Oral Contraception and Eh c
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Transcript of Oral Contraception and Eh c
Oral Contraception and EHC
Your NameMedicines Information PharmacistYour Medicines Information Service
For Health Advisors, Health Information Staff and Nurse Advisors
Oral Contraception and EHC
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
1. 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
Oral Contraception and EHC
Contraception
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
Oral Contraception and EHC
Oral Contraception
Combined oral contraception (COC)Progestogen only pill (POP)Emergency Hormonal Contraception (EHC)
Oral Contraception and EHC
Combined Oral Contraception
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
Oral Contraception and EHC
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
Oral Contraception and EHC
Combined Oral Contraception How does it work?
Oral Contraception and EHC
Oral Contraception
Combined oral contraception (COC)Progestogen only pill (POP)Emergency Hormonal Contraception (EHC)
Oral Contraception and EHC
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
Oral Contraception and EHC
Oral Contraception
Combined oral contraception (COC)Progestogen only pill (POP)Emergency Hormonal Contraception (EHC)
Oral Contraception and EHC
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
Oral Contraception and EHC
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
Oral Contraception and EHC
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
Oral Contraception and EHC
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
Oral Contraception and EHC
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!!!!!
Oral Contraception and EHC
Missed COC pillMissed COC pill
Less than 12 hours elapsedLess than 12 hours elapsed More than 12 hours elapsedMore than 12 hours elapsed
Take missed pill and continue regime as normal. No extra precautions required
Take missed pill and continue regime as normal. No extra precautions required
Where in pill cycle?Where in pill cycle?
1 pill missed from a pack in the cycle
1 pill missed from a pack in the cycle
2 or more pills missed at any time in the cycle
2 or more pills missed at any time in the cycle
2 or more pills missed from days 15-21
2 or more pills missed from days 15-21
Continue COC to end of pack use extra precautions for 7
days
Continue COC to end of pack use extra precautions for 7
days
Continue COCContinue COC Continue COC and use extra precautions for 7 days. GO straight on to
next pack without a break
Continue COC and use extra precautions for 7 days. GO straight on to
next pack without a break
Missed COC Pill/s
Oral Contraception and EHC
Missed POP pill/sMissed POP pill/s
Less than 3 hours late?Less than 3 hours late?
More than 3 hours late (27 hours after last pill)
More than 3 hours late (27 hours after last pill)
Take the missed pill and continue as normal
Take the missed pill and continue as normal
Cerazette?Cerazette?
NONO YESYES
Take missed pill as soon as possible,
Take rest of packet as normalAnd use extra precautions for the
next 2 days
Take missed pill as soon as possible,
Take rest of packet as normalAnd use extra precautions for the
next 2 days
Less than 12 hours late?Less than
12 hours late?More 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 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
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 POP Pill/s
Oral Contraception and EHC
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?
Oral Contraception and EHC
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?
Oral Contraception and EHC
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?
Oral Contraception and EHC
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.
Oral Contraception and EHC
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?
Oral Contraception and EHC
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
Oral Contraception and EHC
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?
Oral Contraception and EHC
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?
Oral Contraception and EHC
Learning Outcomes
1. 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