Comparison of Oral Contraceptives and Non-Oral Alternatives

Full update May 2021

Productsa,b

Manufacturer

Estrogen

Progestin

LOW-DOSE MONOPHASIC PILLS

Alessec,d

Alysenac,d

Avianec,d

 

Pfizer Canada

Apotex

Teva Canada

EE 20 mcg

Levonorgestrel 0.1 mg

Minestrin 1/20c

Allergan

EE 20 mcg

Norethindrone acetate 1 mg

 

Min-Ovralc

Ovimac

Portiac

 

Pfizer Canada

Apotex

Teva Canada

EE 30 mcg

Levonorgestrel 0.15 mg

Loestrin 1.5/30c

Allergan

EE 30 mcg

Norethindrone acetate 1.5 mg

 

Apric

Freyac

Marvelonc

Mirvalac

 

Teva Canada

Mylan

Organon Canada

Apotex

EE 30 mcg

Desogestrel 0.15 mg

Yasminc,d

Zaminec,d

 

Bayer

Apotex

EE 30 mcg

Drospirenone 3 mg

Brevicon 0.5/35c

Pfizer Canada

EE 35 mcg

Norethindrone 0.5 mg

 

Brevicon 1/35c

Select 1/35c

 

Pfizer Canada

Pfizer Canada

EE 35 mcg

Norethindrone 1 mg

BIPHASIC PILLS

Synphasicc

Pfizer Canada

EE 35 mcg

Norethindrone

0.5 mg x 12 days,

1 mg x 9 days

 

TRIPHASIC PILLS

Tri-Cira Loc

Tri-Cyclen Loc

Apotex

Janssen

EE

25 mcg x 21 days

Norgestimate

0.18 mg x 7 days,

0.215 mg x 7 days,

0.25 mg x 7 days

 

Linessac

Aspen Pharmacare Canada

EE

25 mcg x 21 days

Desogestrel

0.1 mg x 7 days,

0.125 mg x 7 days,

0.15 mg x 7 days

 

Triquilarc

Bayer

EE

30 mcg x 6 days,

40 mcg x 5 days,

30 mcg x 10 days

Levonorgestrel

0.05 mg x 6 days,

0.075 mg x 5 days,

0.125 mg x 10 days

 

Tri-Cirac,d

Tri-Cyclenc,d

Tri-Jordynac,d

Apotex

Janssen

Glenmark Canada

EE

35 mcg x 21 days

Norgestimate

0.18 mg x 7 days,

0.215 mg x 7 days,

0.25 mg x 7 days

 

EXTENDED-CYCLE PILLS

LoLo

Allergan

EE

10 mcg x 26 days

Norethindrone acetate

1 mg x 24 days

 

Indayo

Seasonale

Mylan

Teva Canada

EE

30 mcg x 84 days

Levonorgestrel

0.15 mg x 84 days

 

Seasonique

Teva Canada

EE

30 mcg x 84 days,

10 mcg x 7 days

 

Levonorgestrel

0.15 mg x 84 days

MYAd

Yazd

Yaz Plusd,e

Apotex

Bayer

Bayer

EE

20 mcg x 24 days

Drospirenone

3 mg x 24 days

Nextstellisj

Searchlight Pharma

Estetrol

15 mg x 24 days

Drospirenone

3 mg x 24 days

PROGESTIN-ONLY PILLS-“Mini-pill”

Jencycla

Movisse

 

Sandoz Canada

Mylan

None

Norethindrone 0.35 mg

EMERGENCY CONTRACEPTION

Ella

Actavis Specialty

None

Ulipristal

(progesterone receptor modulator)

30 mg tablet x 1

 

Backup Plan Onestep

Contingency One

Plan B

 

Apotex

Mylan

Paladin Labs

None

Levonorgestrel

1.5 mg tablet x 1

NON-ORAL ALTERNATIVES TO ORAL CONTRACEPTION

Brand Nameb

Dose/Route

Manufacturer

Estrogen

Progestin

Depo-Provera1,g

150 mg/mL

IM injection every three months

 

Pfizer Canada

None

Medroxyprogesterone acetate

150 mg

Evra4,i

Transdermal patch applied weekly for three weeks, followed by a patch-free week (i.e., week four)

 

Janssen

EE

35 mcg/day

Norelgestromin

(active form of norgestimate)

200 mcg/day

Kyleena5

(IUS)

Bayer

None

Levonorgestrel

Average 9 mcg/day for up to five years. Must be removed after five years.

