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