Contraception Provision During the COVID 19 Pandemic

Department of Sexual Health C&V proposals for Primary Care settings.

It is paramount that women do not suffer an unplanned pregnancy at present as the availability of a termination service cannot be guaranteed or may be reduced in capacity, and maternity services will be under duress with Pregnant women who will be at high risk when contracting COVID19.

Patients already on contraception

POP: Issue 12 months prescription after telephone consultation to establish that no change in medical history. Advise to use concurrent condoms and /or an app for compliance and safety.

COCP:If no change in medical history and had normal BP in last 12 months and 35 or under issue 12 months prescription. If over 35 or where logistically feasible to attend for self-taken BP at surgery. You may wish to advise extended regimens “tricycling” as per Faculty guidance. https://www.fsrh.org/news/fsrh-release-updated-guidance-combined-hormonal-contraception/

Advise to use an app for compliance and stress the importance of safety, Women may wish to use concurrent condoms.

Ring:    see above

LNG IUC “IUS”: Change of IUS where used for contraception only, can be left in situ for six years, patients may choose to use concurrent condoms. Over 6 years prescribe Levonorgestrel or Desogestrel POP and leave in situ.

If used for HRT and in situ for >5 years change to combined HRT, leave in situ if also serving as contraceptive method.

If used for HMB, leave in situ and top up with POP ( LNG or desogestrel), if UK MEC 1 issue concurrent COCP.

CU IUC  “copper coil”:  use condoms after 10 years, leave IUC in situ. Prescribe Tranexamic Acid or COCP for women experiencing HMB, where possible do not remove LARC at present.

Implant: If within 4 years of fitting protection is likely to continue, patients may want to choose to use concurrent POP or condoms. If in situ for longer than 4 years treat as if not on contraception.

DMPA “depot”:  continue giving DMPA at 13 weekly intervals, consider minimising face2face contact by assessing continued eligibility over the phone.

Patients not currently on contraception or willing/wanting to change

• Consider changing women onto DMPA if they are at risk from pregnancy due to lack of compliance on oral contraception.

Quickstarting DMPA at a time of pregnancy risk ( for example at the time of issuing Levonelle) is justified where deemed necessary to prevent an ongoing pregnancy risk as long as a pregnancy test is advised after 3 weeks.

https://www.fsrh.org/standards-and-guidance/current-clinical-guidance/quick-starting-contraception/

We advise women to take a test after 4 weeks if we are concerned that they may continue to be at risk in the first 7 days after the first injection.

• Consider and discuss DMPA first line for patients starting contraception. See also above.

• Provide oral Emergency contraception and if eligible for an Emergency CU IUC advise to also ring us on 02920 355208 to see if we have capacity on that day for an Emergency Cu IUC fit

Eligibility for an EC IUC is within 120 hrs of Unprotected Intercourse UPSI if that is the only UPSI since last normal period (or in last 3 weeks), or

If within 120 hrs of expected ovulation in that cycle (14 days prior to expected next period, estimated by shortest cycle length the woman has on a regular basis)

In our department we use self fill history forms for first contraceptive prescriptions as well as “rapid repeat pill provision” to minimise face2face contact. We are currently exploring the option of emailing these to patients and receiving them back electronically.

At a time of depleted staff capacity we deem it reasonable to provide Desogestrel only pill on the back of a simple patient self assessment form. Concurrent condom use is advised for extra safety.

We are advising patients by text to access the following information resources for further method specific information: 

 www.contraceptionchoices.org

https://www.fpa.org.uk/professionals/resources/leaflet-and-booklet-downloads