Counselling, hormonal contraception

Question 1

Yaz

Intro

Answer 1

Hi, I’m Alexis, I’m one of the pharmacists. I’ve just dispensed your new script for YAS… Are you happy to chat here or did you want to go somewhere more private? I believe you haven’t used this before, is this correct? This pill is used for lots of things, just to confirm, what are you using this pill for?

Question 2

Yaz

Indication

Answer 2

• So this medicine is your new medicine for your contraception so it’s going to help prevent any pregnancy. It contains two ingredients drospirenone and ethynlestradiol so it has your progesterone hormone and your oestrogen hormone, so they are two mimics of your bodily hormones. And they work by inhibiting ovulation and also developing the cervix in such a way that it won’t allow in the passage of sperm as well and that’s how it prevents the pregnancy.

Question 3

Yaz

dose & directions

Answer 3

So, to take this one, you just want to take one tablet at the same time each day, it’s important that we try take it at the same time each day because that way its most effective. So set reminders on your phone or take it with breakfast just so you have that constant reminder of taking it. You can take it with or without food doesn’t matter too much. If you find that it makes you a little but nauseous, I’d suggest taking it with food

When was your last period? Where abouts are you in your cycle?

has 24 active pills, 4 non active pills

So to start taking it, if we take a look at your tablets there’s a red area thats showing some light yellow, these pill are your active pills and you want to start taking those light yellow active pills in the red section on the first 1-5 days of when you get your period. So, take the pill marked with the correct day and follow the days. This will give you immediate contraception and you will be protected. Okay? Now you’ll notice that down at the bottom you have one week of white pills, these white pills are inactive, and they’re sugar pills. They’re there to get you into the habit of taking the pill every day. So, when taking these white sugar pills this is when you will get your next period. So, you can sort of regulate when you’re going to expect to get the start of your cycle again. Once you’ve finished your sugar pills just start on the next pack straight away.

You will still be protected while you’re only taking the sugar pills because it’s when your lining is shedding so you’re still protected you won’t fall pregnant.

Question 4

Yaz
adverse effects

Answer 4

How do you normally react to medicines? Do you normally react well or do you experience side effects occasionally to medicines?

Side effects tend to be different for everyone. One that I should mention is break though bleeding, this is very common for most people and will usually occur in the first couple of months… Give it about 3 or 4 months see how you go, if you’re finding that side effects are still bad then I’d suggest going to the Dr. Other things you may notice is you might find some nausea or vomiting, breast tenderness and breast enlargement, If you find that they’re effecting you significantly then I would suggest going back to the Dr because there are other types of pills you can try in that case.

Question 5

Yaz

refer

Answer 5

Any history of blood clots in the family?

If you get heat in your leg or real severe pain in one side of your leg or chest pains, I would definitely suggest going to the Dr.

Question 6

Yaz
selfcare/ lifestyle

Answer 6

Things you should look out for in your lifestyle, this pill doesn’t cover STIs, I always recommend practicing safe sex, so making sure you wear a condom. Try get regular breast and cervical checks and your pap smear

Question 7

Missed a pill?

Answer 7

• >24 hours, <48 hours
• If you miss a pill within the first week or you vomit within 2 hours of taking it that’s counted as a missed pill
• you will need to take the missed pill ASAP
• take the next pill as scheduled eg. Tonight
• then continue the pack as usual
• in this case contraception is not affected

Question 8

Micronelle 20 ED
Intro

Answer 8

Hi Wendy, I’m Alexis, I’m one of the pharmacists. I’ve just dispensed your new script for Micronelle 20… Are you happy to chat here or did you want to go somewhere more private? I believe you haven’t used this before, is this correct? This pill is used for lots of things, just to confirm, what are you using this pill for?

