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

Haeger, K; Lamme, Jacqueline; Cleland, Kelly

doi:10.1186/s40834-018-0067-8

Cited by 36 publications

(93 citation statements)

References 93 publications

(162 reference statements)

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“…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 ].…”

Section: Introductionmentioning

confidence: 99%

“…In Germany, it is only used in isolated cases [ 7 ]. 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 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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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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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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“…Body weight should be considered in the clinical effectiveness, as body weight alters the effectiveness of emergency contraception with levonorgestrel. Previous studies showed a significant decrease in the effectiveness of levonorgestrel emergency contraception in women with high body weight (16,17).…”

Section: Discussionmentioning

confidence: 93%

Hormonal Contraceptives: What If Exposed During Pregnancy?

Aykan¹

2019

Erciyes Med J

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Objective: Hormonal contraceptives are contraindicated in pregnancy. However, some women may become pregnant while using contraceptives to prevent pregnancy. In addition, these hormones may be used for abnormal uterine bleeding or secondary amenorrhea. In the present study, we evaluated the fetal outcomes of pregnant women who were inadvertently exposed to hormonal contraceptives during anytime in pregnancy. The aim of the present study was to expand the data about contraceptives with regard to their potential teratogenic effects. Materials and Methods:We collected data of pregnant women who were admitted to the Teratology Information Service (TIS) between 2014 and 2018 with hormonal contraception exposure during pregnancy. Data about medications, exposure to other agents, and comorbidities were documented. We analyzed the exposed drugs with respect to their potential teratogenic effects. Follow-up was conducted with women after delivery to determine whether any major or minor congenital malformations or adverse neurodevelopmental effects occurred in infants. Results:A total of 25 pregnant women who were admitted to the TIS for inadvertent use of hormonal contraception during pregnancy were included in the study. After delivery, we found that one female baby, who was exposed to medroxyprogesterone acetate in utero, had exitus postnatally in the first week of life. Three infants with maternal exposure to medroxyprogesterone acetate, dydrogesterone, estradiol valerate+norgestrel, and ethinyl estradiol+gestodene were born preterm. Among the three infants, two with maternal exposure to medroxyprogesterone acetate and ethinyl estradiol+gestodene had low birth weight. On the other hand, we found that 75% of the infants delivered were female. Conclusion:Contraceptive hormones presented no major teratogenic effects. However, avoidance of hormonal exposure and discontinuation whenever possible during pregnancy are suggested.

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“…Another study in the United States found that 44% of adolescents thought that EC could only be taken within one day of intercourse to be effective [20]. This lack of knowledge extends to providers, with a recent survey in Georgia showing that only 3% of providers knew the maximum window of efficacy for EC [21]. This lack of knowledge is a potential additional barrier for women in Hawaii and future studies should address EC knowledge among women and providers in Hawaii.…”

Section: Discussionmentioning

confidence: 99%

Over-The-Counter Availability of Levonorgestrel Emergency Contraception in Pharmacies on Oahu

2020

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Since the United States Food and Drug Administration’s approval of over-the-counter levonorgestrel emergency contraception, access to this time-sensitive medication has improved. However, multiple barriers, including the cost of the medication and pharmacy availability, still exist. The objective of this study was to determine the over-the-counter availability of levonorgestrel emergency contraception in pharmacies on Oahu, Hawaii. We conducted a cross-sectional population-based study using in-person simulated patient encounters at all pharmacies on Oahu. Out of 109 chain pharmacies and 13 independent pharmacies, 102 (84%) pharmacies had levonorgestrel emergency contraception available over the counter. Of pharmacies in which it was available, 12.7% required an employee to unlock the medication, 37.3% required the medication to be unlocked at the register, 29.4% were packaged in a large plastic box, and 3.9% were packaged in a blister pack. Levonorgestrel emergency contraception is widely available as an over-the-counter medication in pharmacies on Oahu, yet there are packaging and display practices that make it less accessible. Many of these practices could be improved with pharmacy education or changes in store policies. Systems-based interventions are needed to improve the access to levonorgestrel emergency contraception as an over-the-counter medication.

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

Cited by 36 publications

References 93 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

Hormonal Contraceptives: What If Exposed During Pregnancy?

Over-The-Counter Availability of Levonorgestrel Emergency Contraception in Pharmacies on Oahu

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