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And ellaOne® is now available directly from you, without a prescription.
Current emergency contraception solutions are:
The IUD which is suitable for EC is a Copper-T IUD
IUDs are considered the most effective EC option,1 however they may not be a practical option for many women, as an IUD fitting takes time and involves an invasive procedure by a specifically trained healthcare professional. The advantage of an IUD is that it provides an ongoing contraceptive solution.1 But when speed is of the essence, women may not want to rush a decision to fit this long acting reversible contraceptive (LARC).
The Copper-T IUD can be fitted up to 120 hours (5 days) after unprotected sex.2 Its use is restricted by its availability and the need to be inserted by a skilled healthcare professional.3
Women who would prefer a copper IUD for emergency contraception must be advised to contact a GP or family planning service as a matter of urgency.2 Pharmacists should direct women to a local service known to provide IUDs.2
It is also common practice to consider offering EHC to these women in case there are any problems obtaining or fitting the IUD, or indeed if they change their mind.
The mechanism of action of oral ECs is to inhibit or postpone ovulation, so that no ovum is released.5,6
EHCs work by inhibiting or delaying ovulation (the release of an egg), so that fertilisation cannot take place.5,6
Emergency contraceptive pills will not prevent pregnancy in 100% of cases.5 There is a chance that the woman has already ovulated when she takes an emergency contraceptive pill.7 Taking emergency contraceptive pills as soon as possible after unprotected sex gives the best chance of success.8 EHCs have no effect on fertilisation if ovulation has already happened. They do not interfere with an implanted egg (pregnancy)5,6 so they do not cause abortion8.
EHCs are suitable for women of reproductive age and are generally well tolerated.5,9 EHCs do not protect from sexually transmitted infections (STIs).8
EHCs are back-up contraception solutions, which do not replace a regular contraceptive method.
The availability of emergency contraceptive pills from pharmacy without a prescription is critical to increase access and minimise delay of intake. This is especially significant given that emergency contraceptive pills are more effective the sooner they are taken after unprotected intercourse.
Women may also like the anonymity of the pharmacy as they can feel embarrassed about needing emergency contraception.3
When EHC is available through pharmacies without a prescription, the use of the medication increases compared to when it is available from doctors, clinics or hospitals.4 Increased access to EC through pharmacies does not have a negative impact on the use of other forms of contraception.4
Studies show that women and adolescents with greater access to EC are more likely to adopt an ongoing contraceptive method after EC use.9 Notably, it has been shown that greater level of use through non-prescription availability:
Women’s EC experience is actually a motivating factor leading to more consistent use of regular contraception9
Good Pharmacy Practice can include:
The quality of the pharmacy interaction is an important determinant of appropriate use of the product. It is also likely to be an important factor in a woman’s decision to take action in the event of a future UPSI.
Since a woman can never know when she has ovulated, working out the exact point of fertilisation is also impossible. What we do know is that implantation occurs 6-12 days after fertilisation.1 Once implantation is complete, pregnancy is established.2
Pregnancy begins when a fertilised egg has been implanted in the wall of a woman’s uterus. This definition is critical to distinguishing between a contraceptive that prevents pregnancy and an abortifacient that terminates it. 2,3
Many women don’t understand when pregnancy begins. They believe it starts the moment they had UPSI. Within 5 days of UPSI a woman cannot be pregnant from that UPSI, because implantation cannot yet have occurred. But this mistaken understanding means that they can feel guilty about using EC because they wrongly believe it to be a form of abortion.4
So when is the fertile window? Current evidence challenges the simplified ‘text book’ understanding of the menstrual cycle.2 We now know that only about 12% of ovulations happen on day 14.3
The variability of ovulation is large – it can happen from day 11 to day 21.2 Because sperm stay viable for up to 5 days1, the period over which conception is likely to occur runs from day 6 to day 21 for regularly cycling women.2 If the cycle is not regular, there is a risk of ovulation happening even later in the cycle.2 The conception risk period does not end before day 28 of their cycle.2 This shows that there is no such thing as a risk free period.2
Ovulation also varies from cycle to cycle.2
Sperm viability declines over time. This means that the risk of conception is highest during the first three days following unprotected sex or contraceptive failure.6
In a large European survey of over 7000 sexually active women, 30% reported having unprotected sex, at least once, in the last 12 months.1
These frequent acts of unprotected sexual intercourse are not happening in a distinct sub-population, but happen irrespective of age, income, education level and marital status.1
– Accidental condom problem1 (breakage, slippage, not on in time)
– Oral contraceptive (OC) problems1 e.g. forgotten pill
– A temporary break from the usual contraceptive1
– Forgetting to apply a patch or insert a vaginal ring1
UPSI can also happen as a result of non consensual intercourse (rape).
