Contraception

Updated FSRH guidance during the third Covid-19 lockdown

PLEASE NOTE: THIS IS NO LONGER RELEVANT AND IS NOT BEING UPDATED BUT HAS BEEN LEFT ON THE SITE FOR REFERENCE PURPOSES ONLY

This information is sourced from the Faculty of Sexual and Reproductive Healthcare (FSRH):

Service provision

FSRH guidance published on 21st January 2021 details these services as essential during a third Covid-19 lockdown in the UK and beyond January 2021:

Emergency contraception (oral and IUD)
Provision of new and ongoing contraception including LARC
Contraception provision for vulnerable groups
Management of complications with existing contraception including LARC
Abortion and post-abortion care
Post-pregnancy contraception including LARC
Sexual assault care

These essential services should be delivered via remote/digital consultation (phone, video or online), and face-to-face where clinically necessary and/or feasible

Local services should adopt a flexible, realistic approach and inform the local commissioner if they no longer have capacity to provide LARCs so that resources are diverted to those who can

Clinical guidance

Emergency contraception (EC)

Remote assessment for EC should be prioritised so that EC can be offered as soon as possible
Insertion of an IUD for EC should continue to be offered first line to qualifying individuals
If there is a delay prior to Cu-IUD insertion, immediate oral EC should be given in addition
For individuals who do not meet the criteria for emergency IUD insertion, or who decline this option, remote assessment should be undertaken to identify the most appropriate oral EC
They should receive both oral EC and a 3-month supply of desogestrel POP plus clear written/digital advice about additional contraceptive precautions, when to start the POP, and follow up pregnancy testing
Postal delivery of oral EC should be avoided (to avoid delay) and either electronic prescribing or a ‘click and collect’ system encouraged
If POP is not acceptable, CHC may be quick started by eligible individuals in this situation

Combined hormonal contraception

Clinical history must be assessed and information given about risks, benefits and contraceptive effectiveness
An accurate blood pressure and BMI measurement should have been documented within the past year – these may be self-reported during Covid-19 restrictions
A one-year supply of combined oral contraception, Evra or SyreniRing may be given
Nuvaring can only be dispensed three months at a time

Progestogen-only pill

The desogestrel POP is ideal for remote provision as no physical examination (e.g. blood pressure) is required
POP is an ideal bridging method
It can be used safely by most individuals and is over 99% effective for contraception if taken correctly
A one year supply may be prescribed for eligible individuals
It is hoped that the desogestrel POP may be bought from pharmacies without prescription in the near future

Depot medroxyprogesterone acetate DMPA (Depo Provera and Sayana Press)

DMPA can routinely be repeated at 14-week intervals without requirement for additional contraceptive precautions or pregnancy testing
If the interval is >14 weeks but there has been no UPSI since 14 weeks, DMPA may be given, with advice to use condoms for 7 days
If the interval is >14 weeks AND there has been UPSI since 14 weeks, IF a high sensitivity urinary pregnancy test is negative, DMPA may be given, with advice to use condoms for 7 days. A follow up urinary pregnancy test MUST be taken at 21 days after the last UPSI
This may be an opportunity for individuals to be taught to self-administer Sayana Press; a one-year supply can be given, allowing the user to avoid contact with healthcare professionals for repeat injections

Nexplanon

New Nexplanon users should start or quick start according to existing FSRH guidance
To avoid unnecessary risk of coronavirus transmission, replacement can be deferred for up to a year after expiry
Women should be advised that contraceptive effectiveness is not guaranteed during the fourth year and they may wish to use additional contraceptive precautions
For guidance on additional contraceptive precaution when changing a Nexplanon during Covid-19 restrictions see page 3 of this document
Decisions about whether to undertake deep or difficult implant removals that require longer contact time should be made after a risk assessment
The existing implant can safely remain in situ in the short term and a new Nexplanon can be inserted in the other arm

Levonorgestrel-releasing intrauterine systems (LNG-IUS) and copper intrauterine devices (Cu-IUD)

New users

Existing pregnancy should be excluded as usual unless they meet criteria for use as emergency contraception; bridging contraception can be provided where pregnancy cannot be excluded

Existing users

52mg LNG-IUS (Mirena or Levosert)

Risk of pregnancy during the 6th year of use of a 52mg LNG-IUS appears to be very low, but evidence is limited
To avoid unnecessary risk of coronavirus transmission, Mirena or Levosert replacement may be delayed for up to a year after expiry
Users should be advised that contraceptive effectiveness is not guaranteed during the sixth year and that they may wish to use additional contraceptive precautions (e.g. condoms or POP) until the IUS can be replaced
It is standard practice that individuals aged over 45 years at the time of 52mg LNG-IUS fitting can rely on the device FOR CONTRACEPTION until age 55 years
If a 52mg LNG-IUS is used for endometrial protection as part of HRT it must be either changed at 5 years or a combined HRT preparation commenced

Kyleena

Additional contraceptive precautions are required as usual after the licensed 5 years (condoms or add desogestrel POP)

Jaydess

Additional contraceptive precautions are required as usual after the licensed 3 years (condoms or add desogestrel POP)

Cu-IUD with a 10 year licence

The risk of pregnancy up to 12 years of use is likely to be low
Contraception cannot be guaranteed and individuals may wish to use additional contraceptive precautions until it is considered safe to attend for replacement

Cu-IUDs with a 5 year licence

Additional contraceptive precautions are required as usual after the licensed 5 years for 5-year Cu-IUDs

See FSRH guidelines for pregnancy testing/additional contraceptive precautions required for when replacing IUS/IUD after extended use due to the Covid-19 pandemic

FSRH have produced an advice leaflet for women seeking reproductive healthcare during the COVID-19 epidemic

NHS UK Website has an online sexual health service finder for patients