Only progestin pill for emergency contraception

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A European study found that the provision of a bridging progestin-only pill (POP) in conjunction with emergency contraception by a pharmacist or a sexual and reproductive health clinic (SRH) resulted in a significant increase in self-reported follow-up use of effective contraception.

The authors of the prospective study in the Journal Assessment of health technologies believe that simple intervention has enormous potential to prevent more unwanted pregnancies after emergency contraception.

“The emergency pill can prevent pregnancy after unprotected intercourse or a burst condom, but if women do not use regular contraception there is still a risk of pregnancy,” said Dr) Lothian, Scotland, and the University of Edinburgh, Scotland.

Cameron noted that most women in the United Kingdom (UK) receive emergency contraception from a public pharmacy; However, you must make an appointment with a family doctor or an SRH clinic for ongoing contraception.

“Securing an appointment can take time, and unwanted pregnancies can occur during that time,” said Cameron Contemporary OB / GYN®.

The study, which took place between December 2017 and June 2019, involved 29 pharmacies in 3 UK cities (Edinburgh, Dundee and London) to recruit 636 women to receive EG (levonorgestrel): 316 for the intervention group and 320 for the control group . There were no statistically significant differences in demographics between the two groups.

The intervention group received a 3-month supply of the POP (75 µg desogestrel) and a card that enabled quick access to a local SRH clinic. But for the control arm, pharmacists advised women to go to their usual contraceptive provider.

“We chose the POP instead of the combined pill because the POP is extremely safe and has very few contraindications,” said Cameron.

The primary endpoint was the use of effective contraception (hormonal and intrauterine methods) after 4 months for which data were available for 63% of the control group and 65% of the intervention group.

The proportion of participants who reported effective contraception after 4 months was 20.1% higher in the intervention group: 58.4% compared to 40.5% in the control group.

There were no serious adverse events.

“The positive effect of the intervention came as no surprise as our results were consistent with an earlier pilot study that we conducted and published in the journal.” contraception 2014, ”said Cameron. “However, the current study showed that the rapid access card to an SRH clinic was neither widespread nor quickly used, as most women chose to use contraceptives continuously from their family doctor. This indicates that the quick access component did not have any noteworthy effects. “

Cameron said that ensuring a woman will be seen and given birth control when she presents herself to a service “is the element of intervention that is perhaps the most difficult to provide. So maybe it is enough that pharmacists simply refer women to local contraception services. “

Performing the intervention itself was straightforward, according to Cameron. “The pharmacists in the study felt that providing the POP was a natural extension of their current role in providing emergency contraception and did not significantly prolong the consultation,” she said.

The authors believe that bridging POP with emergency contraception will be rolled out nationwide in the UK and become routine for women applying for emergency contraception at their pharmacy.

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Disclosure

Cameron does not report any relevant financial information.

reference

Cameron ST, Glasier A, McDaid L, et al. Public pharmacies provide the progestin-only pill as bridging contraception for women who are receiving emergency contraception: the Bridge-it RCT. Health technology assessment. 2021 May; 25 (27): 1-92. doi: 10.3310 / hta25270

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