Transcript Emergency contraception over the counter

EMERGENCY CONTRACEPTION
OVER THE COUNTER
E. Aubeny
French Association for Contraception
Paris - France
EMERGENCY CONTRACEPTION OVER THE COUNTER
Clarification about the designation
• Emergency contraception over the counter
actually means:
you help yourself without asking anybody.
It is the case only in Sweden and Norway
. It would be more precise to say
Emergency contraception without medical
prescription
i.e. no medical prescription needed but you
have to ask the chemist to get the drug
But usually we speak of « E.C.over the counter »
E. Aubeny, French Association for Contraception
Emergency contraception over the counter
Nowadays,
two hormonal methods are available:
Yuzpe method: ethynyl-oestradiol +
levonorgestrel
Levonorgestrel alone
E. Aubeny, French Association for Contraception
Emergency contraception over the counter
Efficacy of the method
WHO trials have shown emergency contraception is
more
effective
when
taken
very
quickly
after unprotected intercourse.
95
%
85
100
80
58
77
60
36
40
Yuzpe Method
Levonorgestrel
31
20
0
< 24 hrs
24-48 hrs
48-72 hrs
E. Aubeny, French Association for Contraception
Emergency contraception over the counter
A doctor’s prescription:
• Delays the use of medication because of the
waiting time for an appointment.
• Prevents women to use E.C.
Women find this process too complicated
because it is preventing an hypothetical
pregnancy.
A doctor’s physical or gynaecological
exam is useless for EC.
E. Aubeny, French Association for Contraception
Emergency contraception over the counter
The Yuzpe method has one contra-indication:
thrombo-embolic antecedents
Before its use, medical or paramedical staff
must review the patient’s medical history
It would seem better that this method
be delivered by medical prescription
E. Aubeny, French Association for Contraception
Emergency contraception over the counter
Levonorgestrel is very efficient used as emergency
contraception (WHO trials)
• 0.75 mg taken orally twice at 12 hours interval
Levonorgestrel has no contra-indications
It can be safely used without
a medical prescription
E. Aubeny, French Association for Contraception
Emergency contraception over the counter
June 1999, France has allowed levonorgestrel in emergency
contraception over the counter.
A law was pasted to confirm this decision in December 1999
Now many countries have also authorised over the counter
2000 : Portugal, Norway
2001 : Sweden Belgium, Denmark, U.K.
2002 : Finland, South Africa, Sri Lanka, African francophone
countries
This makes its use easier and quicker
as pharmacies are widespread and open day and night
E. Aubeny, French Association for Contraception
EMERGENCY CONTRACEPTION OVER THE
COUNTER
Results
Women used EC : more than 2 000 000 times
- In France
More than 1 000 000 have used it since June 1999
Now 70 000 women used it each month
- In others countries sales are growing regularly
E. Aubeny, French Association for Contraception
EMERGENCY CONTRACEPTION OVER THE COUNTER
Results
Women use EC in a proper way (focus groups):
– as emergency contraception not as a regular
contraception
In France
– contraceptive pills sales keep on rising
– Majority of women are satisfied to be in charge of their
contraception
E. Aubeny, French Association for Contraception
EMERGENCY CONTRACEPTION OVER THE COUNTER
Results
No medical problems in any countries
Pharmacovigilance department received
no complaints
No increase of ectopic pregnancies
No medical publication about complication
E. Aubeny, French Association for Contraception
Emergency contraception over the counter
Actually
The authorisation
to dispense levonorgestrel
E.C.over the counter is
a success story
E. Aubeny, French Association for Contraception
EMERGENCY CONTRACEPTION OVER THE
COUNTER
Beneficial consequences in France
Emergency contraception over the counter
Beneficial consequences in France
1)
Involvement of new health professionals in
contraception
1-1 Pharmacists (focus group 2002)
At the beginning, some:



Felt that they had inadequate information about the drug
Had ethical issues with the drug
Felt that it was too much responsibility
Now, this decision is well accepted.
The majority is very pleased to have this responsibility and to
be included in the contraception development
E. Aubeny, French Association for Contraception
Emergency contraception over the counter
Beneficial consequences in France
1) Involvement of new health professionals in
contraception
1- 2 High school nurses
They are authorised to issue levonorgestrel EC
free to their students in (December 1999 law)
They also start discussions
between them and their students
on contraception and on any sexual problems
E. Aubeny, French Association for Contraception
Emergency contraception over the counter
Beneficial consequences in France
2) Recognition of teenagers sexuality
Levonorgestrel EC delivered by high school nurses
and freely in pharmacies for minors
:
• Pro-life associations challenged the decree
• Public opinion in France supported this practice (63% in
favour)
• The decision was legalized by a law (December 2000)
This opened the discussion about teenage sexuality
and contraception
This recognition is the best way
to prevent abortion and STD
E. Aubeny, French Association for Contraception
Emergency contraception over the counter
Beneficial consequences in France
3)
Renewed interest in contraception particularly
regarding non compliance with regular
contraception
• 2 national campaigns in favour of contraception
• Study on contraception failure and non compliance
E. Aubeny, French Association for Contraception
EMERGENCY CONTRACEPTION OVER THE COUNTER
Beneficial consequences in France
4) Liberalisation of regulation of contraceptive drugs
• July 2001 law
Any new contraceptive drug with no known
medical contra-indications will be sold without
medical prescription
• before this all contraceptive drugs needed a
medical prescription
E. Aubeny, French Association for Contraception
EMERGENCY CONTRACEPTION OVER THE COUNTER
Conclusion
 Levonorgestrel EC without medical prescription or
over the counter is safe
 Women use it properly and not as a regular
contraception
 It opens discussion about contraception acceptability
It permits acknowledgement of and discussion
about teenagers’ contraception and sexuality
E.C contraception over the counter
changes attitudes of professionals and women
boosts interest in contraception
E. Aubeny, French Association for Contraception