Prescribing Notes

Contraceptive devices

Diaphragms are barrier contraceptives which initially require fitting and instruction on their use. They should be positioned diagonally across the cervix, vaginal vault and much of the anterior wall. They should always be used with a spermicide and additional spermicide used for repeated intercourse.

Cervical caps are similar to diaphragms but are smaller and fit over the cervical entrance. They stay in place by suction and may provide more of a barrier to sperm penetration. They should also be used with a spermicide.

Intrauterine devices (IUDs) are thought to stimulate a pronounced inflammatory reaction that may prevent implantation of the fertilised ovum. Copper IUDs need changing at intervals of between five and 10 years as the copper is gradually eluted with a possible reduction in efficacy. Contact manufacturer for further information.

Jaydess, Kyleena, Levosert and Mirena are intrauterine systems consisting of a T-shaped IUD and a hormone reservoir designed to release levonorgestrel daily over a period of at least three years (Jaydess) or five years (Kyleena, Levosert, Mirena). Kyleena and Mirena have a contraceptive failure rate of approximately 0.2% at one year; the cumulative failure rate at five years is approximately 1.4% and 0.7%, respectively. Levosert has a contraceptive failure rate of approximately 0.19% per year. In clinical studies with Jaydess, the failure rate was approximately 0.4% at one year with a cumulative failure rate of 0.9% at three years. Levonorgestrel-releasing intrauterine systems should be prescribed by brand name because they have different indications, durations of use, and introducers.