Category Archives: Pharmacist’s role

ellaOne^® can be used by all women of childbearing age.

Adolescent pregnancy is a recognised public health concern. EHC provides an important tool in the arsenal of contraceptive options that reduce the risk of unintended pregnancies. ellaOne^® is suitable for any woman of childbearing age, including adolescents.

A post-marketing observational study evaluating the safety and efficacy of ellaOne^® in adolescents aged 17 and younger showed no difference in the safety and effiacy profile compared to adult women aged 18 and older.

Practice Point

You may receive requests for EHC from women under 16 years of age. The PSI guidance for pharmacists on the supply of emergency contraception states: “Where a patient is under the age of 16 years it is usual that parental consent is sought. Pharmacists should also be aware that the age of sexual consent in Ireland is 17 years. Where appropriate, pharmacists need to assure themselves of the age of the patient. Having regard to the age and circumstances of the individual patient, and any child protection issues arising, pharmacists should consider whether referral to a medical practitioner, other healthcare professional, or other agency or authority, is appropriate.”

Consideration should be given on a case by case basis and the decision to supply EHC be based on the individual woman presenting. As outlined in the Fraser guidelines, in order to consider the individual’s legal capacity to receive/consent to treatment, you should verify that:

The individual can understand the advice and understands what is involved
The individual cannot be persuaded to inform their parents
Unless the individual receives contraceptive teatment, their physical or mental health (or both) are likely to suffer
The individual’s best interests require them to receive contraceptive advice or treatment, with or without parental consent.

Other resources

You may also wish to view the following websites.

IPU: www.ipu.ie or www.ipunet.ie

PSI: www.thepsi.ie

It is important that women understand that ellaOne^® is not a regular form of contraception.¹ EC is not 100% effective and it is not as effective as a regular contraceptive method.

It is critical women understand that ellaOne^® will not protect them from pregnancy if they have unprotected sex again after taking ellaOne^®. They should use a reliable barrier contraceptive method until their next menstrual period, even if they are taking a regular contraceptive pill.²

EHC is not contraindicated to women using oral contraceptives but they should read the leaflet inside the pack to find out about continuing use of oral contraceptives in the month that they use ellaOne^®.² The package leaflet is also available online .

Fast access to ellaOne^® after UPSI is important. When women come to your pharmacy seeking emergency contraception it is essential that your team know how to respond, so that women get the help they need to avoid unintended pregnancy.

Your team should know:

Your pharmacy offers EHC
Your aim is to offer women EHC in a reassuring way

In training sessions you could develop more examples or role-play the scenarios to build the team’s confidence so they can deal with requests for emergency contraception smoothly.

You can encourage your team to make the process of obtaining ellaOne^® as least embarrassing as possible. They should recognise that this may be an emotional time for the woman. In a large EU survey, 50% of women said they found seeking EC embarrassing,¹ so a welcoming, professional approach is appropriate. Other women may ask for EC in a way that may make you or your team members feel uncomfortable, maybe by providing too many intimate details or having a loud or brazen manner. Exploring ways to deal with this can also form part of a training role-play.

Sexuality and sexual behaviour are sensitive topics. They are part of our most private lives. When a woman asks for emergency contraception, she is disclosing that she had sexual intercourse and that the couple did not use, or had a problem with, their contraception.

When it comes to emergency contraception, some pharmacists can be confronted with his or her own prejudices. It is important to remember that couples and individuals have a right to decide freely and responsibly the timing and number of their children.¹ Women who seek emergency contraception are behaving responsibly by taking steps to avoid unintended pregnancy. They need a warm approach. Treating all women in this way is always good practice, especially as some women may have been coerced to have sex (but not necessarily be disclosing this fact to you).

Unprotected sex or contraceptive failure can happen to anyone, for a number of different reasons.

Customers should always feel like they can talk to you openly and, in your role as a pharmacist, it is important to be able to have a professional conversation without judgement. Always adhere to Principle One of the Code of Conduct for pharmacists, which requires pharmacists to ensure that in instances where they are unable to provide services to a patient, they take reasonable action to ensure those medicines/services are provided and that the patient’s care is not jeopardised. If supply to a patient is likely to be affected by the personal moral standards of a pharmacist, her or she must inform their superintendent and supervising pharmacist, who must ensure that suitable policies and procedures are in place. This may have particular relevance in the supply of ellaOne^®.

It can happen to anyone
Over a woman’s fertile life it would be most unusual if there were not occasional lapses in contraceptive cover
Love (and sex) are unpredictable, but dealing with unexpected events sensibly is the responsible thing to do
Women may stop their regular contraception for many reasons, including because they have no established partner
Human behaviour is complex and sometimes unpredictable
If she’s having sex she needs reliable contraception – including emergency contraception (provided within national guidelines where they exist)

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.
Step 2: Reassure	Tell her she has done the right thing coming into the pharmacy for help. Explain emergency contraceptive pills work by inhibiting or postponing ovulation (release of an egg)^1,2 so sperm will not find an egg to fertilise.
Step 3: Encourage immediate action	Emergency contraception is most effective when used as soon as possible^1,2 after unprotected sex³
Step 4: Advise about sex after ellaOne^®	A rapid return to fertility is likely following treatment with an emergency contraceptive pill. A barrier method of contraception must be used until your next period – even if you are continuing with an oral method of contraception (OC).^1,2 The emergency contraceptive pill is for occasional use only: it should not be used to replace a regular contraceptive method.^1,2 If she requires advice, suggest she visit her GP or Family Planning Clinic for information about regular contraceptive options. Oral emergency contraception is not 100% effective. Emergency contraceptive pill does not protect from STIs.^2,4 Only condoms protect against STIs.
Step 5: Advise what to do if the woman is sick	If vomiting occurs within 3 hours of taking emergency contraception, you should take another tablet as soon as possible.^1,2
Step 6: Advise about the next menstrual period	After taking oral emergency contraception, menstrual periods can sometimes occur earlier or later than expected by a few days.^1,2 If your period is more than seven days late or pregnancy is suspected for any other reason (symptoms of pregnancy, abnormal bleeding at the expected date of menstrual periods) or in case of doubt, you should do a pregnancy test or visit your doctor to make sure you are not pregnant.^1,2

Pharmacists’ role when providing ellaOne^®

Discussing emergency contraception can be distressing for women and it can also be uncomfortable for pharmacists.

You can help by:

Being matter-of-fact
Re-assuring them they have done the right thing
Offering them a more private place to talk if possible (e.g. the consultation room)
Using customer’s language (referring to the “Morning-after pill” or “Day-after pill” instead of EHC)
Having a warm and positive approach

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.

Pharmacists’ role when providing ellaOne®

Pharmacists’ role when providing ellaOne^®