Contraception: the pill, the ring and the patch
Combined pills, progestogen only pills, the vaginal ring and the transdermal patch are all prescription only in Malta, and the same medical questions decide whether a method is suitable and whether it can be continued. Before prescribing, a doctor looks at blood pressure, migraine with aura, smoking, age, weight and the risk of blood clots. This page explains which methods need a prescription, what is reviewed when a repeat is issued, and where the limits of an assessment made from a questionnaire lie.
Which methods are prescription only in Malta
Combined hormonal methods contain an oestrogen together with a progestogen. They include combined tablets such as Yasmin, Yaz, Zoely, Qlaira and Mercilon, the vaginal ring NuvaRing and the transdermal patch Evra. All of them are prescription only, and there is more on /medicines/yasmin/, /medicines/nuvaring/ and /medicines/evra/.
Progestogen only tablets contain a progestogen alone, for example the desogestrel products marketed under names such as Azalia. They are prescription only as well, and they are often the option considered when a combined method is not suitable.
Intrauterine systems releasing levonorgestrel, such as Mirena, Jaydess and Levosert, are prescription only too, but fitting one is a procedure carried out in person. We cannot arrange that and we do not issue documents for it. The same applies to implants and to a diaphragm fitting.
Condoms need no prescription at all. Emergency contraception has its own section below, because in Malta it is obtained differently from a regular method.
What a doctor assesses before prescribing or repeating
Blood pressure sits at the centre of the assessment, because combined methods add to the risk that raised blood pressure already carries. A recent reading matters; a value remembered from years ago does not answer the question.
Migraine with aura is a reason not to use a combined method, and it matters whether the aura appeared for the first time while you were taking it. Migraine without aura is weighed differently, which is why the description of the headache is asked for in detail.
Smoking, age and weight are weighed alongside those, because the risk of a blood clot in a vein rises with each of them and rises further when they combine. A personal or family history of deep vein thrombosis or pulmonary embolism, a known clotting disorder, recent major surgery and long immobility all count here.
Breastfeeding, liver disease, some forms of diabetes with complications, a history of breast cancer and medicines that speed up the breakdown of hormones, including certain anti-epileptic medicines and St John's wort, are all part of the picture. The choice of method and the dosage are set by the doctor.
Why the same questions are asked again at a repeat
Risk changes with time. Age advances, weight changes, blood pressure drifts, new headaches appear and new medicines are added, so an answer that was right a few years ago may not be right now.
That is why a repeat is not a formality. The doctor reviews the same factors, and where something has changed the honest answer may be a different method, or an examination, rather than the same prescription again.
A recent blood pressure reading is the single most useful thing you can provide. Pharmacies and health centres measure it, and a reading with a date attached is worth far more than a description of how you feel.
If the answers are incomplete, the doctor asks for more. Without them the assessment cannot be closed, because closing it would mean deciding without a basis. There is more about repeats without an appointment on /blog/repeat-prescription-without-a-visit/.
When a repeat is not enough
A first prescription and the choice of method need an examination and a conversation, so both sit outside this route. The same is true when you want to move from one method to another for medical reasons.
New or worsening symptoms are a reason to be examined: a first migraine with aura, a severe one-sided headache, chest pain, breathlessness, a painful swollen calf, sudden visual disturbance or yellowing of the skin. Chest pain and breathlessness are emergencies: call 112.
Pregnancy, suspected pregnancy and breastfeeding change the assessment entirely, and so does a recent serious side effect. Unexplained bleeding between periods is a reason to be seen rather than to carry on unchanged.
Fitting or removing an intrauterine system or an implant is a procedure and cannot be arranged from a questionnaire. Cervical screening, breast examination and gynaecological care stay with the Maltese health service.
Missed pills and emergency contraception
What to do after a missed tablet depends on the method, on how many were missed and on where in the pack it happened, and the leaflet in the box carries the instruction for that particular product. There is a fuller explanation on /health-guide/missed-contraceptive-pill/.
Emergency contraception is a different matter from a regular method. In Malta levonorgestrel and ulipristal acetate, the substance in EllaOne, are available from pharmacies without a prescription, so they are not part of our service and there is nothing here for us to issue.
Timing matters a great deal. Levonorgestrel is taken as soon as possible and within 72 hours of unprotected sex, and ulipristal acetate within 120 hours. The sooner it is taken the better it works, and a pharmacist can advise which of the two fits the situation.
Emergency contraception does not replace a regular method and does not protect for the rest of the cycle. If it has been needed, that is a good reason to review the regular method with a doctor rather than to repeat the same prescription unchanged.
