Types of combined hormonal contraception

Warning

Combined oral contraception (COC)

  • Described as any oral hormonal preparation containing an oestrogen in conjunction with
    a progestogen.
  • In current practice, low dose COCs contain 20 – 35 micrograms (mcg) of ethinylestradiol
    (EE) in combination with a progestogen.
  • Progestogens include norethisterone, levonorgestrel, desogestrel, gestodene,
    norgestimate and drospirenone.
  • The primary mode of action of this type of preparation is to prevent ovulation. These pills
    are packed in 21 day packs but are also available as every-day packs with placebo
    tablets to aid concordance with the method.
  • Extended and tailored regimens can be offered (with the client made aware of off license
    use)
  • There are 2 products containing oestradiol (Zoely® with oestradiol hemihydrate combined
    with nomegestrol in a 28 day pack, and Qlaira® with oestradiol valerate combined with
    dienogest in a 28 day pack), but neither are approved by SMC for contraceptive use
    within Scotland

Combined transdermal patch (CTP)

  • Currently in the UK there is one transdermal contraceptive patch which releases 33.9
    micrograms ethinylestradiol and 203 micrograms norelgestromin per 24 hours (Evra®).
  • One patch to be applied once weekly for three weeks, followed by a 7 day patch free
    interval
  • Extended and tailored regimens can also be discussed

Combined vaginal ring (CVR)

  • The combined vaginal ring (Nuvaring®) consists of ethylene vinylacetate (latex-free) and
    releases 15 micrograms ethinylestradiol and 120 micrograms etonogestrel daily. One ring
    should be inserted vaginally for 3 weeks of use per cycle.
  • This should then be removed and a new ring inserted after a 7-day ring-free break.
  • Rings must be kept refrigerated prior to dispensing to the client. Thereafter, they can be
    stored at room temperature and used within 4 months. Women should therefore only be
    supplied with up to 3 rings at a time.
  • Extended and tailored regimens can also be discussed

Editorial Information

Last reviewed: 31/05/2022

Next review date: 31/05/2024

Author(s): West of Scotland Managed Clinical Network for Sexual Health Clinical Guidelines Group.

Version: 7.1

Approved By: West of Scotland Managed Clinical Network for Sexual Health