2 FEBRUARY 2015
Latest edition of Australian Prescriber out now
CHOOSING A COMBINED ORAL CONTRACEPTIVE PILL
Between 50 and 80% of Australian women use the pill at some stage during their reproductive lives. There are over 30 registered brands of the combined oral contraceptive pill available in Australia, but not all are subsidised by the government. An article in the latest edition of Australian Prescriber examines the multiple formulations of the pill.
Authors Mary Stewart from Family Planning NSW and Kirsten Black, Associate Professor at the University of Sydney, write that it is timely to look at the combined pill, with so many options on the market and recent developments with newer forms of progestogen. They recommend that health professionals offer a pill with the lowest effective dose of oestrogen and progestogen.
“The lowest dose should provide good cycle control and effective contraception. In choosing a pill, other factors to consider are that it should be well tolerated by the patient, have the best safety profile, be affordable and should also offer additional non-contraceptive benefits if desired. The non-contraceptive benefits include improving acne and lessening heavy menstrual bleeding.”
Mary Stewart and Kirsten Black write that the effectiveness of combined oral contraceptive pills is dependent on the pill being taken regularly. The pills containing ethinyloestradiol (for oestrogen) at doses equal to or below 35 microgram in combination with levonorgestrel or norethisterone (for progestogen) are considered first-line — due to a possible lower risk of blood clots — compared to other formulations, and are more affordable. Only the pills containing levonorgestrel and norethisterone are listed on the Pharmaceutical Benefits Scheme. The out-of-pocket expense for a four-month supply is approximately $20 compared to up to $120 or more for the newer non-PBS listed pills.
The authors write that newer pills are not necessarily better than formulations that have been available for many years. However, there is some evidence for superior non-contraceptive benefits of the newer pills, such as improving acne and hirsutism, lessening heavy menstrual bleeding, and improving physical symptoms of premenstrual syndrome.
Other articles in this issue are:
Australian Prescriber celebrates 40 years of medical publishing in 2015