Oral Contraception and EHC For Health Advisors, Health Information Staff and Nurse Advisors Your Name Medicines Information Pharmacist Your Medicines Information Service

Aim To enable all staff answering Oral Contraceptive and Emergency Hormonal Contraception calls to work within role competencies and fulfil them safely, reliably and effectively in this area of care.

Learning Outcomes Be familiar with different types of oral contraceptives Understand how emergency hormonal contraception (EHC) and oral contraceptives work Gather necessary information to be able to clarify the question Interpret information about contraceptives and turn it into appropriate advice

Contraception Male and female condoms Intrauterine device Diaphragms and caps Contraceptive injection Contraceptive implant Contraceptive patch Intrauterine system Sterilisation Natural family planning Combined pill Progestogen-only pill Emergency contraception

Oral Contraception Combined oral contraception (COC) Progestogen only pill (POP) Emergency Hormonal Contraception (EHC)

Combined Oral Contraception Contains oestrogen and progestogen Take one tablet daily for 21 days (28 for ED) followed by a 7 day pill free period Most effective preparation for general use With optimal use, > 99% effective Efficacy: 1 per 100 women-years. I.e. if 100 women took for 1 year 1 person could expect to have become pregnant

Combined Oral Contraception Monophasic fixed amount of an oestrogen and a progestogen in each active tablet Biphasic/Triphasic varying amounts of the two hormones according to the stage of the cycle ED (every day) includes 7 days of placebo tablets

Combined Oral Contraception How does it work?

Oral Contraception Combined oral contraception (COC) Progestogen only pill (POP) Emergency Hormonal Contraception (EHC)

Progestogen only pill Contains one active ingredient - progesterone Taken continuously – no break Offers an alternative when oestrogens are contraindicated Efficacy dependent on the meticulousness of the user

Oral Contraception Combined oral contraception (COC) Progestogen only pill (POP) Emergency Hormonal Contraception (EHC)

Emergency Hormonal Contraception Levonelle 1500 (one step) Contains high dose progesterone (levonorgesterel) One 1500mcg tablet taken as soon as possible after unprotected intercourse (up to 72 hours after) Preferably within 12 hours, no later than 72 hours Within 24 hours of unprotected sexual intercourse <95% 25-48 hours 85% and 58% at 49-72 hours

Emergency Hormonal Contraception Taking the dose as soon as possible increases efficacy Available from: A & E GP Walk in Centres Family Planning Clinics Sexual Health Clinics Community Pharmacies

When is EHC indicated? Unprotected sexual intercourse Reduced efficacy of other forms of contraception: Torn, leaking condom Missed pills Late implant or injection Detached contraceptive patch

How does EHC work? Dependent on point in the menstrual cycle Either prevents or delays ovulation, prevents fertilisation or prevents implantation of the fertilised egg into the uterus. Clinical opinion is that EHC is not an abortifacient Legally ; abortion can only take place after a fertilised egg has implanted into the womb. The precise mode of action of Levonelle One Step is not known. At the recommended regimen, levonorgestrel is thought to work mainly by preventing ovulation and fertilisation if intercourse has taken place in the preovulatory phase, when the likelihood of fertilisation is the highest. It may also cause endometrial changes that discourage implantation. Levonelle One Step is not effective once the process of implantation has begun.

Missed Contraceptive Pills COC 7 days of pill taking put the ovaries to sleep More than 7 days since pill taking may wake the ovaries up 7 pill free days are safe POP Not for the forgetful!!!!!

Missed COC Pill/s

Missed POP Pill/s

Missed Contraceptive Pills Which brand of contraceptive pill? How many pills are left in the pack? How long ago should it have been taken? Intercourse since missed pill? Any action taken?

Taken too many pills Which brand of contraceptive pill? How many were taken? Which pills did you take? How long ago did you take it?

Taken wrong pill from packet Which brand of contraceptive pill? Which day of the packet should you have taken? Which pill did you take? How long ago did you take it?

Vomiting & Diarrhoea If vomiting within 3 hours of taking pill then absorption will be reduced and may be ineffective. Diarrhoea alone without vomiting has to be severe to reduce the absorption of the pill.

Vomiting & Diarrhoea When did vomiting occur relative to taking pill? How severe is the diarrhoea? Which brand of contraceptive pill? How many pills left in the pack?

Drug Interactions The effectiveness of COC, POP and EHC will be reduced by interaction with drugs that are enzyme inducers Broad spectrum antibiotics may reduce effectiveness of COC by altering the bacterial flora of the bowel

Drug interactions Which brand of contraceptive pill? Taking another drug or planning to? Prescription OTC Herbal Under medical supervision? How many tablets left in pack? Active sexual relationship?

Case Scenarios Think about what background information you need to answer the enquiry Document information used to answer enquiry What would you advise the caller?

Learning Outcomes Be familiar with different types of oral contraceptives Understand how emergency hormonal contraception (EHC) and oral contraceptives work Gather necessary information to be able to clarify the question Interpret information about contraceptives and turn it into appropriate advice