E2. Emergency contraception Flashcards
what is emergency contraception?
Emergency contraception is contraceptive action where none was in place at the time of sexual intercourse. It can be intentional or unintentional
what are the options for emergency contraception?
-Copper intra-uterine device (IUD)
-Emergency Hormonal contraception (EHC): Levonorgestrel (Levonelle One Step™) and Ulipristal acetate (EllaOne™)
mode of action of copper Intrauterine Device?
-Affects motility and viability of sperm
-Affects viability and transport of egg
-Local endometrial inflammatory reaction prevents implantation
mode of action of Levonorgestrel?
Inhibits ovulation
mode of action of Ulipristal acetate?
Selective progesterone receptor modulator
Describe Copper Intrauterine Device
-Most effective method of emergency contraception
-Inserted by GP or Sexual and Reproductive Health Clinics (Up to 5 days after UPSI or Up to 5 days after expected date of ovulation)
-free
-Refer but also give hormonal contraception (unless contraindicated)
Describe the OTC supply of Levonelle™
-(Relatively) Strict licensing requirements
-Unprotected sexual intercourse within previous 72 hours
-Adults and children 16 years and over
-Must rule out possibility of pregnancy
-Bowel/liver disease
-Concurrent medicines
-Hypersensitivity
-History of ectopic pregnancy
-History of salpingitis (inflammation of the Fallopian tubes)
Levonelle counselling?
-Take as soon as possible to maximise potential effectiveness (Consider offering patient a glass of water in the pharmacy)
-Ongoing contraception need
side effects of Levonelle?
-Nausea, vomiting, headache, dizziness, fatigue, low abdominal pain,
diarrhea and breast tenderness.
-If vomit within 3 hours will need a second dose
-Menstrual timing changes
OTC supply of ellaOne™?
-More relaxed licensing requirements
-Unprotected sexual intercourse within previous 120 hours (5 days)
-Women of reproductive age
-Must rule out possibility of pregnancy
-Bowel/liver disease
-Severe asthma
-Concurrent medicines
-Hypersensitivity
ellaOne™ counselling?
-Take as soon as possible to maximise potential effectiveness (Consider offering patient a glass of water in the pharmacy)
-Ongoing contraception needs
-In the event of pregnancy, encourage patient to report for pharmacovigilance
side effects of ellaOne™?
-Nausea, vomiting, headache, dizziness, fatigue, low abdominal pain, diarrhea and
breast tenderness, painful periods, mood swings, muscle pain.
-If vomit within 3 hours will need a second dose
-Menstrual timing changes
-Consider the symptom of pregnancy
Following EHC supply pharmacists should:
-Establish and support the patient with any ongoing
contraceptive needs
-Establish and support the patient with any potential STI issues
-Pregnancy advice
-Not forget about safeguarding risks
PGD (Patient group direction) Supply?
-Sexual health falls under remit of Public Health England (PHE): Administered by local authority (council)
-Usually POM product supplied as often cheaper and has wider licence
-16 year old age restriction is often lowered for Levonelle but varies across different PGDs
-More extensive records/reporting required
-Doses may need to be supervised
-Action in case of vomiting may differ
-Free at point of supply
(Reimbursement is usually DT cost (POM) plus consultation fee)
questions to ask a patient as a pharmacist?
one note
What would you recommend as a pharmacist?
Faculty of sexual and reproductive healthcare advise:
-First Line: Copper IUD
-Second Line: Ulipristal acetate
-Third Line: Levonorgestrel
-Remember Standard 1 of the GPhC SfPP
where can you get the copper IUD?
-Sexual and Reproductive Health
Clinic (GUM)
-GP – extended skill
where can you get oral emergency contraception?
-Community Pharmacy
-GP
-Urgent Care Centre
-Online GP services
-Sexual and Reproductive Health
Clinic (GUM)
-A&E
-School Nurse
How well does copper IUD work?
<0.1% overall pregnancy rate
How well does oral emergency contraception work?
-Ulipristal acetate (1-2% overall pregnancy rate)
-Levonorgestrel (0.6-2.6% overall pregnancy rate)
Aftercare?
-Pregnancy test if menses delayed by >7 days, is lighter than usual or
is associated with abdominal pain that is not typical of the women’s
usual dysmenorrhoea
-Pregnancy test if quick start hormonal contraception even if they have bleeding as not true menses
-If conception occurs, oral hormonal contraception has no harmful effect on pregnancy outcomes and no increased risk of congenital abnormality
advanced supply?
-Advance provision did not reduce pregnancy rate
-Used more frequently and sooner if supplied in advance
-Did not lead to increased frequency of UPSI, change in
contraceptive method or increased risk of STI
-Not cost effective
-Consider Long Acting Reversible Contraception
