Genito-urinary System - BNF Chapter 7

DGRefHelp - NHS Dumfries & Galloway
NHS Dumfries and Galloway

1. Bladder and urinary disorders

1.1 Urinary frequency and incontinence

  • Oxybutynin Immediate release ✓ First Choice
  • Solifenacin
  • Mirabegron – Note: To be considered where 2 separate trials of anti-muscarinics have not been effective or where first line options are contraindicated. This may be considered a first line option in patients with a high anti-cholinergic burden would be detrimental. In line with Scottish Polypharmacy Guidance 2015.

Stress Urinary Incontinence in Women

  • Pelvic floor muscle exercises

See national guidance -

1.2 Urinary retention

Alpha-andrenoceptor blockers

5α-reductase inhibitors

1.3 Urolithiasis

Consider alpha-adrenoceptor blockers in patients with distal ureteric stones less than 10mm in diameter

1.4 Urological pain

Alkalinisation of urine

2. Bladder instillations and urological surgery

Bladder infection, dissolution of blood clots and maintenance of indwelling urinary catheters

3. Contraception

3.1 Combined hormonal contraception

Refer to sexual health guidelines at – West of Scotland sexual health guidelines

Combined hormonal contraceptives - oral

1st generation

2nd generation – ethinylestradiol + levonorgestrel

Triphasic

3rd generation – ethinylestradiol + desogestrel

  • Bimizza® 150/20 ✓ First Choice
  • Cimizt 30/150 ✓ First Choice

3rd Generation – ethinylestradiol + gestodene

3rd Generation – ethinylestradiol + norgestimate

  • Lizinna® 250/35 (replaces Cilique® 250/35)

4th Generation

Prescribing note
Yasmin and Qlaira are not approved for use in NHS Scotland by the SMC

Combined hormonal contraceptives – transdermal

  • Evra® patches (ethinylestradiol + norelgestromin)
Prescribing note
SMC had advised that Evra® patches should be restricted for use in women who have difficulties adhering to combined oral contraceptives

Combined hormonal contraceptives – vaginal

  • Nuvaring (ethinylestradiol + etonogestrel)

3.2 Contraceptive devices

Inter-uterine devices

  • TT 380® Slimline 10 year IUD
  • Short uterus – Mini TT 380® Slimline (5 year)
  • Narrow os – Nova-T® 380 (5 year)
  • Narrow os and short uterus CU-Safe® T 300 (5 year)

Diaphragms/caps 

Seek advice from sexual health on the most cost effective product at the time of prescribing

3.3 Emergency contraception

  • Copper IUD should be offered first line ✓ First Choice

Hormonal Emergency Contraception

See FSRH guidance (December 2017 – updated 2023) for clarification on when Ulipristal or levonorgestrel is most appropriate, for changes in relation to weight/ unprotected sex during the 5 days prior to the estimated day of ovulation/ progestogen taken in the preceding 7 days or if progestogen to be quick started etc. Faculty of Sexual and Reproductive Healthcare guidance

3.4 Progesterone only oral contraception

3.5 Long acting reversible contraception - LARC

LARC parenteral progestogen - only

LARC - Contraceptive implants

LARC - Hormone releasing intra-uterine systems

Prescribing notes
The FSRH supports extended use of any 52mg LNG-IUD for up to eight years for contraception if the user is under 45 years old at the time of insertion.

Note that the use of Benilexa® and Levosert® for eight years is off-label.

For Mirena® the licensed duration of use for endometrial protection as part of HRT is 4 years, however FSRH supports use of any 52mg LNG IUD for endometrial protection as part of HRT for 5 years.

Levosert® and Benilexa® are not licensed for endometrial protection as part of HRT.

FSRH statement extending use of all 52mg LNG IUDS for up to 8 years

4. Erectile and ejaculatory conditions

4.1 Erectile dysfunction

Prescription must be endorsed ‘SLS’ by the prescriber. Only allowed on the NHS as per criteria listed in BNF chapter 7.4.1

  • Sildenafil tablets ✓ First Choice(Guidance states that no more than 8 per 4 week period should be prescribed )
  • Alprostadil injection (Caverject Dual Chamber®)
  • Alprostadil urethral cream (Vitaros®)

4.2 Premature ejaculation

Specialist treatment

 

5. Polycystic ovarian syndrome

7. Obstetrics

7.1 Induction of labour

7.2 Post-partum haemorrhage

7.3 Pre-term labour

7.4 Termination of pregnancy/Hospital management of non-viable pregnancy

Hospital management - Ectopic pregnancy

Hospital management- Suppression of Lactation

Hospital management - Uterine hyperstimulation

8. Vaginal and vulval conditions

8.1 Female sex hormone responsive conditions

Lichen sclerosis

Vulval moisturizers (Can be used as a wash/ soap substitute)

Vaginal Atrophy

Vaginal Oestrogen Products

Product Oestrogen Content
Estriol 0.1% cream Estriol 500 micrograms per applicator
Estriol 0.01% cream Estriol 500 micrograms per applicator
Estradiol 10 micrograms pessary
(prescribe generically)		 Estradiol 10 micrograms per pessary
Estring
(change every 3 months)		 Estradiol 7.5 micrograms per day

Symptom control

  • Hyalofemme®
  • Sylk® VM
  • YES® VM

Dysmenorrhoea

Oligomenorrhoea

9. Thyroid disorders

9.1 Hyperthyroidism

Antithyroid drugs

To be initiated on specialist advice

Beta-blockers

9.2 Hypothyroidism

MHRA Dryg Safety Update 2021: levothyroxine new prescribing advice for patients whoexperience symptoms on switching between different levothyroxine products

Hypoparathyroidism

Hyperparathyroidism

Editorial Information

Last reviewed: 25/04/2025

Next review date: 30/04/2027

Author(s): Formulary subgroup of ADTC.

Version: 1.0

Approved By: ADTC