1. Oral Contraception and EHC
For Health Advisors, Health Information Staff and Nurse Advisors
Your Name
Medicines Information Pharmacist
Your Medicines Information Service

2. 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.

3. Learning Outcomes
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

4. 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

5. Oral Contraception Combined oral contraception (COC)
Progestogen only pill (POP)
Emergency Hormonal Contraception (EHC)

6. 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
Efficacy: 1 per 100 women-years. I.e. if 100 women took for 1 year 1 person could expect to have become pregnant

7. 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

8. Combined Oral Contraception How does it work?

9. Oral Contraception Combined oral contraception (COC)
Progestogen only pill (POP)
Emergency Hormonal Contraception (EHC)

10. 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

11. Oral Contraception Combined oral contraception (COC)
Progestogen only pill (POP)
Emergency Hormonal Contraception (EHC)

12. 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
Within 24 hours of unprotected sexual intercourse <95%
25-48 hours 85% and 58% at hours

13. 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

14. 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

15. 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
Legally ;
abortion can only take place after a fertilised egg has implanted into the womb.
The precise mode of action of Levonelle One Step is not known.
At the recommended regimen, levonorgestrel is thought to work mainly by preventing ovulation and fertilisation if intercourse has taken place in the preovulatory phase, when the likelihood of fertilisation is the highest. It may also cause endometrial changes that discourage implantation. Levonelle One Step is not effective once the process of implantation has begun.

16. 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!!!!!

17. Missed COC Pill/s

18. Missed POP Pill/s

19. 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?

20. 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?

21. 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?

22. 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.

23. 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?

24. 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

25. 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?

26. 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?

27. Learning Outcomes
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