Sexual Health & Contraception PDF

Sexual Health & Contraception Slide 1 of 28  Learning Outcomes To describe the current role of pharmacy in sexual health To know how to conduct a consultation for the supply of oral emergency hormonal contraception (EHC) and contraceptiv...

Sexual Health & Contraception Slide 1 of 28  Learning Outcomes To describe the current role of pharmacy in sexual health To know how to conduct a consultation for the supply of oral emergency hormonal contraception (EHC) and contraceptive pill (NHS Service) To know how to sell the contraceptive pill OTC To consider how pharmacies can support health protection in relation to Chlamydia infections To examine the ethical, legal and professional considerations of providing sexual health services Slide 2 of 28  A Framework for Sexual Health Improvement in England (2013) Important issues that still need addressing in Sexual Health in England: – Stigma, discrimination and prejudice associated with sexual health matters – Reduction in the rate of STIs through evidence-based screening and treatment – Reduce unwanted pregnancies – Support women with unwanted pregnancies to make informed choices about their options sooner – HIV prevention, testing, diagnosis and treatment in high-risk groups – Promote integration, quality and value for money and innovation in sexual health interventions and services Slide 3 of 28  Conceptions in England and Wales: 2021 (ONS) Women aged 30 to 34 years had the highest number and conception rate for the fifth year in a row and the lowest percentage of conceptions leading to abortion. The conception rate for women aged under 18 years has more than halved since 2011 In 2021, the percentage of conceptions leading to legal abortion reached a record high of 26.5% of conceptions leading to an abortion. Slide 6 of 28 OSPAP MPHM15 Pharmacy Law, Ethics and Practice  The Pharmacy Offer for Sexual Health, Reproductive Health and HIV (2019) Improve access – convenient location and flexible hours Offer a local solution to SH where wait times increased burden on other providers is high Making Every Contact Count (MECC) Confidential and face-to-face consultation Existing links with primary care and local SH providers Community Pharmacy is the main route of access for EHC Women find it difficult to access GP within the 72-hour window Only around half of pharmacies in the UK provide the EHC service Slide 5 of 28  Indications for EHC (FSRH) Conception is most likely to occur when UPSI happens in a woman's fertile window; 5 days before ovulation and up to 2 days afterwards Ovulation is calculated as cycle length minus 14 days e.g. A 29-day cycle; ovulation is 29-14 = Day 15 However, EHC should be offered to any woman who has had UPSI and does not wish to conceive on any day of her cycle From Day 21 after childbirth (unless all conditions of lactational amenorrhoea are met – see later slide) From Day 5 after miscarriage, abortion, ectopic pregnancy or uterine evacuation Slide 6 of 28  Potential Reasons for EHC Failure to use any method of contraception Contraceptive (barrier method) failure Hormonal contraceptive method not effective: Missed pills or when starting a hormonal method of contraception (time varies between COC and POP) Late injection (medroxyprogesterone) - longer than 14 weeks after the last injection or within 7 days after a late injection Partial or complete expulsion of IUD device or 7 days prior to removal Expired Implant Concurrent course of enzyme-inducing drugs – up to 28 days following (not a concurrent course of non-enzyme inducing antibiotics) Slide 7 of 28  Emergency Hormonal Contraception Pharmacological – Levonorgestrel 1.5mg (up to 72 hours post UPSI)* – Ulipristal 30mg (up to 120 hours post UPSI) Non-pharmacological – Copper-bearing intrauterine device (Cu-IUD) *A double dose (3mg) is recommended for some patients Slide 8 of 28  Effectiveness of EHC (FSRH) Product Time period % Effective Levonorgestrel* Within 24hrs 95 Within 25-48hrs 85 Within 49-72hrs 58 Ulipristal Within 120hrs 98 Copper IUD Within 120hrs 99 *Consider stage in cycle, as less effective after LH surge Slide 9 of 28  Product Licenced Indication SPC details from www.medicines.org.uk EC within 72 hours of UPSI or failure of a contraceptive method. Levonelle One Step© (P Med) For adults and adolescents >16 years old. levonorgestrel 1500mcg Levonelle 1500© (POM) EC within 72 hours of UPSI or failure of a co levonorgestrel 1500mcg ntraceptive method. EllaOne© EC within 120 hours (5 days) of UPSI (P Med – used for prescriptions too) or contraceptive failure. Ulipristal acetate 30mg For anyone of child-bearing age including adolescents. 13 Slide 10 of 28  Consultation Skills It is usually the woman who has to initiate the request for EHC Important that they are put at ease - listen! Manner from the pharmacist should be professional, compassionate and non-judgemental Warn patient that you will need to ask some personal questions Re-iterate confidential nature of consultation (especially if under 16) Slide 11 of 28  Considering the age of the Patient – FSRH Contraceptive Choices for Young People Legal age of sexual consent in the UK is 16 years Although unlawful mutually agreed sexual activity between two under 16s is unlikely to lead to prosecution unless exploitation or abuse is suspected In the UK those under 13 are not considered to legally consent to sexual activity Consent to treatment under 16 years can be undertaken using ‘Fraser Guidance’ Safeguarding issues should be considered at all ages The GPhC and RPS offer guidance on safeguarding issues Slide 12 of 28  Fraser Guidance (FSRH) Provides a legal framework which HCP providing sexual health services may treat young persons under 16 without their parents’ consent in England, Wales and N. Ireland Made up of five criteria that the HCP treating the young person must be satisfied to be true: – The young person understands the professional's advice – The young person cannot be persuaded to inform their parents – The young person is likely to start, or continue having sexual intercourse with or without contraceptive treatment – Unless the young person receives contraceptive treatment, their physical or mental health, or both, are likely to suffer – The young person’s best interests require them to receive contraceptive advice or treatment with or without parental consent Slide 13 of 28  PGD Supply of EHC - PharmOutcomes Questions to ask the person presenting for supply of EHC (1) Who is the EHC for? Check they are over 13 years (Under 13 is an immediate safeguarding issue) Women asking for EHC should be informed that an IUD is more effective than oral methods Request the reason that contraception is needed – no contraception used/failed contraception/missed pill Was alcohol involved? (Yes/No) Levonorgestrel Effectiveness Within 24hrs UPSI – 95% What is the time since UPSI? 24-48hrs – 85% 48-72hrs – 58% Is the patient taking any liver inducing medicines? Remember OTC/herbal – St John's Wort Is the pt more than 70kg? (Double dose of levonorgestrel required) Slide 14 of 28  PGD Supply of EHC - PharmOutcomes Questions to ask the person presenting for supply of EHC (2) Menstrual history: Cycle Length Date of last period (first day of bleeding) Day in Cycle Is there a possibility that the patient may already be pregnant? – Ascertain point in menstrual cycle and if any other instances of unprotected sex. Was last period also normal for them? Exclusion Criteria Thromboembolic Malabsorption Syndrome Hypersensitivity to Conditions levonorgestrel Cardiovascular Disease Liver Disease Likelihood of pregnancy Interacting medications Slide 15 of 28  Copper-Bearing Intrauterine Device (FSRH) First line emergency hormonal contraception as it is the most effective method of emergency contraception, offered to ALL women requiring EHC, overall pregnancy rate of