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H ormonal e mergency contraception in Europe : accessibility and availability

H ormonal e mergency contraception in Europe : accessibility and availability. Dr E. AUBENY French Association for Contraception (AFC) - Paris. Levonorgestrel E.C. : more efficient and better tolerated It has become the reference E.C. Two hormonal methods are presently available.

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H ormonal e mergency contraception in Europe : accessibility and availability

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  1. Hormonal emergency contraception in Europe : accessibility and availability Dr E. AUBENY French Association for Contraception (AFC) - Paris

  2. Levonorgestrel E.C. : more efficient and better tolerated • It has become the reference E.C. Two hormonal methods are presently available Dr E. AUBENY - AFC, Paris Hormonal E. C. in Europe : accessibility and availability Techniques : • Yuzpe method (EE+ levonorgestrel). It has been abandoned : lover efficacy and medical contra-indications

  3. Hormonal E. C. in Europe : accessibility and availability Levonorgestrel E.C. Reference as emergency contraception Dr E. AUBENY - AFC, Paris Reference method  Posology : 2 pills at 0.75 mg in one intake When : as soon as possible, preferentialy before 120 h after unprotected intercourse  Efficacy : 80 % Conter-indication : none

  4. Dr E. AUBENY - AFC, Paris Hormonal E. C. in Europe : accessibility and availability Levonorgestrel E.C. : accessibility • For some years only in Hungary • Nowadays widespread all over Europe under different names and by different laboratories : Levonnelle (Schering), Norlévo, (HRA pharma), Postinor (Gédéon Ritcher)

  5. to take a pill quickly for a maximum efficacy  easy access to be used Dr E. AUBENY - AFC, Paris Hormonal E. C. in Europe : accessibility and availability Levonorgestrel E.C. : availability Emergency contraception requires : Medical prescription causes delay and dicourages the use of E.C.

  6. No contra indication No need for a physical examination Dr E. AUBENY - AFC, Paris Hormonal E. C. in Europe : accessibility and availability Levonorgestrel E.C. : availability So levonorgestrel E.C. is available in numerous countries without a medical prescription France since June 1999 (1st country)

  7. HormonalE. C. in Europe : accessibility and availability Levonorgestrel E.C. availability Today without a medical prescription • Pharmacies • Belgium • Denmark • Finland • France • Portugal • Belgium • U.K. • Switzerland • Slovenia • Drugstores • Norway • Sweden Europe Dr E. AUBENY - AFC, Paris

  8. Hormonal E. C. in Europe : accessibility and availability Resultsof distribution without a medical prescription Dr.E. AUBENY - AFC, Paris

  9. HormonalE. C. in Europe : accessibility and availability Levonorgestrel E.C. without a medical prescription Results : medical point of view No major medical problem reported by pharmacovigilance No reduction in hormonal contraception (rise in the sale of contraceptive pills in France) Dr E. AUBENY - AFC, Paris No increase of ectopic pregnancies

  10. Hormonal E. C. in Europe : accessibility and availability Levonorgestrel E.C. without a medical prescription Results : Use by women  Women use this emergency contraception very widely even information only goes through by the media and very little through by the doctors  In France and in U.K. 85 000 women use this drug each month even though it is not reimbursed by the Frech Social Security and it is very expensive in the U.K.(18 euros). E.C. meets a real need Dr.E. AUBENY - AFC, Paris

  11. Hormonal E. C. in Europe : accessibility and availability • Levonorgestrel E.C. without a medical prescription • Results : Use by women • No medical prescription facilitates the use of E.C. • August 2002 • E.C without medical prescription : France 80 000 sales, U.K. 80 000 (in spite of the price) • E.C with medical prescription : Germany 9 000 sales, Austria 1 800 • Countries where levonorgestrelE.C. is distributed with a prescription women use it very little E.C. meets a real need, it should be used very easily Dr.E. AUBENY - AFC, Paris

  12. Hormonal E. C. in Europe:accessibility and availabilityLevonorgestrel E.C. without a medical prescription Results : prevention of abortion No figures yet In France, in 2000, for the first time, one year after the selling of levonorgestrel E.C.without a prescription a slight decrease has been acknowledged in the number of abortions Coincidence or beneficial effect of levonorgestrel E.C ? It is too early to conclude Dr E. AUBENY - AFC, Paris

  13. For condoms users • In case of a forgotten pill Dr. E. AUBENY - AFC, Paris Hormonal E. C. in Europe : accessibility and availabilityLevonorgestrel E.C. without a medical prescription Results :Role of doctors : preventative distribution - Coraliance Study * • 23 % of forgotten pills during the month preceeding the study • 46 % of these when starting again : dangerous period • 33 no precaution whatsoever Preventive distribution does not result in a decrease of the use of regular contraception** *The "Coraliance Study" ESC Journal Oct. 2002,**A. Glasier

  14. Results Dr E. AUBENY - AFC, Paris Hormonal E. C. in Europe : accessibility and availability In France two specific measures for youngsters 1) Delivery of lévonorgestrel E.C. by school nurses in case of emergency  September 2001/September 2002 : 15 125 pupils asked for it, 9 000 have received it, among them of 6 000 from a nurse  Teenagers talk about their sexuality and contraception problems

  15. Hormonal E. C. in Europe : accessibility and availability 2) Free delivery of Levonorgestrel E.C. to teenagers in pharmacies Teenagers ask for E.C. lévorgestrel (Norlévo) no checking of age or identity Pharmacist gives advice on the use of Norlévo and normal contraception STD, medical follow-up gives a leaflet about Norlevo reimbursed by Social Security Difficulties of implantation : pharmacistsare afraid to speak to youngsters Dr E. AUBENY - AFC, Paris

  16. Hormonal E. C. in Europe : accessibility and availability TO CONCLUDE • Lévonorgestrel E. C. replaced by Yuzpe method • It is available in most countries • This E.C. has widely spread in Europe because it meets a need Dr E. AUBENY - AFC, Paris

  17. Hormonal E. C. in Europe : accessibility and availability TO CONCLUDE • Its delivery varies from one country to another Levonorgestrel E.C. without a medical prescription is authorised in many countries in Europe - No medical problem - Facilitates its use Levonorgestrel E.C. without a medical prescription has to be developed Insufficient information about E:C. Dr E. AUBENY - AFC, Paris

  18. Dr E. AUBENY - AFC, Paris Hormonal E. C. in Europe : accessibility and availability TO CONCLUDE • In France levonorgestrel E.C. without a medical prescription : • No accident • No decrease of regular contraception • But under-used : forgotten pill unprotected intercourse Insufficient information about E.C.

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