The majority of women say that there are no particular circumstances that could explain their lack of contraception or contraception failure.1 Only a minority recognised that some factors may have influenced their behaviour, making contraceptive failure more likely.1
These factors included a new partner or relationship breakdown, travel, influence of alcohol or using a new contraceptive method.1
A discussion guide has been developed to help you choose the most appropriate EHC for your customers. It is available here to download and is also available as a tear off pad to ensure you have all the information you need to make the right recommendation.
As part of the support for women, we have developed an information leaflet to supplement the PIL. The leaflet is intended to be given to a woman when once it has been decided that ellaOne® is the appropriate product for her. It answers the most commonly asked questions, such as what to do if she vomits, whether further intercourse will be protected, what to expect with her next period and more.
| Step 1: Listen | A woman comes to your pharmacy and asks for the morning after pill. Listen to her needs. Women can download an ellaOne® app, where they can display on their mobile phone screen a request for emergency contraception. They may use this if they are embarrassed to approach the counter when others are around, to request somewhere more private to talk, or that they wish to speak with the pharmacist. Ensure that you and your team are prepared to be approached in this way and be as discreet as possible.
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|---|---|
| Step 2: Reassure |
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| Step 3: Encourage immediate action |
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| Step 4: Advise about sex after ellaOne® |
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| Step 5: Advise what to do if the woman is sick |
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| Step 6: Advise about the next menstrual period |
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Discussing emergency contraception can be distressing for women and it can also be uncomfortable for pharmacists.
You can help by:
You can use the good practice at the counter guide as a framework for your conversation.
Customer satisfaction and comfort in discussing ECPs with a pharmacist can be very high.
What is ellaOne® ?
How to use ellaOne®
Definition
Emergency contraception (EC) is defined as the use of any drug or device after unprotected intercourse to prevent an unintended pregnancy.1
It is an ‘after-sex’ or ‘back-up’ contraception solution.
It is also commonly known as ‘morning-after pill’ or ‘day-after pill’.
When might EC be used?
Emergency contraception can best prevent pregnancies when used soon after intercourse. It provides an important back-up in cases of unprotected intercourse or contraceptive accident (such as forgotten pills, torn condoms) and after rape or coerced sex.2
How women might explain their need for EC
The follicular phase (stages 1-4 on the diagram below)
The follicular phase starts on the first day of menstruation and ends with ovulation.1 Prompted by the hypothalamus, the pituitary gland releases follicle stimulating hormone (FSH).2 This hormone stimulates the ovary to produce several follicles (tiny nodules or cysts), on the surface.1 Each follicle houses an immature egg.1 Usually, only one follicle will deliver an egg, while the others die.1 The growth of the follicles stimulates the endometrium to thicken in preparation for possible pregnancy.1
The ovulatory phase (stage 5 on the diagram below)
Ovulation is the release of a mature egg from the ovary’s surface in response to rising levels of luteinising hormone (LH) and FSH.1 When the LH reaches a peak it triggers the rupture of the developing follicle to release the mature egg: ovulation; with no LH surge, ovulation does not occur.1 The released egg is funnelled into the fallopian tube and towards the uterus by waves of small, hair-like projections. The life span of the typical egg is only around 24 hours.3 Unless it meets a sperm during this time, it will die.
The luteal phase (stages 6-8 on the diagram below)
Upon the release of the ovum, the ruptured follicle stays on the surface of the ovary. The follicle transforms into a structure known as the corpus luteum, which releases progesterone and small amounts of oestrogen.1,2 The thickened lining of the uterus is maintained and waits for a fertilised ovum to implant.1 If this happens the implanted ovum will start to produce human chorionic gonadotropin, detectable in a urine test for pregnancy.4 If pregnancy doesn’t happen, the corpus luteum regresses, usually around day 22 in a 28-day cycle.1 The drop in progesterone levels causes the endometrium to break down and menstruation begins again.1
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