Indications: -contraception
Cautions: - heart disease, sex - steroid dependent functional ovarian cysts, active, liver disease, recurrent cholestatic jaundice, history of jaundice in pregnancy; see also interactions
Drug interactions: - see notes above under interaction and progestogen only contraceptives notes.
Contraindications: - pregnancy, undiagnosed vaginal bleeding; severe arterial disease; liver adenoma, porphyria; after evacuation of hydatidiform mole (until return to normal of urine and plasma gonadotrophin values); see notes above
Side effects: -menstrual irregularities (see also notes above); nausea, vomiting, headache dizziness, breast discomfort, depression, skin disorders, disturbance of appetite, weight changes, changes in libido.
Breast cancer: There is a small increase in the risk of having breast cancer diagnosed in women using or who have recently used, a progestogen - only contraceptive pill; this relative risk may wholly or partly be due to an earlier diagnosis. The most important risk factor appears to be the age at which the contraceptive is stopped rather than the duration of use; the risk disappears gradually during the 10 years after stopping and there is no excess risk by 10 years.
Dose and Administrations: - see under preparation
Oral Preparations
Ethynodiol Diacetate, Tablet, 0.5mg
Levonorgestrel (D-Norgestrel) - Tablet, 0.03 mg
Lynestrenol, Tablet 0.5mg
Norethindrone (Norethisterone) - Tablet, 0.35mg
Dose: - 1 tablet daily at same time each days starting on day 1 of cycle then continuously; if administration delayed for 3 hours or more it should be regarded as a 'missed pill'.
Parentral preparations
Medroxyprogesterone Acetate, injection (aqueous suspension), 150mg/ml in l ml vial
Dose: - by deep intramuscular injection, 150mg within first 5 days of cycle or within first 5 days after parturition (delay until 6 weeks after parturition if breast-feeding); for long-term contraception, repeated every 12 weeks (if interval greater than 12 weeks and 5 days, exclude pregnancy before next injection and advise patient to use additional contraceptive measures (e.g barrier) for 14 days after the injection).
Norethindrone (Norethisterone) Enanthate, injection (oily), 200mg/ml in 1 ml ampoule.
Dose: by deep intramuscular injection given very slowly into gluteal muscle, short-term contraception, 200mg with in first 5 days of cycle or immediately after parturition (duration 8 weeks); may be repeated once after 8 weeks (withhold breast-feeding for neonates with severe or persistent jaundice requiring medical treatment).
Implants
Etonogestrel, Implant (subdermal) 68 mg/capsule, pack of 1 capsule.
Dose: -by subdermal implantation, no previous hormonal contraceptive, 1 implant inserted during first 5 days of cycle; parturition or abortion in second trimester, 1 implant inserted between days 21 - 28 after delivery or abortion (if inserted after 28 days additional precautions necessary for next 7 days); abortion in first trimester, 1 implant inserted immediately; changing from an oral contraceptive, consult product literature; remove within 3 years of insertion.
Levonorgestrel (D-Norgestrel); Implant capsule (subdermal); 36mg/capsule pack of 6 capsules, 108mg/capsule pack of 2 capsules; 75mg/capsule pack of 2 capsules.
Dose: - Implant capsule -by subdermal implantation, set of 6 implant capsules inserted within first 5 days of cycle (preferably on 1st day after 1st day additional precautions necessary for following 7 days) or 21st day after parturition (after this any additional, precautions necessary for following 7 days), remove within 5 years of insertion.
