may last for longer than the expected time so there is no need for an additional injection until the menstrual problem recurs.

 

EMERGENCY CONTRACEPTION

If you are in need of emergency contraception, please ring the practice and we will assess every situation individually.

Source www.pcwhf.co.uk following recommendations from the Faculty of Sexual and Reproductive Health