Contraception

EMERGENCY CONTRACEPTION

Emergency contraception is a safe, effective and responsible method of preventing pregnancy when regular contraception has failed, no contraception was used, and/or in the case of sexual assault. For those who act quickly, emergency contraception will usually prevent pregnancy.

Emergency contraception will not prevent someone from getting a sexually transmitted infection (STI).

It is important for pharmacy teams to understand that many customers will often find it embarrassing to talk about sexual health and would prefer to do this in an informal, but confidential and private manner, with someone they trust.

It is also best not to assume anything about the patient when they approach the pharmacy for advice on sexual health. A person who is asking for information may not be sexually active and just want to be better informed. A person may not already know all the facts. Being prepared to go back to basics and giving information in stages ensures you give a patient time to ask questions about what you have said and clarify any areas of misunderstanding.

It can be hard to reduce a whole conversation about sexual health into a 30-secondover-the-counter chat. It is much more beneficial if consultations can take place in an appropriately confidential space if possible. This helps to build up a trusting relationship with the patient as confidentiality is a priority when accessing sexual health services in any setting.

Use visual tools to tell young customers that contraception is available, such as leaflets about STI prevention methods, contraception and sexual health at the counter and posters around the pharmacy. Information slips about safe sex could be included in prescription bags, especially when issuing scripts for contraceptives and STI treatments.

When teenagers are approaching the pharmacy for EHC, this may provide an ideal opportunity for pharmacy staff to refer them to the pharmacist to discuss wider aspects of contraception and sexual health, including protection from sexually transmitted infections (STIs).

DISCUSSING CONTRACEPTION

Reassure them they have done the right thing. Offer them the use of a private consultation room, so that they may talk more freely. Talk to them in consumer language, for example mention ‘morning-after pill’ rather than EHC.

Be professional but have a warm and approachable manner. The risk of becoming pregnant after unprotected sexual intercourse (UPSI) depends on the age and relative fertility of the lady and timing of the intercourse. The highest risk part of a cycle starts approximately 5 days before ovulation to approximately 2 days after ovulation but when those days occur may be hard to predict. When studies are done looking at all women who present for Emergency Contraception (EC) advice - regardless of their age or when in the cycle they had the UPSI- the pregnancy risk is sometimes quoted as about a 5% overall.

According to the Faculty of Sexual and Reproductive Healthcare, EC should be indicated when:

Women who do not wish to conceive should be offered EC after unprotected sexual intercourse (UPSI) that has taken place on any day of a natural menstrual cycle. Women who do not wish to conceive should be offered EC after:

UPSI from Day 21 after childbirth (unless the criteria for lactational amenorrhoea are met).

UPSI from Day 5 after abortion, miscarriage, ectopic pregnancy or uterine evacuation for gestational trophoblastic disease (GTD).

Women who do not wish to conceive should be offered EC after UPSI if their regular contraception has been compromised or has been used incorrectly. There are two hormonal methods of EC routinely used today and either of them may be purchased over the counter. They are:

1. The high dose (1500microgram (1.5mg)), progestin-only levonorgestrel (LNG) tablet – marketed under the names ‘Norlevo’ or ‘Prevonelle’.

or

2. The high dose (30mg), progesterone receptor modulator ulipristal acetate (UPA) tablet- marketed under the name ‘ellaOne’

Women with medical cards can get the EHC pill free-of-charge directly from a pharmacist without the need for a prescription from their GP. This is an important public health measure and will remove any barrier to women getting timely treatment from their local pharmacy.

When it comes to which EC should be supplied, according to the IPU Emergency Hormonal Contraception (EHC) Protocol, Ulipristal acetate (ellaOne) has been demonstrated to be more effective than levonorgestrel from 0-120 hours after unprotected sexual intercourse (UPSI) so it should be considered first-line oral emergency contraception unless contraindicated. The main reasons to give levonorgestrel instead of ulipristal acetate would be if the patient was taking liver enzyme-inducing drugs or was breastfeeding or was taking a progestogencontaining oral contraceptive or had severe asthma treated by oral glucocorticoids.

Always refer to the pharmacist, anyone seeking EC who is taking medications that may interact with it. These include medicines used to treat HIV, tuberculosis, epilepsy and those taking St John’s Wort.

W W

H A

Who? Sexually active women for whom regular contraception has failed/no contraception was used, and/or in the case of sexual assault.

What are the symptoms? Unprotected sexual intercourse/failed contraception method. Many will be embarrassed so ensure to offer private consultation space.

How long has the patient had the symptoms? EC is most effective as soon after sexual intercourse as possible.

Action already taken? Routine contraception may have been used/ some may have taken the opportunity to discuss with friends/family members for advice before visiting the pharmacy.

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1 Based on combined MAT sales data. To verify contact: verify@perrigo.com 2Associated with a cold. 3 Bronchostop Junior is a medical device according to Directive 93/42/EEC, used to relieve any cough (dry & chesty) associated with a cold for children from 1 year. Children under 3 years of age should consult with a doctor to exclude more serious diseases being present. Use in children under 1 year of age is not recommended. Children aged 1 year and above 5ml up to 3 times daily. Children 2 to 3 years: 5ml up to 4 times daily. Children 4 to 5 years: 7.5ml up to 4 times daily. Children 6 to 11 years: 15ml up to 4 times daily. Always read the leaflet. 4 Buttercup Bronchostop Cough Syrup contains thyme herb extract and marshmallow root extract. A traditional herbal medicinal product for the relief of coughs, such as chesty, dry, tickly, irritating coughs and catarrh, exclusively based upon long-standing use. Adults and children over 12 years: 15ml every 4 hours. Max dose 90ml per day. Not recommended for children under 12 years. Seek medical advice if symptoms persist after 7 days or if dyspnoea, fever or purulent sputum occurs. Contraindications: Known hypersensitivity to ingredients, rare hereditary intolerance to some sugars. Caution: Not recommended for use in Pregnancy and lactation. Contains methyl parahydroxybenzoate and propyl parahydroxybenzoate, which may cause allergic reactions. Side effects: Hypersensitivity reactions and stomach disorders. TR 2006/1/1. TR Holder: Kwizda Pharma GmbH, Effingergasse 21, A-1160 Vienna, Austria.

SPC: https://www.medicines.ie/medicines/buttercup-bronchostop-cough-syrup-31510/spc IRE BRO 2020 18