Progesterone-only Contraceptives


 

Desogestrel, Etonogestrel, Levonorgestrel, Medroxyprogesterone, Norethisterone, Ulipristal acetate

 

[For norethisterone therapeutic doses >5mg – see separate monograph]

  Issues for Surgery


None – there is no evidence to suggest an increased risk of venous thromboembolism with the use of progesterone-only contraceptive pills1, implants2, injectables3, intrauterine systems4 or emergency contraception5.


  Advice in the Perioperative period


Elective and Emergency Surgery

Continue.

EXCEPT:

  • Norethisterone at therapeutic doses i.e. > 5mg (see Norethisterone (Therapeutic doses i.e. > 5mg) monograph)

Risk of contraceptive failure and pregnancy (potentially leading to cancellation of surgery) if discontinued preoperatively or if dose of progesterone-only oral contraceptive delayed by longer than 12 hours5.

Perioperative Considerations

If sugammadex is administered in theatre see post-operative advice under Interaction(s) with Common Anaesthetic Agents.

Post-operative Advice

Continue post-operatively.


  Interaction(s) with Common Anaesthetic Agents


Sugammadex

Administration of a single bolus dose of sugammadex is predicted to cause a 34% decrease in progestogen exposure (comparable to the decrease when a daily dose of oral contraceptive is taken 12 hours late).  This predicted pharmacokinetic reaction has not been proven clinically, however it is recommended that users of oral contraceptives follow the missed dose advice in the package leaflet and that users of non-oral hormonal contraceptives use an additional non-hormonal contraceptive method for the next 7 days6, 7.


  Interaction(s) with other Common Medicines used in the Perioperative Period


None5, 6.


  Further Information


Progesterone-only oral contraceptives are recommended as an alternative to combined oral contraceptives for patients before major elective surgery, before surgery to the lower limbs or before surgery that involves prolonged immobilisation of a lower limb5.


  References


  1. Faculty of Sexual and Reproductive Healthcare. Clinical Guidance Progesterone-only pills. Clinical Effectiveness Unit. March 2015 (updated April 2019).  https://www.fsrh.org [Accessed on 10th May 2019]
  2. Faculty of Sexual and Reproductive Healthcare. Clinical Guidance Progesterone-only implants. Clinical Effectiveness Unit. February 2014.  https://www.fsrh.org [Accessed on 10th May 2019]
  3. Faculty of Sexual and Reproductive Healthcare. Clinical Guidance Progesterone-only injectable contraception. Clinical Effectiveness Unit. December 2014 (updated April 2019).  https://www.fsrh.org [Accessed on 10th May 2019]
  4. Faculty of Sexual and Reproductive Healthcare. Clinical Guidance Intrauterine Contraception. Clinical Effectiveness Unit. April 2015 (updated October 2015).  https://www.fsrh.org [Accessed on 10th May 2019]
  5. Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 10th May 2019]
  6. Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. www.medicinescomplete.com [Accessed on 10th May 2019]
  7. Summary of Product Characteristics - Bridion® (sugammadex). Merck Sharp & Dohme Limited.  Accessed via www.medicines.org.uk 10/05/2019 [date of revision of the text March 2019]