Current controversies with oral emergency contraception

Cameron, Sharon; Li, Raymond; Gemzell‐Danielsson, Kristina

doi:10.1111/1471-0528.14773

Cited by 28 publications

(19 citation statements)

References 83 publications

(158 reference statements)

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“…Emergency contraception (EC) plays an important role in preventing this situation. EC can be divided into copper intrauterine devices (Cu-IUD) and oral hormonal methods [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…The Cu-IUD is the most reliable EC method with a failure rate of <0.1%, and it is also effective after ovulation has occurred [ 6 ]. However, access to this form of EC is made difficult in that a gynaecologist must insert the Cu-IUD, meaning that this is not the preferred method for many users [ 5 ]. In Germany, it is only used in isolated cases [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Of the oral hormonal methods, the Yuzpe method (oestrogen–progesterone combination comprising two doses of 50 µg ethinylestradiol and 0.25 mg levonorgestrel) is also no longer recommended in Germany for post-coital contraception [ 7 ] because it is less effective than other EC methods and is also associated with more adverse events [ 1 , 6 , 7 ]. Because mifepristone is not available in Germany for this indication [ 7 , 8 ]—unlike some other countries [ 5 , 9 ]—the oral hormonal methods are concentrated on emergency contraceptive pills (or “morning after pills”) containing the active substances levonorgestrel (LNG) and ulipristal acetate (UPA).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Quality of Counselling for Oral Emergency Contraceptive Pills—A Simulated Patient Study in German Community Pharmacies

Langer

Grimm

Lungfiel

et al. 2020

IJERPH

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Background: In Germany, there are two different active substances, levonorgestrel (LNG) and ulipristal acetate (UPA), available as emergency contraception (the “morning after pill”) with UPA still effective even 72 to 120 h after unprotected sexual intercourse, unlike LNG. Emergency contraceptive pills have been available without a medical prescription since March 2015 but are still only dispensed by community pharmacies. The aim of this study was to determine the counselling and dispensing behaviour of pharmacy staff and the factors that may influence this behaviour in a scenario that intends that only the emergency contraceptive pill containing the active substance UPA is dispensed (appropriate outcome). Methods: A cross-sectional study was carried out in the form of a covert simulated patient study in a random sample of community pharmacies stratified by location in the German state of Mecklenburg-Vorpommern and reported in accordance with the STROBE statement. Each pharmacy was visited once at random by one of four trained test buyers. They simulated a product-based request for an emergency contraceptive pill, stating contraceptive failure 3.5 days prior as the reason. The test scenario and the evaluation forms are based on the recommended actions, including the checklist from the Federal Chamber of Pharmacies. Results: All 199 planned pharmacy visits were carried out. The appropriate outcome (dispensing of UPA) was achieved in 78.9% of the test purchases (157/199). A significant correlation was identified between the use of the counselling room and the use of a checklist (p < 0.001). The use of a checklist led to a significantly higher questioning score (p < 0.001). In a multivariate binary logistic regression analysis, a higher questioning score (adjusted odds ratio [AOR] = 1.41; 95% CI = 1.22–1.63; p < 0.001) and a time between 12:01 and 4:00 p.m. (AOR = 2.54; 95% CI = 1.13–5.73; p = 0.024) compared to 8:00 to 12:00 a.m. were significantly associated with achieving the appropriate outcome. Conclusions: In a little over one-fifth of all test purchases, the required dispensing of UPA did not occur. The use of a counselling room and a checklist, the use of a checklist and the questioning score as well as the questioning score and achieving the appropriate outcome are all significantly correlated. A target regulation for the use of a counselling room, an explicit guideline recommendation about the use of a checklist, an obligation for keeping UPA in stock and appropriate mandatory continuing education programmes should be considered.

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“…Emergency contraception (EC) plays an important role in preventing this situation. EC can be divided into copper intrauterine devices (Cu-IUD) and oral hormonal methods [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Quality of Counselling for Oral Emergency Contraceptive Pills—A Simulated Patient Study in German Community Pharmacies

Langer

Grimm

Lungfiel

et al. 2020

IJERPH

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show abstract

“…There are three methods of EC currently available in the UK (Table ). The Cu‐IUD is the most effective method of EC . If not inserted in the immediate 48 hours postpartum (as PPIUC), it is currently advised that insertion should generally be delayed until 28 days postpartum…”

Section: Method‐specific Guidancementioning

confidence: 99%

Postpartum contraception

Cooper

Cameron

2018

The Obstetric & Gynaecologis

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Sexual activity and fertility can resume shortly after childbirth, and therefore there is a risk of pregnancy unless contraception is initiated. Unintended pregnancy and short inter-pregnancy intervals (of less than 1 year) can increase the risk of obstetric and neonatal complications. The antenatal and postpartum periods present a unique opportunity to discuss contraceptive options, many of which can be safely initiated immediately after childbirth. Training maternity staff in the provision of long-acting reversible contraceptive insertion (implant and intrauterine devices) can overcome some of the barriers women experience in accessing these highly effective methods after leaving the birth unit. Learning objectivesTo understand the risks of unintended pregnancy and short interpregnancy intervals. To understand the UK Medical Eligibility Criteria for the use of contraceptive methods in the postpartum period.To be up to date on the most common contraceptive methods and their use in the postpartum period. To be familiar with the technique of postpartum intrauterine contraception insertion. To appreciate the increasing role of maternity services in the discussion and provision of contraception after childbirth.

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“…Women, and even some providers, believe that because they are nulliparous, they are not able to get an IUD [69]. Finally, there is an unfounded belief that the availability of EC could lead to increased risk-taking behavior among teens [70–72]. One of the biggest hurdles to increasing uptake of EC is dispelling myths and increasing knowledge among providers, pharmacists, and individuals of reproductive age who have sex with opposite-sex partners and are thus at risk of unintended pregnancy.…”

Section: Misconceptions About Ecmentioning

confidence: 99%

State of emergency contraception in the U.S., 2018

Haeger¹,

Lamme²,

Cleland³

2018

Contracept Reprod Med

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Emergency contraception is indicated in instances of unprotected sexual intercourse, including reproductive coercion, sexual assault, and contraceptive failure. It plays a role in averting unintended pregnancies due to inconsistent use or non-use of contraception. Options for emergency contraception vary by efficacy as well as accessibility within the U.S. This paper provides an overview of levonorgestrel (Plan B One-Step and generic counterparts), ulipristal acetate (sold as ella), and the copper intrauterine device (IUD, sold as ParaGard), including the mechanisms of action, administration, efficacy, drug interactions, safety, side effects, advantages, and drawbacks. It will also review current misconceptions about emergency contraception and access for subpopulations, including adolescents, immigrants, survivors of sexual assault, rural populations, and military/veteran women. This paper will address barriers such as gaps in knowledge, and financial, health systems, and practice barriers. Continuing areas of research, including the impact of body weight on the efficacy of emergency contraceptive pills and potential interactions between ulipristal acetate and ongoing hormonal contraceptives, are also addressed.

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Current controversies with oral emergency contraception

Abstract: Controversy about emergency contraception restricts access for women.

Cited by 28 publications

References 83 publications

The Quality of Counselling for Oral Emergency Contraceptive Pills—A Simulated Patient Study in German Community Pharmacies

The Quality of Counselling for Oral Emergency Contraceptive Pills—A Simulated Patient Study in German Community Pharmacies

Postpartum contraception

State of emergency contraception in the U.S., 2018

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