Oral Contraception and EHC For Health Advisors Health

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. Oral Contraception and EHC

Learning Outcomes Be familiar with different types of oral contraceptives 2. Understand how emergency hormonal contraception (EHC) and oral contraceptives work 3. Gather necessary information to be able to clarify the question 4. Interpret information about contraceptives and turn it into appropriate advice 1. Oral Contraception and EHC

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

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

Combined Oral Contraception Contains oestrogen and progestogen n Take one tablet daily for 21 days (28 for ED) followed by a 7 day pill free period n Oral Contraception and EHC Most effective preparation for general use n With optimal use, > 99% effective n

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

Combined Oral Contraception How does it work? Oral Contraception and EHC

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

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

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

Emergency Hormonal Contraception n Levonelle 1500 (one step) n Contains high dose progesterone (levonorgesterel) n One 1500 mcg tablet taken as soon as possible after unprotected intercourse (up to 72 hours after) n Preferably within 12 hours, no later than 72 hours Oral Contraception and EHC

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

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

How does EHC work? n Dependent on point in the menstrual cycle n Either prevents or delays ovulation, prevents fertilisation or prevents implantation of the fertilised egg into the uterus. n Clinical opinion is that EHC is not an abortifacient Oral Contraception and EHC

Missed Contraceptive Pills n COC n n n 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 n POP n Not for the forgetful!!!!! Oral Contraception and EHC

Missed COC Pill/s Missed COC pill Less than 12 hours elapsed More than 12 hours elapsed Take missed pill and continue regime as normal. No extra precautions required Where in pill cycle? 1 pill missed from a pack in the cycle Continue COC Oral Contraception and EHC 2 or more pills missed at any time in the cycle Continue COC to end of pack use extra precautions for 7 days 2 or more pills missed from days 15 -21 Continue COC and use extra precautions for 7 days. GO straight on to next pack without a break

Missed POP Pill/s Missed POP pill/s More than 3 hours late (27 hours after last pill) Less than 3 hours late? Cerazette? Take the missed pill and continue as normal NO Take missed pill as soon as possible, Take rest of packet as normal And use extra precautions for the next 2 days Oral Contraception and EHC YES Less than 12 hours late? More than 12 hours late? Take missed pill as soon as possible and continue with packet as normal Take missed pill as soon as possible, take the rest of the packet as normal. Use extra precautions until pills taken for 2 consecutive days

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

Taken too many pills n Which brand of contraceptive pill? n How many were taken? n Which pills did you take? n How long ago did you take it? Oral Contraception and EHC

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

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

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

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

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

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

Learning Outcomes Be familiar with different types of oral contraceptives 2. Understand how emergency hormonal contraception (EHC) and oral contraceptives work 3. Gather necessary information to be able to clarify the question 4. Interpret information about contraceptives and turn it into appropriate advice 1. Oral Contraception and EHC