Emergency Contraceptive Pills Session II: Indications for Use and Screening Clients

Indications for use of ECPs A couple recently had sex without using contraception. A condom broke or slipped. A woman using oral contraceptive pills missed three or more pills or started later in the month than instructed. A woman using contraceptive injections was late for her next shot. A woman experienced an IUD expulsion or could not locate the IUD string. Ask participants <When might the use of ECPs be indicated?> List their responses on a flip chart and then compare their list to the one on this slide and the next one. Explain that we will be discussing more about why ECPs might be needed when we do roleplays later during the training. But, overall, ECPs are indicated when: No contraceptive was used (including cases of rape) A contraceptive was used incorrectly A contraceptive was used correctly, but was immediately observed to have failed (such as condom slippage or breakage).

Indications for use of ECPs (continued) Sex was forced (rape). Failed coitus interruptus (e.g., ejaculation in vagina or on external genitalia). Miscalculation of the periodic abstinence method or failure to abstain on a fertile day of the cycle. Failure of a spermicide tablet or film to melt before intercourse. Diaphragm or cap dislodgment, breakage, tearing, or early removal.

Screening customers for ECP use   The most important screening question for ECP use is: Did you have unprotected sex within the last 5 days (120 hours)? If “yes” then the client is eligible for ECPs. Effectiveness will be lower the longer a woman waits to take ECPs. Explain that it is important to understand that there are no medical restrictions to the use of ECPs except for pregnancy. But, there are certain questions that you should ask to be sure that a client needs ECPs. Ask participants <What key screening questions should a woman be asked when providing her with ECPs for recent unprotected intercourse?> <How can the pharmacist reassure the client and make her feel comfortable?> List their responses on a flip chart. Show this slide and the next slide to reinforce or correct their answers. Distribute Handout #2: Screening Checklist and review it with participants.

Screening questions for ECP use (continued)   You can also ask questions to determine if the woman is pregnant. ECPs will not work if she is pregnant. Was your last menstrual period less than 4 weeks ago? If “No,” the client may be pregnant. Was this period normal for you in both its length and timing? If “No,” the client may be pregnant. Is there reason to believe you may be pregnant? If “Yes,” the client may be pregnant. If the client is not pregnant, ECPs may be given. If the client’s pregnancy status is unclear, ECPs may still be given, with the explanation that the method will not work if she is already pregnant. You can also ask about other drugs the woman is taking: Are you taking the any of these drugs: rifampicin, griseofulvin, Saint John’s Wort, anticonvulsant drugs or ritonavir? ECPs may be less effective if you are taking any of these medications. But ECPs should still be given, as there are no contraindications to ECPs.

ECP Screening Flow Chart 1. Did you have unprotected sex in the last 120 hours (5 days)? ECPs are not right for you. If your last menses was over 4 weeks ago, see a health care provider to determine next steps. No Yes Yes 2. Are you pregnant? Don’t know Yes Show the slide. Ask for a volunteer to explain the flow chart. Explain that the screening check list and the flow chart are slightly different. Ask trainees <What are the differences they observe?> 3. Was your last menses was over 4 weeks ago? No No Recommend ECPs. If your next period does not come within 7 days of when you would normally expect it, see a health care provider to determine pregnancy status. Don’t know No 4. Do you want to prevent pregnancy? Yes