Question 9

Micronelle 20 ED
Indication

Answer 9

So this medicine is your new medicine for your contraception so it’s going to help prevent any pregnancy. It contains two ingredients levonorgestrel and ethynlestradiol so it has your progesterone hormone and your oestrogen hormone, so they are two mimics of your bodily hormones. And they work by inhibiting ovulation and also developing the cervix in such a way that it won’t allow in the passage of sperm as well and that’s how it prevents the pregnancy

Question 10

Micronelle 20 ED
dose & directions

Answer 10

So, to take this one, you just want to take one tablet at the same time each day, it’s important that we try take it at the same time each day because that way its most effective. So set reminders on your phone or take it with breakfast just so you have that constant reminder of taking it. You can take it with or without food doesn’t matter too much. If you find that it makes you a little but nauseous, I’d suggest taking it with food.

When was your last period? Where about are you in your cycle? How far into the cycle are you?

has 21 active pills, 7 non active pills

So to start taking it, if we take a look at your tablets there’s a red area thats showing some beige pills, these pill are your active pills and you want to start taking those beige active pills in the red section on the first 1-5 days of when you get your menstruation or when you start your period. So, take the pill marked with the correct day and follow the days. This will give you immediate contraception and you will be protected. Okay? Now you’ll notice that down at the bottom you have one week of white pills, these white pills are inactive, and they’re sugar pills. They’re there to get you into the habit of taking the pill every day. So, when taking these white sugar pills this is when you will get your next period. So, you can sort of regulate when you’re going to expect to get the start of your cycle again. Once you’ve finished your sugar pills just start on the next pack straight away.

You will still be protected while you’re only taking the sugar pills because it’s when your lining is shedding so you’re still protected you won’t fall pregnant.

Question 11

Micronelle 20 ED
Adverse effects

Answer 11

How do you normally react to medicines? Do you normally react well or do you experience side effects occasionally to medicines?

All meds have unwanted effects, side effects tend to be different for everyone. One that I should mention is break though bleeding, this is very common for most people and will usually occur in the first couple of months… Give it about 3 or 4 months see how you go, if you’re finding that side effects are still bad then I’d suggest going to the Dr. Other things you may notice is you might find some nausea or vomiting, breast tenderness and breast enlargement, If you find that they’re effecting you significantly then I would suggest going back to the Dr because there are other types of pills you can try in that case

Question 12

Micronelle 20 ED

refer

Answer 12

If you get heat in your leg or real severe pain in one side of your leg or sudden chest pain, I would definitely suggest going to the Dr

Question 13

Micronelle 20 ED

lifestyle/ selfcare

Answer 13

Things you should look out for in your lifestyle, I always recommend practicing safe sex, so making sure you wear a condom. Try get regular breast and cervical checks and your pap smear

Question 14

Missed a pill?

Answer 14

• >24 hours, <48 hours
• If you miss a pill within the first week or you vomit within 2 hours of taking it that’s counted as a missed pill
• you will need to take the missed pill ASAP
• take the next pill as scheduled eg. Tonight
• then continue the pack as usual
• in this case contraception is not affected

Question 15

Mirena IUD
Introduction

Answer 15

Hi Wendy, I’m Alexis, I’m one of the pharmacists. I’ve just dispensed your new script for Mirena… Are you happy to chat here or did you want to go somewhere more private? I believe you haven’t used this before, is this correct? This is used for lots of things, just to confirm, what are you using this for?

Question 16

Mirena IUD
Indication

Answer 16

• IUD- intra uterine device
• may be used as a long term method of contraception, for the treatment of excessive menstrual bleeding or for protection from excessive growth of the lining of the uterus during HRT… in your case…
  
  • When used as contraceptives, progestogens thicken cervical mucus to stop the passage of sperm, reducing the potential for implantation
• it consists of a T shaped frame that carries 52 mg levonorgestrel, a hormone used in many contraceptive pills
• there are 2 fine threads at the bottom of the frame, they’re there to allow for easy removal and allow you or your doctor to check that the device is in place

Question 17

Mirena IUD

Dose and directions

Answer 17

• so, the doctor will be inserting this one for you and they will also remove it for you, it should be replaced every 5 years
• It is placed inside the womb where it slowly releases the hormone over a period of five years or until it is removed
• The system should be inserted within seven days from the beginning of your period
• When Mirena is used to protect the lining of the womb during estrogen replacement therapy, it can be inserted at any time if you do not have monthly bleeding or else during the last days of menstruation or withdrawal bleeding

