I heard recently that prescriptions for many contraceptive had fallen so I have looked at the Prescription Cost Analysis from DoH for data on GP prescribing. Data are available for England from 1998 to 2010.

Most prescribing of contraceptive is done in general practice, although this applies more to the OCs and DMPA than to the other LARC methods, which require specialist training for insertion.

LARCs

Prescription for Injectable contraceptive peaked in 2004, fell to 2008/9 but then picked up again in 2010. As mostly 3-monthly prescription (almost all DMPA) the number of prescription far exceeded those of the other long-acting methods.

Implantable contraceptives

The prescriptions for Mirena have risen steadily over the 14 years, a proportion of the most recent years will have been inserted at Contraction and Sexual Health clinics. The rise in the use of IUS has been accompanied by a fall in IUD prescription, although some if not all of this will have been taken up by clinics supply of IUDs. Prescriptions for the IUS will also have had a boost with publication of the NICE guidance on Heavy Menstrual Bleeding, published in Jan 2007, which recommended the IUS as the first-line pharmaceutical treatment.

The prescriptions for the contraceptive implant have risen exponentially since 2004, and especially after the publication of the LARC from NICE in Oct 2005, and for the first time in 2010 prescriptions for Implanon outstripped those for the IUS and if trends continue will exceed all intrauterine methods soon.

Oral contraceptives

The use of the combined pill among patients at GP practices has fallen steadily since the late 1990's, especially since 2008, although the latter seems to have been offset by the increase in use of the progestogen only pill. The graphs show the number of pills prescribed.

Trends in OC use
The quantify of the main COCs prescribed, i.e. the number of individual pills prescribed, over the 14 year period is shown below.

We knew that Yasmin was doing well, but Cerazette has become even more popular. Both of these seem to be the only OCs that are increasingly being prescribed – all the other OCs being used less – with a sharp drop in Microgynon use in the past couple of years. Surprisingly, Cilest use has fallen steadily since the early part of the last decade.

Expenditure on OCs

Expenditure on different OCs has changed markedly in the past decade, with Yasmin coming to dominate other OCs. The success of Cerazette compared to the other OCs is more marked when we look at the cost of GP prescribing, where it has become second only to Yasmin in the last two years.