Types of combined hormonal contraception | Right Decisions

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Types of combined hormonal contraception

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Welcome to the Right Decision Service (RDS) newsletter for August 2024.

Contingency planning for RDS outages

Following the recent RDS outages, Tactuum and the RDS team have been reviewing the learning from these incidents. We are committed to doing all we can to ensure a positive outcome by strengthening the RDS to make it fully robust and clinically resilient for the future.

We would like to invite you to a webinar on 26^th September 3-4 pm on national and local contingency planning for future RDS outages. Tactuum and the RDS team will speak about our business continuity plans and the national contingency arrangements we are putting in place. This will also be a space to share local contingency plans, ideas and existing good practice. We would also like to gather your views on who we should send communications to in the event of future outages.

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2.National IV fluid prescribing calculator

This UK CA marked calculator is now live at https://righdecisions.scot.nhs.uk/ivfluids . It has been developed by a multiprofessional steering group of leads in IV fluids management, as part of the wider Modernising Patient Pathways Programme within the Centre for Sustainable Delivery. It aims to address a known cause of clinical error in hospital settings, and we hope it will be especially useful to the new junior doctors who started in August.

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New toolkits

The following toolkits are now live;

Gender identity healthcare: adults and young people standards. (https://rightdecisions.scot.nhs.uk/genderidentity ) Note that this toolkit includes self-evaluation forms for each standard. A Scottish Government launch of these standards, together with the toolkit and NES educational resources, is planned for 3^rd September.
Care Inspectorate staffing method framework.
Vascular surgery pathways from the Modernising Patient Pathways Programme within the Centre for Sustainable Healthcare Delivery.

Updated guidance on current and future Medical Device Regulations

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Guide to six stages of RDS toolkit development

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Thursday 5 September 1-2 pm
Wednesday 24 September 4-5 pm
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7 Evaluation projects

Dr Stephen Biggart from NHS Lothian has kindly shared with us the results of a recent survey of use of the Edinburgh Royal Infirmary of Edinburgh Anaesthesia toolkit. This shows that the majority of consultants are using it weekly or monthly, mainly to access clinical protocols, with a secondary purpose being education and training purposes. They tend to find information by navigating by specialty rather than keyword searching, and had some useful recommendations for future development, such as access to quick reference guidance.

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Healthcare Improvement Scotland

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® or Syreniring® ) consists of ethylene vinyl acetate (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.
Nuvaring® must be kept refrigerated prior to dispensing to the client. Syreniring® does not require refrigeration. After removal from the fridge, Nuvaring® can be stored at room temperature and used within 4 months. Women should therefore only be supplied with up to 3 Nuvaring® rings at a time. Syreniring® can be supplied as a years supply
Extended and tailored regimens can also be discussed

Last reviewed: 31/01/2024

Next review date: 31/01/2026

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

Version: 9.1

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