 

Mirena2,f

(IUS)

Bayer

None

Levonorgestrel

Average 15 mcg/day for up to five years. Must be removed after five years.

 

Nexplanon6,h

Implanted subdermally just under the skin at the inner side of the non-dominant arm.

Organon Canada

None

Etonogestrel

(active form of desogestrel)

After about 5 to 6 weeks: 60 to 70 mcg/day, then at the end of first year: ~35 to 45 mcg/day, at the end of second year: ~30 to 40 mcg/day, and at the end of third year: ~25 to 30 mcg/day. Must be removed after three years.

 

NuvaRing3

Vaginal ring left in for three weeks, followed by a ring-free week (i.e., week four)

Organon Canada

EE

15 mcg/day

Etonogestrel

(active form of desogestrel)

120 mcg/day

 

Nova-T

Flexi-T

Liberte

Mona Lisa

SMB

Bayer

Prosan

7-Med Industrie

Searchlight Pharma

SMB Medical Devices

 

Non-hormonal, copper IUDs

Time to removal ranges from 2.5 to 10 years, depending on the product. See product labeling for specific timing.

Abbreviations: EE = ethinyl estradiol; IM = intramuscular; IUD = intrauterine device; IUS = intrauterine system.

  1. Products are grouped together based on hormone content. This grouping is not an indication of therapeutic equivalence for purposes of substitution.
  2. For information on which hormonal contraceptive to use, see our charts, Choosing a Hormonal Contraceptive and Contraception for Women With Chronic Medical Conditions.
  3. Available in 21- and 28-day packs. 28-day packs have seven placebo pills.
  4. Health Canada-approved for contraception and acne.
  5. Yaz Plus contains levomefolate 451 mcg in each tablet of the 28-day regimen.
  6. Health Canada-approved for contraception and idiopathic menorrhagia.2
  7. Health Canada-approved for contraception and treatment of endometriosis.1
  8. Effectiveness has not been studied in females who are overweight (i.e., >130% of ideal body weight). Etonogestrel serum concentrations are inversely related to body weight and decrease over time; therefore, removal and replacement before three years should be considered in females who are overweight, due to the potential for reduced efficacy.6
  9. Use in females with a body weight >90 kg may have reduced efficacy.4
  10. Nextstellis may be less effective in patients with a body mass index (BMI) 30 to 35 kg/m2. Reduced efficacy may be associated with increasing BMI. The safety and efficacy of Nextstellis in patients with a BMI >35 kg/m2 has not been studied.7

References

  1. Product monograph for Depo-Provera. Pfizer Canada. Kirkland, QC H9J 2M5. February 2018. 
  2. Product monograph for Mirena. Bayer. Mississauga, ON L4W 5R6. November 2020.
  3. Product monograph for NuvaRing. Organon Canada. Kirkland, QC H9H 4M7. March 2021.
  4. Product monograph for Evra. Janssen. Toronto, ON M3C 1L9. March 2020.
  5. Product monograph for Kyleena. Bayer. Mississauga, ON L4W 5R6. January 2021.
  6. Product monograph for Nexplanon. Organon Canada. Kirkland, QC H9H 4M7. March 2021.
  7. Product monograph for Nextstellis. Searchlight Pharma. Montreal, QC H3J 1M1. March 2021.

Cite this document as follows:  Clinical Resource, Comparison of Oral Contraceptives and Non-Oral Alternatives.  Pharmacist’s Letter/Prescriber’s Letter.  May 2021.  [370532]

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