Prescriber Update Articles

Ministry of Health (Medsafe) advice on the use of combined oral contraceptives - June 2000

Web site: July 2000
Medsafe Editorial Team

Medical practitioners and midwives are advised to consider the following recommendations when prescribing low dose oral contraceptives.

The view of the Medicines Adverse Reactions Committee and the Ministry of Health remains unchanged that combined oral contraceptives containing desogestrel or gestodene:

• do not appear to possess significant additional health benefits (eg. reliability of contraception, reduction in the risk of cardiovascular disease) above the second generation oral contraceptives, other than improvement in tolerability and quality of life in some patients;
• may be prescribed for women who have adverse effects such as breakthrough bleeding or androgenic side effects with other combined oral contraceptives.

When initiating contraceptive therapy the prescriber should:

• take a comprehensive personal and family history to exclude contraindications to the use of combined oral contraceptives. If there is a family history of thromboembolism, screening for thrombophilia should be considered in consultation with a haematologist. Hereditary thrombophilia and personal history of venous thromboembolism are contraindications;
• counsel women about the risks and benefits associated with the use of all forms of contraception;
• consider prescribing a low dose combined oral contraceptive, containing no more than 35mcg ethinyloestradiol and a progestogen other than desogestrel or gestodene, where the woman has no contraindications to the use of a combined low dose oral contraceptive and has indicated that she wishes to take a combined oral contraceptive. Prescribe a pill containing a higher dose of oestrogen only if it is specifically indicated.
• advise women about the symptoms of venous thromboembolism, especially pulmonary embolism, and situations of increased risk.

When reviewing combined oral contraceptive therapy the prescriber should:

• review the personal and family history to identify contraindications for the use of combined oral contraceptives and risk factors for venous thromboembolism as for initiation of therapy;
• counsel about the risks and benefits associated with the use of the contraceptive the woman is currently taking compared to the risks and benefits of other forms of contraception;
• if contraindications to the use of combined low dose oral contraceptives are present, another form of contraception should be agreed upon;
• advise women prescribed a combined oral contraceptive about symptoms of venous thromboembolism, especially pulmonary embolism, and situations of increased risk;

For women taking oral contraceptives containing desogestrel or gestodene:

• in the presence of thromboembolic risk factors the woman should be advised to change to a preparation that does not contain desogestrel or gestodene, or to another contraceptive method, as appropriate;
• offer prescription of other hormonal or non-hormonal contraception if, after counselling, the woman finds the relative risk of venous thromboembolism with combined oral contraceptives containing desogestrel or gestodene unacceptable;
• respect the woman's informed choice if she chooses to continue to take her current contraceptive.

Risk factors for venous thromboembolism (VTE)

*Contraindications for combined oral contraceptives.