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


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.


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


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

Combined oral contraception (COC)Progestogen only pill (POP)Emergency Hormonal Contraception (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


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


Combined Oral Contraception How does it work?


Oral Contraception



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



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


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


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


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


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!!!!!


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


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


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?


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?


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?


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.


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?


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


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?


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?


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

Documents

Oral Contraception and Eh c