Synphase

Synphase is a combined hormonal contraceptive pill, which means it uses hormones oestrogen and progesterone together to prevent unwanted pregnancy. It has 3 stages during treatment, which use 2 different dosages.

Oestrogen and progesterone hormones naturally occur in women during their menstrual cycle. They control when a woman is able to get pregnant. Synphase changes how much of these hormones are in a woman’s body, to prevent her from becoming pregnant.

Synphase is a biphasic combined hormonal contraceptive. This means that you will be given two types of pill to take in each pill packet, and both types will have different amounts of progesterone in them (500µg and 1000µg). Every tablet will contain the same amount of oestrogen (35µg), it is only the dose of progesterone that will change part way through your menstrual cycle. This is to mimic your body’s natural hormonal changes during each menstrual cycle.

Synphase is sometimes wrongly called a triphasic pill. This is because it uses two different doses over three phases. It starts with 7 blue tablets of 500 µg (micrograms) norethisterone, followed by 9 white tablets of 1 mg (milligrams) norethisterone, and then ends with 5 blue tablets of 500 µg norethisterone. So although there are only two different doses of norethisterone in your pill packet, it is split into three ‘phases’.

The extra progesterone added part way through the treatment cycle allows the lining of your womb to thicken, as it would normally part way through your period cycle. This does not mean you are at more risk of getting pregnant though. You will lose this lining when you bleed during your break, like a normal period.

You must always take your pills as directed by your doctor, nurse or pharmacist, and it is best to consult either of these professionals if you are even unsure of how to take your pill. The side-effects produced by each type of pill varies, and some women will be more likely to experience certain side-effects than others. Therefore, if you choose to take any type of combined hormonal contraceptive pills, it is important that you give correction information to a doctor or nurse about any side-effects you experience, either in person or via an online doctor. This will ensure you take a contraceptive that is right for you.

As well as preventing pregnancy, Synphase can have a number of other positive effects on your body.

Synphase can improve acne. This is thought to be because of several effects the hormones in combined hormonal contraceptives have on a woman’s body.

Although combined hormonal contraceptives can improve acne in women who suffer with this, there are other acne treatments, like antibiotics, that may be considered depending on your case.

Other advantages of taking Synphase include:

• Reduced risk of womb and ovarian cancer
• Regulating periods
• Reducing heavy bleeding and pain during periods

Biphasic pills like Synphase might be best for you depending on your current health conditions, or if you normally experience side effects on the pill. A doctor consultation will help you decide if Synphase is best.

Biphasic pills that use 2 different dosages are different from monophasic pills, where the dosage remains the same throughout your cycle. This does not mimic your natural menstrual cycle as well.

Triphasic pills often have less unexpected vaginal bleeding (spotting) between periods compared to biphasic pills, where this symptom is more common. Biphasic pills are only available in 21 day packets.

With most combined hormonal contraceptives like Synphase, you usually have a 7-day break from taking your pill (or seven days in which you take placebo pills). During this time, the sudden drop in hormones in your body causes you to have your period. Currently in the UK, Qlaira is the only licensed combined hormonal contraceptive available that only has 2 days off from taking your pill, rather than a 7 day break. This pill is known to be as effective at preventing pregnancy as other combined hormonal contraceptives. It is a newer alternative approach for women who usually suffer from unwanted side-effects during their 7 day break, when using other combined hormonal contraceptive pills.

It’s known that combined contraceptive pills can also be taken back to back (this means without break between the packs). Your doctor will be able to explain more about this and assess if this could be a good option for you.

When taking Synphase, it‘s normal to sometimes have irregular periods or bleeding between periods (spotting) after recently starting on this pill. However, you may also bleed less during your period, or have no bleeding during your 7-day break.

It is always best to record what changes you have experienced to your periods so that you can tell your doctor or nurse at your next check-up. If you are worried, or think you might be bleeding for reasons other than taking Synphase, always speak to your doctor as soon as possible to get checked for other possible causes.

If you don’t bleed during your 7-day break, it doesn’t necessarily mean you are pregnant. If you’re unsure, or have accidentally missed a pill or taken one or more late in your pill packet, see your doctor as soon as possible to check for pregnancy. You could also be at risk of pregnancy if you are taking, or have recently taken, any of the medications or herbal remedies which interfere with how well Synphase works. It’s important that you read the patient leaflet to get more information on this.

You can take Synphase if you have a prescription for it. Regular prescriptions of Synphase are available from your doctor’s surgery (GP), local Contraceptive and Sexual health Clinic (CASH) or online doctor services. However, you will need to discuss your choice of contraception with a doctor or nurse, before obtaining a prescription. This can be done in your doctor’s surgery, or at your local contraceptive and sexual health clinic (CASH). You can dispense any of your prescriptions for Synphase at an in store pharmacy, or repeat prescriptions can be delivered through online doctor services.

It is not recommended for any women over the age of 50 years to take combined hormonal contraceptives. At 50 years of age, it is generally recommended to switch to a non-hormonal, or progesterone-only method of contraception. Therefore, if you wish to continue taking combined hormonal contraceptives above the age of 50 years, you must speak to your doctor or nurse for advice.