Question 18

Mirena IUD

adverse effects

Answer 18

• all medicines have se, side effects tend to be different for everyone
• some people experience post insertion pain and cramping, most common during the first months and decrease as time goes on
• At first your periods may be prolonged or irregular and spotting may occur; with time, usually settles after 3-6 months
• infrequent se: n/v, headache, dizziness
• if period becomes heavier: this may mean the IUD has come out (common for it to come out in the first year)
• You should have Mirena checked usually 1-3 months after it is placed and then once a year until it is removed

Question 19

Mirena IUD

referral (iud has come out)

Answer 19

• If the system comes out either partially or completely you may not be protected against pregnancy. It is rare but possible for this to happen without you noticing during your menstrual period
• Possible symptoms of an expulsion are pain and increased amount of bleeding. If you have signs indicative of an expulsion or you cannot feel the threads you should either avoid intercourse or use another contraceptive (e.g. condoms) and consult your doctor
• After each menstrual period, you can feel for the two thin threads attached to the lower end of the system. Your doctor will show you how to do this. Do not pull on the threads because you may accidentally pull it out. If you cannot feel the threads, consult your doctor
• You should see your doctor if you can feel the lower end of the system itself or you or your partner feel pain or discomfort during sexual intercourse
• if you have signs of an infection, such as fever, unusual vaginal discharge or pain low in your abdomen because the IUD can increase the chance of pelvic inflammatory disease. It is most likely in the 3 weeks after the IUD is fitted (but can happen at other times)

Question 20

Mirena IUD

lifestyle/ selfcare

Answer 20

• Mirena does not protect against HIV infection (AIDS) and other STIs. Additional methods should be used (i.e. condoms) to prevent transmission of STIs

Question 21

Implanon NXT
Intro

Answer 21

Hi Wendy, I’m Alexis, I’m one of the pharmacists. I’ve just dispensed your new script for implanon… Are you happy to chat here or did you want to go somewhere more private? This is used for lots of things, just to confirm, what are you using this for?

Question 22

Implanon NXT
Indication/ MOA

Answer 22

• Implanon NXT is a contraceptive implant
• it contains 68 mg of the active substance etonogestrel
• mimics the bodily hormone, progesterone
• a small amount of the hormone is continuously released into the bloodstream for three years to prevent pregnancy by preventing the release of an egg cell from the ovaries (ovulation) and causes changes to cervical mucus that makes it difficult for sperm to enter the womb
• It is one of the most reliable birth control methods (over 99% effective)
• You do not have to worry about taking a tablet each day; the implant should be replaced every 3 years.

Question 23

Implanon NXT
dose and directions

Answer 23

• dr will insert this one for you & tell u the most appropriate time to insert it
• Unless you are switching from another hormonal contraceptive method, insertion should be done on day 1-5 of your normal menstrual bleeding to rule out pregnancy
• Before inserting or removing Implanon NXT, your healthcare professional will give you a local anaesthetic
• Implanon NXT is inserted directly under the skin, on the inside of your upper nondominant arm (the arm that you do not write with)
• after the insertion, you should be able to feel the implant under your skin

Question 24

Implanon NXT

adverse effects

Answer 24

• During the insertion or removal of Implanon NXT, its common for people to experience bruising, pain, swelling or itching at the implant site
• causes irregular, prolonged bleeding or sometimes stops period
• cal 12
• infrequently: some people get nausea, vomiting, headache, dizziness, lethargy
• in rare cases infection may occur

Question 25

Implanon NXT

referral

Answer 25

• allergic reaction: swollen face, tongue or throat, trouble swallowing or hives and trouble breathing

Question 26

Implanon NXT

lifestyle/ selfcare

Answer 26

• When you are using Implanon NXT, you should arrange for regular checkups by your doctor. He or she should pay special attention to your blood pressure and your breasts and give you a regular examination of the pelvic organs (including a cervical smear)