Emergency Hormonal Contraception.

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Emergency Hormonal Contraception

Emergency contraception refers to the contraceptive methods that are used as the last chance to prevent pregnancy for women who have been exposed to unprotected coitus and who do not wish to become pregnant. There are two types of emergency contraception: hormonal methods and the insertion of an intrauterine device (IUD). In this essay I am going to discuss emergency hormonal contraception (EHC) only.

EHC consists of a short-course of progestogen-estrogen combination pills (Yuzpe method) or progestrogen-only pills taken within 72 hours of unprotected intercourse. They can be taken any time during the menstrual cycle and if used appropriately the chance of getting pregnant is significantly reduced. The Yuzpe method consists of two doses of 0.1 mg of ethinyl estradiol and 1mg of DL-norgestrel. The progestrogen-only method consists of two doses of 0.75 mg of levonorgestrel.

EHC is an important tool to reduce the high teenager pregnancy rate in the UK. By increasing the awareness of emergency contraceptive methods, the costs to the health care and social systems can be reduced and a woman can be spared from the burden of coping with an unintended pregnancy. Emergency contraception may also act as a mean of increasing the opportunities for counselling on responsible sexual behaviour, contraception and the prevention of sexually transmitted infections (STIs) including HIV/AIDS.

Now in the UK there are three routes by which women can obtain EHC:

  • From general practitioners (GPs) surgeries, family planning clinics, Brook Centres to women of all ages, free of charge: Schering Levonelle-2, 2 tablets of 0.75 mg levonorgestral
  • Free under patient group directions (PGDs) from NHS Walk-in Clinics and community pharmacies in ‘pilot areas’ to women of all ages: Schering Levonelle-2, 2 tablets of 0.75 mg levonorgestral
  • From pharmacies for women aged 16 and over, at a cost of £19.99: Schering Levonelle-P (pharmacy pack), 2 tablets of 0.75 mg levonorgestral

Supply of EHC in the UK must follow patient group directions (PGDs). A PGD is defined as a written direction, sighed by a doctor or dentist and by a pharmacist, relating to supply and administration, or administration only, of a prescription-only medicine or pharmacy medicine to persons generally, subject to any exclusions that may be set out in the direction.

Although different areas may have different PGDs the general requirements for the supply of EHC in pharmacies in the UK are: clients must be over 16 years of age (if not, the client must be referred to a GP. But women under 16 can purchase EHC in pharmacies taking part in ‘pilot schemes’); the client has only had unprotected sex within the last 72 hours (EHC is not licensed for use after 72 hours of unprotected sex because it is not effective); supply to third parties is not recommended unless in exceptional circumstances (e.g. the woman is housebound. In such cases, telephone calls should be made to the woman concerned to check weather the treatment is appropriate); if the client is pregnant or likely to become pregnant, supply should not be made (not because that EHC would do any harm to the foetus but it simply does not work); clients on certain medications and herbal remedies should be referred to their GPs because there are possible drug interactions so the outcome of the treatment could be undermined; women with conditions associated with malabsorption should be referred to their GPs before a supply is made; EHC is not recommended to women with severe liver problems; allergy to levonorgestrel is a medical contraindication to EHC treatments.        

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Although now more than a third of all EHC has been dispensed in pharmacies, some people still think that EHC should only be a prescription-only medicine (POM) because pharmacists do not have access to clients’ medical records. But it has been well documented that GP’s reluctance to issue emergency contraception has been barriers to wider emergency contraceptive use. Because the efficacy of EHC decreases with time, improved access and improved awareness for women is essential in preventing unwanted pregnancies.

For the following reasons I believe that pharmacists are well positioned to play a major role in increasing ...

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