Podcast
Questions and Answers
What is the maximum time frame for taking EllaOne® after unprotected sexual intercourse?
Which statement accurately reflects the considerations for professionals providing sexual health services to minors?
What is the primary skill a pharmacist should utilize when consulting with a patient regarding emergency contraception?
Which of the following statements is correct regarding the legal age of sexual consent in the UK?
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What is a common misconception about the effectiveness of Levonelle One Step© as a method of emergency contraception?
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What legal consideration is important when providing sexual health services to young people?
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Which method of emergency contraception is considered most effective when taken within 72 hours after unprotected intercourse?
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What is one of the five criteria that must be met for a young person to receive contraceptive treatment without parental consent?
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Which statement best reflects the effectiveness of modern oral contraceptive pills?
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What does the Fraser Guidance relate to in the context of sexual health services?
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What is the most effective method of emergency contraception compared to oral methods?
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Which skill is critical in conducting a successful consultation for sexual health services?
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What is the expected effectiveness of levonorgestrel when taken within 24 hours of unprotected sex?
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In the context of addressing STIs, what strategy has been highlighted as crucial in the sexual health framework?
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Which of the following is NOT a potential issue to discuss with a patient seeking emergency contraception?
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What ethical consideration is critical when addressing unwanted pregnancies?
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Which criterion related to Fraser guidance indicates that a young person's health may be at risk without contraceptive treatment?
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Why is it significant to ascertain if alcohol was involved before supplying emergency contraception?
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What demographic is reported to have the highest conception rate in England and Wales according to recent statistics?
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What information should be gathered about a young woman’s last menstrual period when supplying emergency contraception?
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What is a critical consideration when a young person presents for emergency contraception and is over 70 kg?
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Study Notes
OSPAP Programme: Sexual Health & Contraception
- The OSPAP Programme covers sexual health and contraception.
- Learning outcomes include describing the role of pharmacies in sexual health, consulting for emergency hormonal contraception (EHC) and the contraceptive pill, selling the contraceptive pill over the counter (OTC), supporting health protection related to chlamydia, and examining ethical, legal, and professional considerations for providing sexual health services.
Sexual Health Improvement in England (2013)
- Important issues needing address in England's sexual health include stigma, discrimination, and prejudice related to sexual health matters.
- Reducing rates of sexually transmitted infections (STIs) through evidence-based screening and treatment is needed.
- Reducing unwanted pregnancies and supporting women with unwanted pregnancies to make informed choices sooner is crucial.
- HIV prevention, testing, diagnosis, and treatment for high-risk groups must be promoted.
- Integration of services, quality, value for money, and innovation in sexual health interventions and services must be improved.
Conceptions in England and Wales (2021)
- The percentage of conceptions resulting in legal abortion has generally increased for most age groups since 2015.
- Women aged 30-34 had the highest conception rate and lowest percentage of conceptions leading to abortion in 2021.
- The conception rate for women under 18 has more than halved since 2011.
- In 2021, 26.5% of conceptions led to legal abortion, a record high.
Pharmacy Offer for Sexual Health, Reproductive Health, and HIV (2019)
- Improving access to sexual health services through convenient locations and flexible hours is essential.
- Offering local solutions to sexual health issues where wait times burden other providers is essential.
- Using Making Every Contact Count (MECC) practices in consultations.
- Providing confidential and face-to-face consultations is key.
- Utilizing existing links with primary care and local sexual health providers.
- Community pharmacies should be the primary route for accessing EHC.
- Ensuring women can easily access GPs within the necessary 72-hour window.
- About half of UK pharmacies provide EHC services.
Indications for Emergency Hormonal Contraception (EHC)
- Conception is most likely within a woman's fertile window, 5 days before ovulation and up to 2 days afterward.
- Ovulation occurs approximately 14 days before the next expected period.
- EHC should be offered to any woman who has had unprotected sex and does not want to conceive.
- EHC can be taken from day 21 after childbirth (unless conditions for lactational amenorrhoea are met) and day 5 after miscarriage, abortion, ectopic pregnancy or uterine evacuation.
Potential Reasons for EHC Use
- Failure to use any method of contraception at all.
- Contraceptive failure (barrier methods).
- Hormonal contraceptive method failure, including missed pills or difficulties in starting a method
- Late injections
- IUD expulsion or removal within 7 days prior.
- Expired implant usage.
- Concurrent enzyme-inducing drug use within the last 28 days.
Emergency Hormonal Contraception (EHC)
- Pharmacological options include Levonorgestrel (1.5mg up to 72 hours post unprotected sex) and Ulipristal (30mg up to 120 hours post unprotected sex)
- Non-pharmacological option is a copper-bearing intrauterine device (Cu-IUD).
- A double dose (3mg) of Levonorgestrel is sometimes recommended for patients over 70kg
EHC Effectiveness
- Effectiveness of EHC varies depending on the time taken to take it.
- Levonorgestrel is most effective within the first 24 hours, effectiveness decreases between 25-48hrs and 49-72hrs.
- Ulipristal is effective up to 120hrs after.
- The Copper IUD remains effective throughout the 120hrs timeline
- Consider the timing of the LH surge in the evaluation of effectiveness
Licensed Indications for EHC
- Levonorgestrel 1500 mcg (One Step) is for adults/adolescents over 16; EC within 72 hours of unprotected sex or failure of contraception.
- Levonorgestrel 1500 mcg (POM) is for adults/adolescents over 16; EC within 72 hours of unprotected sex or failure of contraception.
- Ulipristal Acetate 30mg (EllaOne) is for adults of child-bearing age, including adolescents; EC within 120 hours (5 days) of unprotected sex or contraception failure
Consultation Skills for EHC
- Woman usually initiates request.
