Current prescribing guidelines

Please note: Yasmin®/Lucette® are non formulary in most Health Boards and non formulary systems may apply. They do not have SMC approval.

Yasmin® contains 30 micrograms ethinylestradiol plus 3 micrograms drospirenone (an anti-mineralocorticoid gestogen).

Indications
This should be offered only as second line oral contraceptive where there:

1. have been side effects related to fluid retention, mood change, acne or true weight gain related to oral contraception
2. other methods of contraception have been discussed
3. clients have tried at least two COCs with different gestogens.

Careful documentation of the side effects should be made.

Dianette® Clairette®, Acnocin® and Cicafem® contains 35mcg EE plus 2mcg cyproterone acetate and are not licensed as a COC.
Recent data confirms that co-cyprindiol has a VTE risk which is greater than second generation CHCs, but is equivalent to that of third generation CHC.

Indications

• In the UK the CSM advises: Co-cyprindiol is not indicated solely as a contraceptive; it is a treatment option for women with severe acne, which has not responded to oral antibiotics, or for moderately severe hirsutism.
• It should be withdrawn 3 – 4 months after the treated conditions has resolved or if there is no improvement in symptoms.
• If a women wishes to continue with a combined oral contraceptive pill an alternative preparation should be offered with a progestogen with low androgenic side effects eg: gestodene, desogestrel, drospirenone
• There are however a number of women whose skin control deteriorates significantly on withdrawal of Co-cyprindiol and they should be counselled on an individual basis with regard to the risks and benefits of this preparation for them as it may be that it is on balance appropriate for them to continue with Dianette®.

• If availability of hormone is likely to be improved by the transdermal / transmucosal route of absorption as opposed to the use of an oral preparation (inability to take tablets, bowel disease)
• Where a woman chooses and is suitable for combined hormonal contraception, and continuation of the method would be improved by the transdermal / transmucosal system of a once weekly patch change or four weekly ring change (including one week ring free).
• Please discuss with a senior colleague
• Cost effectiveness should also be considered with the recent reduction in price per cycle