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® 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

Editorial Information

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