ESTRADIOL/ NORETHINDRONE FILM,CONT REL
Clinical Criteria Summary
Document 338
Indication & Efficacy
- Highly effective in preventing pregnancy when used as directed
- Classified as a combination hormonal contraceptive agent
Regimen & Administration
- Monophasic pills with 30 mcg EE and desogestrel 0.15 mg: 21 active pills; 7 inert pills
Clinical Considerations & Management
- Nuisance side effects associated with combination hormonal contraceptives may be managed by adjusting the estrogen/progestin content or ratio
- Progestin-only products may be considered in patients with contraindications or a desire to avoid estrogen (general class guidance)
Formulary & Substitution Criteria
- Listed on the VA National Formulary as generic components to allow for substitution of the least expensive equivalent product
- Product availability varies and the listed products are not comprehensive
Document 560
Systemic Hormonal Menopausal Therapy (Oral Estrogen Combinations)
- Dosing Criteria: 0.45 mg conjugated equine estrogens/20 mg bazedoxifene daily
- Clinical Use Criteria: Bazedoxifene is an alternative to progestin for patients with a uterus
- Systemic Estrogen Formulary Requirements:
- Prescribe the lowest effective dose of estrogen
- Product selection should consider patient symptoms, risk-benefit profile, and patient preference
- A progestin (or bazedoxifene alternative) must be prescribed for all patients with an intact uterus receiving systemic estrogen to reduce endometrial hyperplasia and cancer risk