New advice for contraceptive prescribers during COVID-19 pandemic

The Faculty of Sexual and Reproductive Healthcare (FSRH) has recommended giving users of combined and progestogen-only contraception a prescription for 6—12 months' supply with no need for face-to-face review.

Provision of effective contraception and emergency contraception are considered priority services. | GETTY IMAGES
Provision of effective contraception and emergency contraception are considered priority services. | GETTY IMAGES

For women already established on combined hormonal contraception, the FSRH's clinical advice to support provision of effective contraception during the COVID-19 outbreak says 'it is reasonable at this time' to allow further remote prescription to cover the next 6—12 months without rechecking BMI and blood pressure as the risk associated with unplanned pregnancy 'is likely to be greater than the risk relating to continued use'.

It may not be necessary to review the patient's medical history if this was comprehensively documented at the time of the last contraceptive prescription and no contraindications were identified.

For users of the progestogen-only pill (POP) a further 12-month supply can be given without review. The FSRH suggests that local patient group directions for POP could be modified in the short term to allow remote provision by non-prescribing nursing or pharmacy staff.

Long-acting contraception

The FSRH's guidance also provides advice on long-term reversible contraception, including medroxyprogesterone acetate depot injections (Depo-Provera and Sayana Press).

It says women using Depo-Provera should be switched to a desogestrel POP; if this is started up to 14 weeks after the last injection no additional contraceptive precautions are required. Face-to-face assessment is not needed but prescribers should note that concomitant use of an enzyme-inducing medication could reduce effectiveness of the POP.

Women who self-administer Sayana Press can receive up to 12 months' supply of the injection without a face-to-face review or blood pressure check.

Replacement of the etonogestrel implant (Nexplanon) and the 52mg levonorgestrel-releasing IUS (Mirena or Levosert) can be deferred for a year after expiry. Women should be advised that contraceptive efficacy cannot be guaranteed but their risk of pregnancy is likely to be very small. They can be offered a POP to use in addition without face-to-face assessment if they wish. Beyond the first year after expiry (after 4 years of Nexplanon use, or 6 years of Mirena/Levosert use) a POP should be offered. 

All women over the age of 45 at insertion of the 52mg levonorgestrel IUS can rely on the device for contraception until the age of 55. 

The FSRH's recommendations do not apply to women using the 52mg levonorgestrel IUS for endometrial protection as part of HRT, who must have their device changed at 5 years, or stop oestrogen, or switch to a combined HRT preparation. 

Women using lower-dose levonorgestrel IUS (Jaydess or Kyleena) should be advised to use condoms or prescribed a desogestrel POP at the end of the licensed duration of use.

For women with copper IUDs licensed for 5 years' use, additional use of condoms or a desogestrel POP is advised from the time of expiry, although any device inserted over age 40 years will provide effective contraception until age 55 years.

The FSRH says expired copper IUDs, implants and IUS do not need to be removed at this time.

New users

The FSRH suggests that people wanting to start contraception be assessed remotely and a 6—12 month supply of a desogestrel POP provided. 

If a POP is not suitable or not acceptable, a 6—12 month supply of combined hormonal contraception can be prescribed following complete remote assessment of medical eligibility and documentation of accurate self-reported blood pressure and BMI. 

Medroxyprogesterone acetate depot injection, the etonogestrel implant and intrauterine methods can be considered if there are concerns about adherence, intolerance of oral contraceptives or use of teratogenic medicines. Pre-procedure assessment and counselling should be done remotely to minimise face-to-face contact. 

Emergency contraception

The FSRH says remote assessment of patients requiring emergency contraception should be prioritised.

Insertion of a copper IUD should continue to be offered first line, where possible and appropriate; if there is a delay before insertion, immediate oral emergency contraception should also be offered.

People who do not meet the criteria for emergency IUD insertion or who decline an emergency IUD should be assessed remotely, receive both oral emergency contraception and a 3-month supply of POP and be given clear written/digital advice about additional contraceptive precautions, when to start the POP, and follow-up pregnancy testing.

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