- Several studies have shown that facilitating access to EHC does NOT increase sexual or contraceptive risk-taking behaviour1
- A number of studies show that women and adolescents with greater access to EC are NOT more likely to engage in unprotected intercourse, and are more likely to adopt an ongoing contraceptive method after EHC use2,3
- Use of EHCs has NO effect on future fertility1,4
- If a woman is already pregnant, it is too late for EC. Emergency contraception does NOT interrupt an existing pregnancy or harm a developing embryo1,5
- EHCs do NOT protect against STIs.6 Only condoms protect against sexually transmitted infections.
- EHCs do NOT provide contraceptive cover for unprotected intercourse in the days following intake6
Current emergency contraception solutions are:
- Intrauterine device (IUD), to be fitted in the womb
- Oral emergency contraception, as a tablet
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.
There are two oral ECs available4
- One containing levonorgestrel which was first made available in 2005, and became available through pharmacy in 2011.
- One containing ulipristal acetate (ellaOne®), which was launched in 2012.
The mechanism of action of oral ECs is to inhibit or postpone ovulation, so that no ovum is released.5,6
Mechanism of action of oral EC
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.
Pharmacists play a vital role in providing emergency contraception to customers, where the vast majority of women choose to visit a pharmacy over their GP. Emergency contraceptive pills are available without a prescription directly from pharmacists in Ireland, making pharmacists key EC providers.1
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
- Pharmacists promote dialogue on contraceptive alternatives and influence the beliefs and the outcomes through effective counselling on EHCs. The supply of emergency contraception from pharmacies can be accompanied by patient education from pharmacists, who have expertise on this topic4
- Pharmacists provide information to patients at the time of EHC supply, which allows women to understand proper use of this medicine. Pharmacists ensure consistency of information about EHCs, in particular for women less than 17 years of age4
Pharmacy access to EHCs has not led to any negative consequences
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:
- Does not lead to increased rates of STIs5
- Does not increase sexual risk-taking behaviour in adolescents6,7
- Does not lead to increased frequency of unprotected sex5
- Does not lead to decreased use of other contraceptive methods5
- Does not lead to decreased use of contraception, including the most common methods such as contraceptive pills and condoms5,8
Women’s EC experience is actually a motivating factor leading to more consistent use of regular contraception9
Good Pharmacy Practice can include:
- Asking the right questions; avoiding unnecessary, personal or intrusive questioning
- Providing quality advice in a sensitive way, without lecturing
- Providing an environment where women feel comfortable and not judged, for example in the consultation room.
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.
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
- Condom broke or slipped off
- Missed pill, forgot to insert contraceptive ring or apply patch
- Diaphragm or cap slipped out of place
- Failure of withdrawal method
- No contraception used
- They were forced to have unprotected sex