What a pharmacist checks
Dispensing is a professional decision taken by the pharmacist. He or she checks the identity of the person collecting the medicine, whether the details on the document are complete and legible, and whether what is prescribed fits the information available, and may refuse where something is doubtful.
A pharmacist may offer an interchangeable product with the same active substance, strength and form. With contraception that happens often, because the same combination of hormones is marketed under several different names.
It is worth checking in advance whether the brand you use is authorised and on the market in Malta, and under which name; the Medicines Authority publishes that information. A pharmacy may also simply not have a particular pack in stock.
Entitlement under the public scheme is assessed separately from dispensing, so expect to pay the pharmacy price for a medicine dispensed against a document created outside the Maltese system. There is more on /blog/eu-prescription-maltese-pharmacy/.
What we offer and what we do not offer
We offer a medical questionnaire and a doctor's review for a method you already use. The route is /contraception/ and the review costs 24,90 €; priority handling is available for an extra 9,90 €, which means a place in the queue and not a promised date.
The document is a cross-border prescription in the format set out in the Annex to Directive 2012/52/EU. You receive it as a PDF by email and bring it to the pharmacy printed or on screen, together with photo identification. It is not written into any Maltese state record and is not visible in myHealth, so there is no code at the pharmacy to call up.
It is issued by lek. Damian Wojno, registered with the Polish Medical Chamber, licence no. 3211301. He is not registered with the Medical Council of Malta, which keeps the register of doctors practising here, and he does not take over the role of your family doctor.
We do not offer video calls, telephone consultations or live chat. We do not issue first prescriptions, we do not choose a method for you, we do not fit intrauterine systems, we do not issue medical certificates and we do not handle mental health problems. The fee covers the doctor's review, not the issuing of a document and not the price of the medicine at the pharmacy. If the doctor decides on medical or legal grounds that a prescription is not justified, we refund the fee, and the same applies when the assessment cannot be completed. There is more about the fee on /blog/online-prescription-cost-malta/.
Is the pill prescription only in Malta?
Yes. Combined tablets, progestogen only tablets, the vaginal ring and the transdermal patch are all prescription only, and so are intrauterine systems, although fitting one is a procedure carried out in person. Condoms need no prescription. Emergency contraception is obtained differently and is described separately on this page.
How is a repeat handled?
You fill in a questionnaire about the method you already use and about your health, and a doctor reviews it in writing. The same factors are weighed as at the first prescription, because risk changes over time. Where the answers are complete and nothing worrying has changed, a cross-border prescription may follow; where something has changed, the doctor may advise a different method or an examination.
Which checks are needed first?
Have a recent blood pressure reading with its date, and the exact name and strength of the method you use, along with when it was started and by whom. Note your weight, whether you smoke, any headaches and their type, and every other medicine and supplement you take. Pharmacies and health centres measure blood pressure, and a reading with a date is worth more than a description.
What does the doctor assess?
Blood pressure, migraine and whether it comes with aura, smoking, age and weight, and the risk of a blood clot in a vein, including personal and family history, a known clotting disorder, recent surgery and long immobility. Breastfeeding, liver disease, diabetes with complications, a history of breast cancer and interacting medicines are weighed as well. The decision belongs to the doctor together with the patient.
Which method suits a smoker?
That is a decision for a doctor, not for a web page. Smoking raises the risk of a blood clot associated with combined methods, and the concern grows with age, so a doctor may consider a progestogen only method or a non-hormonal one instead. What the doctor needs is how much you smoke, your age, your weight and your blood pressure, and the answer is reached with you rather than for you.
Is emergency contraception part of this service?
No. In Malta levonorgestrel and ulipristal acetate, the substance in EllaOne, are available from pharmacies without a prescription, so there is nothing here for us to issue. Timing matters: levonorgestrel is taken as soon as possible and within 72 hours of unprotected sex, and ulipristal acetate within 120 hours. A pharmacist can advise which of the two fits the situation.
Will a pharmacy dispense it?
That cannot be promised. Dispensing is decided by the pharmacist, who checks identity and the completeness of the document and who may refuse where something is doubtful. The pharmacist may also offer an interchangeable product with the same substance, strength and form, which with contraception is common. Expect to pay the pharmacy price in full.
What does the fee cover?
The doctor's review of your questionnaire, not the issuing of a document and not the price of the medicine at the pharmacy. The review costs 24,90 €, with priority handling for an extra 9,90 €. If the doctor decides on medical or legal grounds that a prescription is not justified, we refund the fee, and the same applies when the assessment cannot be completed.