Notes for: ContraceptivesLast edited [26/03/2014 14:38:37]Drug Safety Update Feb'14 advice
Notes for: Parenteral Progestogen-only ContracepLast edited [04/07/2012 09:12:01]
NICE Clinical Guideline 30 Long-acting reversible contraception (Issued October 2005) refers.
Women considering LARC methods should receive detailed information - both verbal and written - that will enable them to choose a method and use it effectively. This information should take into consideration their individual needs and should include:
-
contraceptive efficacy
-
duration of use
-
risks and possible side effects
-
non-contraceptive benefits
-
the procedure for initiation and removal / discontinuation
-
when to seek help while using the method
Last edited [21/08/2013 15:04:54]
Injection
1. CSM advice (Nov 2004) The CSM has advised that
-
In adolescents, medroxyprogesterone acetate (Depo-Provera®) be used only when other methods are inappropriate.
-
In all women, benefits of using medroxyprogesterone acetate beyond 2 years should be evaluated against risks.
-
In women with risk factors for osteoporosis an alternative method of contraception instead ofmedroxyprogesterone acetate should be considered.
2. The interval between injections does not need to be altered when an enzyme-inducing drug is also prescribed (even rifampicin).
3. Before administration it should be established with reasonable certainty that the woman is not pregnant. Provide the manufacturer's leaflet (with time to read it and any questions answered) before she decides on injectable contraception.
Counselling should cover:
-
Amenorrhoea
-
Frequent irregular bleeding patterns, particularly at outset.
-
There is an association with weight gain.
-
On average it may take up to 1 year from the time of last injection to return to fertility.
-
Use of progestogen-only injectables is associated with a small loss of bone mineral density, which is usually recovered after discontinuation. There is no evidence of an increased risk of fracture.
4. Norethisterone enantate (Noristerat®) has not been included in this formulary because it is only licensed for 2 injections.
Last edited [21/08/2013 15:11:38]
Implant
1. Before treatment commences it should be established with reasonable certainty that the woman is not pregnant. Provide the manufacturer's leaflet (with time to read it and any questions answered) before she decides on an implant. Counselling should cover:-
2. Women prescribed enzyme inducing drugs require additional precautions. An alternative contraceptive method should be considered if long term use of the enzyme-inducing drug is contemplated.
3. There is no evidence of a delay in fertility following removal of a progestogen-only implant.
NB:
- The PPD has classified Nexplanon® as an implant and not an injection. Therefore, it will not be reimbursed as a personally administered item.
- The practitioner fitting (or removing) Nexplanon® should be fully trained in the technique. Therefore Nexplanon® has been included as a ORANGE drug. As the responsibility for prescribing lies with the doctor who signs the prescription the doctor fitting Nexplanon® should also prescribe it.