CONTRACEPTION THE HUMAN MENSTRUAL CYCLE.
Both levonorgestrel and ulipristal work by delaying ovulation, and if the woman has already ovulated, taking either one will not work.
When counselling a woman using the emergency contraceptive pill, they should be told that: their next period may be early or delayed, if nausea or vomiting occurs within three hours another pill will need to be taken, taking the emergency contraceptive pill will not provide future contraception9
and they should use
additional precautions (required in the cause of ulipristal use on initiation of the combined hormonal contraceptive patch or vaginal ring or POP)7
. • References
1. Contraception - Contraception guide - NHS Choices [Internet]. Nhs. uk. 2015 [Accessed on: 11 May 2017]. Available from:
http://www.nhs.uk/ Conditions/contraception-guide/Pages/
contraception.aspx
2. Female condoms - Contraception guide - NHS Choices [Internet]. Nhs. uk. 2015 [Accessed on: 11 May 2017]. Available from:
http://www.nhs.uk/ Conditions/contraception-guide/Pages/
female-condoms.aspx 3. Contraceptive diaphragm - Contraception guide - NHS Choices [Internet].
Nhs.uk. 2015 [Accessed on: 11 May 2017]. Available from: http://www.
nhs.uk/Conditions/contraception-guide/ Pages/
contraceptive-diaphragm.aspx 4. Contraceptive cap - Contraception guide - NHS Choices [Internet]. Nhs. uk. 2015 [Accessed on: 11 May 2017]. Available from:
http://www.nhs.uk/ Conditions/contraception-guide/Pages/
contraceptive-cap.aspx
women who take the POP will have a quicker return to fertility on discontinuation compared to the COC. Most COCs are taken for 21 days with a seven-day pill free interval (Qlaira® has a shorter pill-free interval). Women will experience a withdrawal bleed due to the drop in hormones7
.
LOSS OF CONTRACEPTION Loss of contraception is most probable when pills are missed at the beginning of the cycle or at the end, as this will lengthen the pill-free interval. For COCs, a missed pill will be a pill that is not taken within 24 hours of the normal time it is usually taken (twelve hours for Qlaira® and Zoely®)8
. If
one pill is missed, then that pill and the next active pill should be taken at the normal time, even if this means two pills would have to be taken at the same time. If two or more pills are missed, it is likely that protection would have been lost. The woman should resume normal pill taking and use extra precautions (like the
26 - SCOTTISH PHARMACIST
barrier method) for the next seven days (nine days for Qlaira®). For the POP, a missed pill will be one that is not taken within three hours of the normal time it is usually taken (twelve hours for Cerazette® and Cerelle®)8
.
EMERGENCY CONTRACEPTION There are currently only three options available for emergency hormonal contraception (EHC). The first is the copper coil (Cu-coil) and is the most effective method (almost 100 per cent) for preventing unwanted pregnancy. The Cu-coil can be inserted up to five days after unprotected sexual intercourse and is indicated for patients taking enzyme-inducing drugs7
form. The first is Levonelle 1500® or Levonelle One-Step® (both products contain the drug levonorgestrel) which can be used up to 72 hours after unprotected sex. In some cases it can be used for 96 hours post sexual activity; however, this is its unlicensed use7
. The second option,
ellaOne® (ulipristal acetate), is a progesterone receptor modulator and is more effective than levonorgestrel. The advantages ulipristal are: it can be taken up to 120 hours post unprotected sexual intercourse, it can potentially delay ovulation by up to five days and it is licensed for use in all women of childbearing age9
. . The Cu-coil
prevents implantation and may block fertilization. Also, copper in the coil is toxic to the foetus. The Cu-coil can only be inserted by a doctor or nurse; therefore, the patient will have to be referred to the nearest GUM clinic or family planning clinic.
The other two options are taken in pill
However, the disadvantages include: reduced bioavailability with drugs that increase gastric pH (eg, proton pump inhibitors, H2 antagonists and antacids); action is affected by enzyme inducing drugs; it may reduce the effectiveness of both the COC and POP, and it is not suitable for women with severe asthma who are being treated with oral glucocorticoids9
.
5. Knudtson J, McLaughlin J. Female Reproductive Endocrinology - Gynecology and Obstetrics - MSD Manual Professional Edition [Internet]. MSD Manual Professional Edition. [Accessed on: 11 May 2017]. Available from:
http://www.msdmanuals.com/ en-gb/professional/gynecology- and-obstetrics/female-reproductive- endocrinology/female-reproductive- endocrinology
6. Knudtson J, McLaughlin J. Menstrual Cycle - Women’s Health Issues - MSD Manual Consumer Version [Internet]. MSD Manual Consumer Version. [Accessed on: 11 May 2017]. Available from:
http://www.msdmanuals.com/ en-gb/home/women-s-health-issues/ biology-of-the-female-reproductive- system/menstrual-cycle
7. Bolton E. Contraceptive Methods. Lecture presented at; 2014; St. George’s Hospital.
8. Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. Available from: http://www.
medicinescomplete.com [Accessed on: 11 May 2017] 9. POM to P Training for Pharmacists [Internet]. 1st ed. HRA Pharma; 2016 [Accessed on: 11 May 2017]. Available from:
http://psnc.org.uk/sheffield-lpc/ wp-content/uploads/sites/79/2013/06/ ellaOne-Pharmacist-Training-Booklet- PDF-version.pdf
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