Combined Oral Contraceptive Pill shortages – advice for GPs

The team at Sexual Health Quarters in Northbridge would like to inform you of the current situation confronting many GPs.  A global shortage of certain contraceptive pills has led to shortages in Australia since March 2020.  Many of these pills are “second line” agents that have been used for patients with particular side-effects or other issues from previously tried COCPs.

This information is for GPs to help them navigate the options with patients.

The manufacturer, Pfizer, has advised the TGA that this is due to changes at the manufacturing plant, and that these pills will be available again as indicated below, however there may be additional COVID-19 related delays.

Details can be found on the  TGA website here:

https://www.tga.gov.au/alert/shortage-brevinor-and-norimin-ethinylestradiolnorethisterone

NORIMIN-1 28 ethinylestradiol/norethisterone – 02 Dec 2020

NORIMIN 28 ethinylestradiol/norethisterone – 17 Nov 2020

BREVINOR 28 ethinylestradiol/norethisterone – 11 Nov 2020

BREVINOR-1 28 ethinylestradiol/norethisterone – 16 Oct 2020

NORINYL-1 28 mestranol/norethisterone – 28 Aug 2020

NORIDAY 28 norethisterone 350 microgram  – 15 Nov 2020

TRIPHASIL 28 ethinylestradiol/levonorgestrel tablet  – 30 Sep 2020

The recommendation for GPs is to discuss available options with patients:

• Many patients on COCP will wish to remain on a COCP. Transition to another pill is very likely to be smooth.  The other PBS-listed pills that contain levonorgestrel (eg Levlen, Microgynon, Monofeme) would be the first line option (evidence states a similar side-effect profile to the norethisterone containing pills and likely to benefit acne and have similar reduction in menstrual blood loss).
• Remember that current evidence is that continuous taking (ie skipping the pill-free week) not only increases contraceptive efficacy but also will decrease menstrual blood loss.
• This is a very good opportunity to discuss the additional benefits of LARCs (ie contraceptive implants, hormonal and copper IUDs) over COCP (in particular greater contraceptive efficacy and reduced side-effect profile due to not containing estrogen).
• If none of the above are suitable options, the non-PBS listed combined pills containing other progestogens could be considered
• Patients on Noriday Norethisterone 350 ug) may choose to change to Microlut (levonorgestrel 30 ug).