You may not take Synphase if you:

• have had cancer of the cervix, vagina, womb or breast
• have or have had hepatitis C, and are taking medicinal products containing ombitasvir, paritaprevir, ritonavir and/or dasabuvir
• are allergic to any of the ingredients in Synphase (norethisterone, ethinyl estradiol, maize starch, polyvidone, lactose, colouring E132 (blue pills only), and magnesium stearate)
• have a family history of blood clotting disorders or blood clots
• have had blood clots anywhere in your body, particularly your veins, legs, lungs or brain
• have had a heart attack or stroke
• currently or previously have had angina
• have or have had high levels of fats in your blood (hyperlipidaemia)
• have or have had a disorder of body fats
• any of the following during pregnancy: pruritus, jaundice, yellowing of your skin without a known cause, or pemphigoid gestationis (previously known as herpes gestationis)
• severe chronic liver disease or liver tumours
• vaginal bleeding with no known cause
• bad migraines
• are pregnant, or think you might be pregnant
• are currently breastfeeding (the oestrogen in Synphase can reduce your supply of breast milk), depending on when you gave birth
• have given birth less than 21 days ago
• have undiagnosed abnormal vaginal bleeding

Synphase might not be safe for you to take if you have another medical problem. Therefore, it is important that you check with your doctor or nurse if it is okay for you to take Synphase if you have:

• irregular periods
• any problems with your breasts
• migraines
• frequent headaches
• either sudden or slow visual disturbances, such as losing some or all of your sight
• diabetes
• asthma
• severe depression
• sharp pains in your abdomen (the middle part of your body)
• varicose veins (twisted or enlarged vein(s), usually in your leg)
• chloasma (brown patches on your skin which appeared while you were pregnant, and may or may not have faded)
• any disease which tends to get worse during pregnancy
• fibroids in your uterus
• epilepsy
• conditions affecting your heart or blood vessels
• high blood pressure (known as hypertension)
• sickle-cell anaemia
• kidney disease
• liver dysfunction
• multiple sclerosis
• tetany
• gallstones
• otosclerosis
• porphyria

Some medicines or herbal remedies you take can stop Synphase from working properly, which would put you at risk of becoming pregnant after having sex. It is best to talk to your doctor or pharmacist if you are currently taking, have recently taken, or are thinking of taking any of these medications or herbal remedies:

• St John’s wort (also known as Hypericum perforatum)
• Ritonavir
• Rifampicin
• Rifabutin
• Oxacarbazepine
• Carbamazepine
• Griseofulvin
• Phenytoin
• Primidone
• Topiramate
• Phenobarbital
• Nelfinavir
• Nevirapine
• Modafinil

If you experience any side effects, you can report them directly to the yellow card scheme. This helps provide more information to improve the safety of this medication, and you may report side-effects which aren’t listed here, or in the leaflet accompanying this medication, at the MHRA YellowCard Scheme website.

It’s important that you have regular reviews with a doctor or nurse regarding taking Synphase to discuss the possible side effects.

Side effects that have been reported when taking Synphase include:

• Nausea (feeling sick)
• Abdominal discomfort
• Breast tenderness
• Changes in libido
• Headaches
• Feeling depressed
• Hypertension
• Spotting (irregular bleeding throughout your cycle)

Most of these side effects usually resolve within the first three months, so if it isn’t the case, or they’re severe, don’t hesitate to discuss them with your GP.

Sometimes unexpected vaginal bleeding can be a sign of an infection in your womb or vagina. So if you had spotting before starting Synphase or if it started afterwards but doesn’t disappear within the first months, it’s important that you discuss this with your GP.

When taking any combined hormonal contraceptives, there is an increased risk of developing blood clots. To ensure Synphase is safe for you to take, speak with your doctor or nurse about your health and family history before choosing your contraceptive, who’ll be able to assess your risk. Some women have conditions or risk factors that increase the risk of blood clots , such as:

• Smoking (or having stopped smoking in the past year)
• Being immobile (such as after having an operation)
• Having a family history of blood clots
• Having had a previous blood clot
• Having some genes that are associated to higher risk of blood clots
• Being overweight

Speak to your doctor urgently if you:

• experience ongoing dizziness
• have sudden and unusually severe headaches which you don’t normally have
• have your first migraine (very painful headache with sickness and sometimes blurred or distorted vision)
• have migraines which become worse than is normal for you
• have a migraine where your vision becomes distorted, your lose part or all of your sight, you see things which aren’t there, your body feels weak, or you feel unusual sensations in your limbs
• develop chest pains, difficulty breathing or coughing up blood
• develop pain or swelling in one leg

You shouldn’t take Synphase if you are allergic to any of its ingredients.

If you think you might be having an allergic reaction, call the emergency services (999 or 112) immediately or go to your closest hospital. Some signs that you are having an allergic reaction include:

• Sudden swellings appearing on your skin, particularly around your lips, face, tongue, throat or face
• Suddenly developing a rash or itching, particularly if it affects your whole body
• Finding it hard to breathe
• Sudden wheeziness
• Sudden nasal congestion
• Chest pains
• Lightheadedness or dizziness
• Passing out
• Suddenly developing a pale skin colour
• Blueness around the lips

Seek emergency medical help from your nearest hospital if you:

• have signs of a stroke or Transient Ischemic Attack (temporary stroke symptoms)
• have signs of breathing problems
• have signs of circulatory problems (such as fainting)
• have painful or inflamed veins in your legs, or signs of having a blood clot
• have unusual sensations in your body
• have distorted vision
• see, hear, smell, or taste things that aren’t there
• have trouble speaking or moving your body
• suddenly become short of breath
• have a seizure
• cough up blood
• have swelling or tenderness in your stomach
• find breathing painful
• have a sudden sharp pain in your chest
• pass out

Before you decide the best contraceptive option for you, it’s important that you get informed on what contraceptive methods are available.

It’s particularly important that you think about your preferences and your needs. If you feel you’ll need a contraceptive method for a long time, but don’t want it to be permanent, you could consider the hormonal implant, the progesterone injection or the coil (intrauterine device) with or without hormones. All these are known as LARC or long-acting reversible contraception and are available at most GP surgeries, contraception clinics, or sexual health clinics.