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

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Oral Contraception and EHC

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Oral Contraception and EHC

For Health Advisors, Health Information Staff and Nurse Advisors

Your Name

Medicines Information Pharmacist

Your Medicines Information Service


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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.


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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


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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

Contraception


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Oral Contraception

  • Combined oral contraception (COC)

  • Progestogen only pill (POP)

  • Emergency Hormonal Contraception (EHC)


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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

Combined Oral Contraception


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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


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Combined Oral Contraception How does it work?


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Oral Contraception

  • Combined oral contraception (COC)

  • Progestogen only pill (POP)

  • Emergency Hormonal Contraception (EHC)


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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


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Oral Contraception

  • Combined oral contraception (COC)

  • Progestogen only pill (POP)

  • Emergency Hormonal Contraception (EHC)


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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


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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


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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


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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


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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!!!!!


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Missed COC Pill/s


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Missed POP Pill/s


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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?


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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?


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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?


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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.


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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?


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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


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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?


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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?


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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


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