Shortage of norethisterone-containing pills in Australia: Advice for GPs

July/August 2020

The Therapeutic Goods Administration (TGA) advises:

Consumers and health professionals are advised that there is a shortage of oral contraceptive pills containing the combination ethinylestradiol and norethisterone.

The affected products are:

  • Brevinor – norethisterone 0.5 mg and ethinylestradiol 35 micrograms
  • Norimin – norethisterone 0.5 mg and ethinylestradiol 35 micrograms
  • Brevinor-1 – norethisterone 1 mg and ethinylestradiol 35 micrograms
  • Norimin-1 – norethisterone 1 mg and ethinylestradiol 35 micrograms.

All four products are sponsored by Pfizer Australia Pty Ltd.

Pfizer has advised the Therapeutic Goods Administration (TGA) the shortage of these products is due to manufacturing issues and is expected to continue until mid-October 2020 and early December 2020, depending on the product. Further information about the shortage is available on the TGA’s Medicine Shortage Reports Database.

Meanwhile, SPHERE (NHMRC Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care) have released a statement:

A global shortage of contraceptive pills containing the progestogen contrnorethisterone (NET) has led to shortages in Australia since March 2020. The reason for the shortages, as provided by the manufacturer Pfizer, is ‘’manufacturing delays’’ as the company states it is upgrading engineering on packaging lines and implementing additional packaging lines to rectify the shortages.

At the time of writing, the Therapeutic Goods Administration (TGA) website indicates that the pills will become available in November-December 2020, however, there may be additional COVID-19-related delays.

Updated IMPLANON NXT Procedures Statement

SHINE SA, September 2020

The contraceptive implant (Implanon NXT) is one of the most effective contraceptives available. Along with the hormonal and copper IUDs, it is classified as Long Acting Reversible Contraception (LARC) which are recommended as first-line options for all people choosing to use contraception.

SHINE SA wish to alert clinicians to important updated information about Implanon NXT procedures following an update of the product information in January 2020. These changes have been made to avoid the large blood vessels and nerves within and around the sulcus between biceps and triceps and reflect published research.

RACGP offers new suite of IUD resources

RACGP, 25th August 2020

The newly released suite consists of five intrauterine device (IUD) resources, including a checklist and patient confirmation form, patient pre- and post-insertion checklist, practitioner checklist and disclaimer. Current evidence-based options for pain relief during IUD procedures are provided as an appendix.

Dr Amy Moten, Chair of the RACGP Specific Interests Sexual Health Medicine network, led development of the resources, which she says are designed to provide guidance and support to all Australian practitioners.

NEW Fact Sheet for Health Professionals – Contraception During the COVID-19 Pandemic.

SHINE SA, 15/4/2020

SHINE SA have released a new Fact Sheet for health professionals: Contraception During the COVID-19 Pandemic.

Contraception is an essential service during the COVID-19 pandemic. This includes the provision of emergency contraception, access to long acting reversible contraception (LARC) and management of complications of LARC. Health professionals can continue to facilitate access to contraception via telehealth consults and limited face-to-face consultations where possible.

This Fact Sheet provides advice for health professionals on the provision and management of contraception during the COVID-19 pandemic. This includes LARC, combined hormonal contraception, emergency contraception, progestogen only pill and depot medroxyprogesterone acetate (DMPA).

Position Statement on LARC access during the COVID-19 pandemic

SHINE SA, April 7, 2020

SHINE SA, along with Family Planning VictoriaFamily Planning NTFamily Planning TasmaniaSexual Health and Family Planning ACTSexual Health Quarters, and True Relationships & Reproductive Health have co-signed a Position Statement on LARC access during the COVID-19 pandemic.

Extended use of and ongoing access to LARCs during the COVID-19 pandemic

Provision of contraception is essential during the COVID-19 pandemic to prevent unintended pregnancies. This is particularly important for individuals most at risk, including young people due to their high levels of fertility, people with serious health conditions, and for those who are post-abortion. Long Acting Reversible Contraceptive methods (LARCs) are more effective than shorter acting methods and increased community access and uptake is associated with lower abortion rates.

Ongoing access to LARC insertion is essential during the pandemic

Contraception is essential health care and all efforts should be made to continue the insertion of LARCs during the pandemic. To reduce the risk of infection with COVID-19, this may require different approaches to insertion such as a wearing mask during insertion of contraceptive implant or using an inserter-only approach for IUD insertion (with an assistant outside the room for emergencies).

Summary of recommendations during the pandemic

  • All efforts should be made to continue access to insertion of LARCs during the pandemic, particularly for younger people, people with serious health conditions, and post-abortion
  • The etonogestrel implant (Implanon NXT) can be extended off-label for use up to 4 years
  • The 52mg LNG IUD (Mirena) can be extended off-label for use up to 6 years
  • The 19.5mg LNG IUD (Kyleena) cannot be extended beyond 5 years
  • Standard sized T shaped banded copper IUDs can be extended off-label for use up to 12 years
  • 5-year copper IUDs (Load 375 and Copper T short) can be extended off-label for use up to 6 years
  • Additional use of condoms and/or a contraceptive pill should be discussed with users for whom the risk of an unintended pregnancy is unacceptable during extended use.

 

SHINE SA media release: CONTRACEPTION IS ESSENTIAL IN PREVENTING RISE IN UNINTENDED PREGNANCY DURING COVID-19

SHINE SA Media Release: 2 April 2020

Sexual and reproductive health must remain at the forefront of our minds during the COVID-19 pandemic. It is possible that throughout this crisis we may see a rise in unintended pregnancy as well as incidences of domestic violence, sexual violence and sexual coercion.  Unfortunately this could come at a time where our health systems are focused on the prevention and management of the pandemic itself. In addition to general sexual health services, access to pregnancy options including abortion may be impacted over the next 6 months.

Unintended pregnancy rates are already high in Australia. It is estimated that half of all pregnancies are unplanned. It is possible that self-isolation/quarantine measures could see an increase in unprotected sexual activity without reliable forms of contraception. These circumstances may contribute to unintended pregnancy and sexually transmitted infections in an environment where support systems and personal wellbeing have been affected.

SHINE SA asks that people consider all of their contraceptive choices at this time. This includes long-acting reversible contraception (LARC) options, especially if they do not wish to become pregnant in the near future. These options can be discussed with a general practitioner.

It’s also important that people are aware that they can access the emergency contraceptive pill (ECP) from community pharmacies. Oral emergency contraception is effective up to 120 hours after unprotected sex but the sooner it is taken, the greater the effectiveness.

  • South Australians looking for advice on any sexual health issue including contraception and unintended pregnancy can call SHINE SA’s Sexual Healthline.
    This is a free and confidential service provided by SHINE SA’s sexual health nurses. Call: 1300 883 793; Toll free: 1800 188 171 (country callers only).
    The Sexual Healthline is open Monday – Friday, 9:00 am – 12:30pm.
  • Australians can also call 1800 RESPECT, the national sexual assault, domestic and family violence counselling and information referral service. This service is available 24 hours a day, every day of the year. Yarrow Place Rape and Sexual Assault Service is a South Australian service for anyone who has been sexually assaulted. Call 8226 8777 or visit the Yarrow Place website for more information.
  • Visit the SHINE SA website for more information on Emergency ContraceptionChoices in Contraception and Safer Sex.
  • Download this Media Release.