COVID-19 – FSRH CEU Contraceptive Advice

The Clinical Effectiveness Unit of the Faculty of Sexual & Reproductive Health have published clinical advice to support provision of effective contraception during the COVID-19 outbreak.

BRIEF SUMMARY

EXISTING USERS

1.       COC/CHC – remote prescription to cover next 6-12 months without BMI/BP check reasonable – consider further supply without review of history if all relevant history documented & no contraindications at time of last supply.

2.       POP – further 12 months supply without review reasonable. Consider local PGD for remote provision by non-prescribing HCPs (nurses/pharmacists).

3.       Depot MPA – switch to desogestrel POP recommended – F2F assessment NO required. Caution/exception if absorption/adherence of concern or enzyme-inducing medication. No additional precautions needed if POP started up to 14 weeks after last DPMA injections.

4.       Sayana Press self-administration – up to 12 months supply + equipment for self-admin without F2F review or BP check reasonable.

5.       ENG-IMP – Replacement can be deferred for a year after expiry to avoid unnecessary F2F contact – women should be made aware that contraceptive effectiveness cannot be guaranteed but is likely to be adequate. Limited evidence suggests that the risk of pregnancy in the 4th year of use of an ENG-IMP is likely to be very low. Can offer additional POP without F2F – caution if absorption/adherence issues or enzyme-inducing meds.  Beyond 4 years – offer additional desogestrel POP. No indication for ENG-IMP removal unless planning pregnancy or serious adverse effects.

6.       LNG-IUS

a.       Mirena or Levosert – Replacement can be deferred for a year after expiry to avoid unnecessary F2F contact – women should be made aware that contraceptive effectiveness cannot be guaranteed but is likely to be adequate. Limited evidence suggests that the risk of pregnancy in the 6th year of use of an ENG-IMP is likely to be very low. Can offer additional POP without F2F – caution if absorption/adherence issues or enzyme-inducing meds. All women over age 45 years at insertion can rely on the 52mg IUS for contraception until age 55 (includes Levosert short term to avoid F2F). Beyond 6 years – offer additional desogestrel POP. No indication for LNG-IUS removal unless planning pregnancy or serious adverse effects.

b.      Jaydess or Kyleena – as above BUT should be advised to use condoms or add desogestrel POP as above at the end of the licensed duration of use.

c.       INDIVIDUALS USING THE 52mg LNG-IUS FOR ENDOMETRIAL PROTECTION AS PART OF HRT MUST HAVE THE IUS CHANGED AT 5 YEARS (OR STOP ESTROGEN, OR SWITCH TO A COMBINED HRT PREPARATION).

7.       Cu-IUD

a.       Licensed for 5 years – Use of additional condoms/desogestrel POP is advised from the time of expiry.

b.      Licensed for 10 years [e.g. TCu380A] – extremely limited evidence suggests that could be effective for up to 12 years – if use extended, women may wish to use additional condoms.

c.       Any Cu-IUD inserted over age 40 years will provide effective contraception until age 55 years.

d.      No indication for LNG-IUS removal unless planning pregnancy or serious adverse effects.

NEW STARTS

1.       STANDARD – remote assessment with 6-12 month supply of desogestrel POP – unless teratogenic meds or enzyme inducing meds. Local patient group direction for POP could be modified in the short term to allow remote provision by non-prescribing nursing/pharmacy staff.   NOTES:

a.       enzyme inducers can reduce contraceptive effectiveness of POP (DMPA, LNG-IUS and Cu-IUD are not affected)

b.      Teratogenic meds – ideally use LARC methods.

2.       If POP is not suitable or not acceptable:-

a.       First CHC prescription would require complete remote assessment of medical eligibility and accurate self-reported BP/BMI.  6-12 month supply should be provided.

b.      DMPA or ENG-IMP or IUS or IUD – may be considered where concerns about adherence, intolerance of oral contraceptives or use of teratogens make LARCs the only suitable options.

c.       Pre-procedure assessment and information-giving should be done remotely to minimise face-to-face contact time with healthcare professionals. Current local protocol regarding infection control should be followed at the time of the procedure.