- Pharmacist should put the woman at ease, listen, be professional, compassionate, and non-judgmental.
- Patient should be informed they will need to answer personal questions.
- Importance of confidentiality, especially with patients under 16.
Considering the Age of the Patient
- Legal age of sexual consent in the UK is 16.
- Unlawful sexual activity between two under-16s is unlikely to result in prosecution unless exploitation or abuse is suspected.
- Under-13s are not considered to consent to sexual activity.
- Fraser Guidance can be used for consent for treatment for under-16s.
- Safeguarding should be considered in all ages.
- GPhC and RPS offer guidelines on safeguarding.
Fraser Guidance (FSRH)
- Provides a legal framework for healthcare professionals (HCPs) to treat young people under 16 without parental consent concerning sexual health.
- Made up of five criteria needed to be satisfied to be true:
- Understanding of advice
- No possibility of persuading the young person to inform parents.
- Likelihood of having sexual intercourse with or without treatment.
- Best interests warranting contraceptive advice or treatment.
PGD Supply of EHC
- Questions to ask:
- Identifying the patient
- Ensuring patient is over 13 years old.
- Reason for needing EHC (contraception failed/missed pill)
- Alcohol use? (yes/no)
- Time since unprotected sexual intercourse.
- Taking any liver-inducing medicines?
- Patient's weight
PGD Supply of EHC - 2nd Set of Questions
- Collect menstrual history (cycle length, date of last period, day in cycle)
- Possibility of patient being already pregnant? (If so, assess point in the cycle, other instances of unprotected sex, last period normality)
- Additional considerations: Thromboembolic conditions, Cardiovascular disease, Malabsorption Syndrome, Liver Disease, Interacting medications, and hypersensitivity to levonorgestrel.
Copper-Bearing Intrauterine Device (Cu-IUD)
- First line emergency hormonal contraception (as an effective method).
- High effectiveness overall pregnancy rate (< 0.1%).
- Provides ongoing contraception once placed.
- Copper's toxicity prevents ovum and sperm interaction, halting fertilisation and implantation.
- Fitted by an HCP, usually in a sexual health clinic.
- Pharmacists may still provide oral EHC.
Supply on a Patient Group Direction (PGD)
- May supply in-line with PGDs.
- Supply of EHC will vary by the commissioning local authority
- Levonorgestrel and Ulipristal: Can supply depending on PGD, age considerations depending on PGD; Levonorgestrel effective up to 72hrs, and Ulipristal up to 120hrs.
- Ulipristal less effective if previous hormonal contraception taken within 5 days prior.
EHC OTC Supply
- Questions to ask:
- Patient's eligibility for EHC
- Confirmation of unprotected sex
- Timeframe for unprotected sex (72/120 hrs from last intercourse/contraceptive failure).
- Assess likelihood of pregnancy and other medical conditions.
- Past oral emergency contraception use.
PGD Supply of EHC - Advice to the Patient
- Dose and administration (one tablet as soon possible (two if above 70kg/enzyme-inducing medication in past 4 weeks).
- Vomiting, side effects: up to 1 in 10 will vomit within 3hr; repeat dose. Possible side effects include nausea, bleeding, headaches, fatigue, lower abdominal pain (potential ectopic pregnancy).
- Mode of action (prevents ovulation)
- Effect on fetus (delays next period possibly over 7 days)
- Patient Information Leaflet to provide important info & advice.
Ethics Associated with EHC
- Before accepting employment in the pharmacy, think about the availability of the service you offer to the patients
- Open and honest if refusing to offer service
- Sensitively handle the situation
- Signpost to find alternative services if necessary.
EHC through Community Pharmacies
- Black et al. (2008) study compared access to EHC through pharmacies vs clinical settings. Women presenting at pharmacies were more likely to have attended within 24hrs.
- Some inadequacies were found in pharmacy procedures and practices, particularly in privacy, information provision, and future contraception discussions.
Condoms (FSRH)
- Two types: condoms (98% effective) and femidoms (95%).
- The only method of contraception that prevents STIs.
- Wide variety available; users should be encouraged to explore options
- Widely available, including some free of charge locations like Sexual Health Clinics
- Using correctly is important to avoid splitting and failure risk.
Sexual Health Advice
- Emphasized a 4C approach: contraception, condoms, copper coil (IUDs), and chlamydia.
Role of Pharmacy in Sexual Health
- A major focus on STI knowledge is important for pharmacists for public understanding and service provision
- Public interest in pharmacy availability for advice on contraception and safe sex is high.
- People value quality and confidentiality when choosing a pharmacy for women's health advice.
- Pharmacists are supportive and want to get involved, but may be reluctant to offer.
- Pharmacists should be proactive in assisting clients regarding future contraceptive choices.
- Community-based Chlamydia testing and treatment in pharmacies increases accessibility.
OTC Regular Contraception
- Two new brands (Hana and Lovima), containing desogestrel, are available without prescription; it may be purchased over the counter with a short consultation with the pharmacist
- Cost for a month of contraception for 1 month is approximately £10, £20 for 3 Months.
- Training and consultation info available on the Hana website
Contraception - The new NHS Pharmacy Service
- In April 2023, new NHS service began for repeat oral contraception (OC)
- Tier 2 (commissioned since Dec 2023): Intial supply via a PGD maximum 3 months (ongoing up to 12 months)
- The service can include combined oral contraceptive (COC) and Progestogen-only pill (POP) prescriptions.
- Age limit: COC for under 49 years, POP for under 54 years
- Training required is available
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Description
Test your knowledge on emergency contraception, including guidelines for EllaOne® and Levonelle One Step©. This quiz covers professional considerations for minors and legal aspects of sexual consent in the UK. Challenge yourself and ensure you're well-informed about this crucial aspect of sexual health.
