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Oral Contraception and EHC
For Health Advisors, Health Information
Staff and Nurse Advisors
Your Name
Medicines Information Pharmacist
Your Medicines Information Service
Aim
To enable all staff
answering Oral
Contraceptive and
Emergency Hormonal
Contraception calls to
work within role
competencies and
fulfil them safely,
reliably and
effectively in this area
of care.
Oral Contraception and EHC
Learning Outcomes
1.
2.
3.
4.
Be familiar with different types of oral
contraceptives
Understand how emergency hormonal
contraception (EHC) and oral
contraceptives work
Gather necessary information to be able to
clarify the question
Interpret information about contraceptives
and turn it into appropriate advice
Oral Contraception and EHC
Contraception
Male and female
condoms
 Intrauterine device
 Diaphragms and caps
 Contraceptive injection
 Contraceptive implant
 Contraceptive patch

Oral Contraception and EHC
Intrauterine system
 Sterilisation
 Natural family planning
 Combined pill
 Progestogen-only pill
 Emergency
contraception

Oral Contraception
Combined
oral
contraception (COC)
Progestogen only
pill (POP)
Emergency
Hormonal
Contraception (EHC)
Oral Contraception and EHC
Combined Oral Contraception
Contains oestrogen
and progestogen
 Take one tablet
daily for 21 days (28
for ED) followed by
a 7 day pill free
period

Oral Contraception and EHC
Most effective
preparation for
general use
 With optimal use,
> 99% effective

Combined Oral Contraception
Monophasic
 fixed amount of an oestrogen and a
progestogen in each active tablet
 Biphasic/Triphasic
 varying amounts of the two hormones
according to the stage of the cycle
 ED (every day)
 includes 7 days of placebo tablets

Oral Contraception and EHC
Combined Oral Contraception
How does it work?
Oral Contraception and EHC
Oral Contraception
Combined
oral
contraception (COC)
Progestogen only
pill (POP)
Emergency
Hormonal
Contraception (EHC)
Oral Contraception and EHC
Progestogen only pill
Contains one active ingredient progesterone
 Taken continuously – no break
 Offers an alternative when oestrogens
are contraindicated
 Efficacy dependent on the
meticulousness of the user

Oral Contraception and EHC
Oral Contraception
Combined
oral
contraception (COC)
Progestogen only
pill (POP)
Emergency
Hormonal
Contraception (EHC)
Oral Contraception and EHC
Emergency Hormonal
Contraception
Levonelle 1500 (one step)
 Contains high dose progesterone
(levonorgesterel)
 One 1500mcg tablet taken as soon as
possible after unprotected intercourse
(up to 72 hours after)
 Preferably within 12 hours, no later
than 72 hours

Oral Contraception and EHC
Emergency Hormonal
Contraception
Taking the dose as soon as possible
increases efficacy
 Available from:
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A&E
GP
Walk in Centres
Family Planning Clinics
Sexual Health Clinics
Community Pharmacies
Oral Contraception and EHC
When is EHC indicated?
Unprotected sexual intercourse
 Reduced efficacy of other forms of
contraception:

Torn, leaking condom
 Missed pills
 Late implant or injection
 Detached contraceptive patch

Oral Contraception and EHC
How does EHC work?
Dependent on point in the menstrual
cycle
 Either prevents or delays ovulation,
prevents fertilisation or prevents
implantation of the fertilised egg into
the uterus.
 Clinical opinion is that EHC is not an
abortifacient

Oral Contraception and EHC
Missed Contraceptive Pills

COC
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7 days of pill taking put the ovaries to sleep
More than 7 days since pill taking may wake the
ovaries up
7 pill free days are safe
POP

Not for the forgetful!!!!!
Oral Contraception and EHC
Missed COC Pill/s
Missed COC pill
Less than 12 hours elapsed
More than 12 hours elapsed
Take missed pill and continue regime as
normal. No extra precautions required
Where in pill cycle?
1 pill missed from a pack
in the cycle
Continue COC
Oral Contraception and EHC
2 or more pills missed at any
time in the cycle
Continue COC to end of pack
use extra precautions for 7
days
2 or more pills missed from
days 15-21
Continue COC and use
extra precautions for 7
days. GO straight on to
next pack without a break
Missed POP Pill/s
Missed POP pill/s
More than 3 hours late
(27 hours after last pill)
Less than 3 hours late?
Cerazette?
Take the missed pill and
continue as normal
NO
Take missed pill as soon as
possible,
Take rest of packet as normal
And use extra precautions for the
next 2 days
Oral Contraception and EHC
YES
Less than
12 hours late?
More than
12 hours late?
Take missed pill as soon
as possible and continue
with packet as normal
Take missed pill as soon as
possible, take the rest of the
packet as normal.
Use extra precautions until pills
taken for 2 consecutive days
Missed Contraceptive Pills
 Which
brand of contraceptive pill?
 How many pills are left in the
pack?
 How long ago should it have been
taken?
 Intercourse since missed pill?
 Any action taken?
Oral Contraception and EHC
Taken too many pills
Which brand of contraceptive pill?
 How many were taken?
 Which pills did you take?
 How long ago did you take it?

Oral Contraception and EHC
Taken wrong pill from packet
Which brand of contraceptive pill?
 Which day of the packet should you
have taken?
 Which pill did you take?
 How long ago did you take it?
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Oral Contraception and EHC
Vomiting & Diarrhoea
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If vomiting within 3
hours of taking pill
then absorption will be
reduced and may be
ineffective.
Diarrhoea alone
without vomiting has to
be severe to reduce the
absorption of the pill.
Oral Contraception and EHC
Vomiting & Diarrhoea
When did vomiting occur relative to
taking pill?
 How severe is the diarrhoea?
 Which brand of contraceptive pill?

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How many pills left in the pack?
Oral Contraception and EHC
Drug Interactions

The effectiveness of COC, POP and EHC
will be reduced by interaction with
drugs that are enzyme inducers

Broad spectrum antibiotics may reduce
effectiveness of COC by altering the
bacterial flora of the bowel
Oral Contraception and EHC
Drug interactions
Which brand of contraceptive pill?
 Taking another drug or planning to?

Prescription
 OTC
 Herbal

Under medical supervision?
 How many tablets left in pack?
 Active sexual relationship?

Oral Contraception and EHC
Case Scenarios
 Think
about what background
information you need to answer
the enquiry
 Document information used to
answer enquiry
 What would you advise the caller?
Oral Contraception and EHC
Learning Outcomes
1.
2.
3.
4.
Be familiar with different types of oral
contraceptives
Understand how emergency hormonal
contraception (EHC) and oral
contraceptives work
Gather necessary information to be able to
clarify the question
Interpret information about contraceptives
and turn it into appropriate advice
Oral Contraception and EHC