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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
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.
2.

3.
4.

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

Oral Contraception and EHC

Contraception

Male and female


condoms
Intrauterine device
Diaphragms and caps
Contraceptive injection
Contraceptive implant
Contraceptive patch

Oral Contraception and EHC

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)

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

Oral Contraception and EHC

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

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 Pill/s


Missed COC
COC pill
pill
Missed
Lessthan
than12
12hours
hourselapsed
elapsed
Less

Morethan
than12
12hours
hourselapsed
elapsed
More

Takemissed
missedpill
pilland
andcontinue
continueregime
regimeas
as
Take
normal.No
Noextra
extraprecautions
precautionsrequired
required
normal.

Whereininpill
pillcycle?
cycle?
Where

pillmissed
missedfrom
fromaapack
pack
11pill
thecycle
cycle
ininthe

ContinueCOC
COC
Continue

Oral Contraception and EHC

ormore
morepills
pillsmissed
missedat
atany
any
22or
timeininthe
thecycle
cycle
time
ContinueCOC
COCtotoend
endof
ofpack
pack
Continue
use
extra
precautions
for
use extra precautions for 77
days
days

ormore
morepills
pillsmissed
missedfrom
from
22or
days15-21
15-21
days

ContinueCOC
COCand
anduse
use
Continue
extra
precautions
for
extra precautions for 77
days.GO
GOstraight
straighton
onto
to
days.
nextpack
packwithout
withoutaabreak
break
next

Missed POP Pill/s


Missed POP
POP pill/s
pill/s
Missed
Morethan
than33hours
hourslate
late
More
(27hours
hoursafter
afterlast
lastpill
pill) )
(27

Lessthan
than33hours
hourslate?
late?
Less

Cerazette?
Cerazette?

Takethe
themissed
missedpill
pilland
and
Take
continue
as
normal
continue as normal
NO
NO

Takemissed
missedpill
pillas
assoon
soonas
as
Take
possible,
possible,
Takerest
restofofpacket
packetas
asnormal
normal
Take
And
use
extra
precautions
forthe
the
And use extra precautions for
next
2
days
next 2 days

Oral Contraception and EHC

YES
YES
Lessthan
than
Less
12hours
hourslate?
late?
12

Morethan
than
More
12
hours
late?
12 hours late?

Takemissed
missedpill
pillas
assoon
soon
Take
aspossible
possibleand
andcontinue
continue
as
withpacket
packetas
asnormal
normal
with

Takemissed
missedpill
pillas
assoon
soonas
as
Take
possible,
take
the
rest
of
the
possible, take the rest of the
packetas
asnormal.
normal.
packet
Use
extra
precautions
untilpills
pills
Use extra precautions until
taken
for
2
consecutive
days
taken for 2 consecutive days

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.
2.

3.
4.

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

Oral Contraception and EHC

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