Page 13 | To think women should be told this about the morning after pill?

Boysgrownbutstillathome · 22/12/2020 22:41

Why not just have a coil fitted or an implant or go on the pill?

TheClitterati · 22/12/2020 22:49

@christmaselfie1

The morning after pill is directly linked to ovulation, and if you have already ovulated then it is pretty much pointless!

I had sex where the condom split on Monday last week, but due to covid restrictions and living rurally I was not able to get the morning after pill until Friday (4 days after sex). I have taken Ellaone before, the brand that you can take up to 5 days after, so assumed that all would be okay. I am also tracking my cycles on the instruction of my gynaecologist because I suffer with ovarian cysts.

I got my LH surge and a positive ovulation test on Wednesday morning, which means ovulation would have occurred imminently, most likely well before I took the morning after pill on Friday evening!

Since researching, I have discovered that the morning after pill works by delaying or preventing ovulation. Therefore, if you have already ovulated, and the sperm happened to meet the egg in that time, the morning after pill has pretty much zero effect! You can read it yourself on the manufacturers website...

www.ellaone.co.uk/faqs/does-ellaone-work-if-youve-already-ovulated

I have taken the morning after pill three times and I have never been told this by any pharmacist. I have never been informed on how it works, just that is it effective up to 5 days after unprotected sex. The only emergency contraception that works in these circumstances is the IUD. I have now got the worry for the next week that I might be pregnant.

Am I the only person that had no idea how the morning after pill works?!

Wow op you've just explained why MAP didn't work for me and I got pg at 18. Condom fail, MAP fail, termination at 18.

Supermum29 · 23/12/2020 00:14

I didn’t know this was how it worked.... or didn’t in my case, I took it but found out I was pregnant shortly after so total fail for me!

Miisty · 23/12/2020 03:42

Yes I have looked after women who had a baby after taking the morning after pill but also rarely after having an Coil fitted

sundaysupperclub · 23/12/2020 08:22

I didn't know this.
I've only taken MAP once, from a pharmacy.
It wasn't explained to me.
I have no idea when I ovulate (my periods are regular - but I'm a scatter brain who doesn't remember/notice this stuff as I'm not TTC.)

PutsFootInIt · 23/12/2020 08:26

"@littleyell withdrawal is the most useless advice. You can not rely on withdrawal"

I can vouch for this, gave me two children and I only have one (polycystic) ovary! Thought I was going going to struggle. Withdrawal is completely unreliable.

BobbidyBob · 23/12/2020 08:26

@Boysgrownbutstillathome

Why not just have a coil fitted or an implant or go on the pill?

What makes you think this will be new information to OP?

She also clearly said earlier that she cannot use hormonal contraceptives.

You’re not suggesting anything that nearly every woman knows above anyway
You have no right to question the OP’s medical history when this thread is not about her regular method of contraception; especially when it comes across as a thinly-veiled dig at OP for using the MAP.

I don’t know why posters are derailing this useful thread in this way.

TrufflyPig · 23/12/2020 09:06

The pharmacist told me it was only 75% effective.

Efficacy depends upon the time in which its taken and the point in cycle in which its taken, efficacy drops as time passes and it is less effective if taken during the window of ovulation (for the reasons discussed on here). So it's impossible to give an exact percentage.

Approximate values for levonelle are 95% effective if taken within 24 hours, 85% between 24-48 hours and 58% between 48-72 hours.

I can't find approximate values for ellaone (will keep looking) but it is more effective in clinical trials that levonelle.

the PHARMACIST told me it stops the egg attaching

The mode of action is not fully understood, its primary mode of action is thought to be delaying ovulation but a secondary mode could be a change in uterine lining making implantation more difficult. So they weren't wrong.

jwpetal · 23/12/2020 09:09

Thank you for sharing this information. An important message to share for awareness. I would suggest to write a letter or email to the pharmacy, to give this feedback. That is a key point that you have made in the efficacy of the drug they are providing. . We trust our professionals and this dies not help.

Original poster

christmaselfie1 · 23/12/2020 09:18

@TrufflyPig

The pharmacist told me it was only 75% effective.

Efficacy depends upon the time in which its taken and the point in cycle in which its taken, efficacy drops as time passes and it is less effective if taken during the window of ovulation (for the reasons discussed on here). So it's impossible to give an exact percentage.

Approximate values for levonelle are 95% effective if taken within 24 hours, 85% between 24-48 hours and 58% between 48-72 hours.

I can't find approximate values for ellaone (will keep looking) but it is more effective in clinical trials that levonelle.

the PHARMACIST told me it stops the egg attaching

The mode of action is not fully understood, its primary mode of action is thought to be delaying ovulation but a secondary mode could be a change in uterine lining making implantation more difficult. So they weren't wrong.

In none of the literature or studies I have read (and I have read a lot since this incident), does it mention anything about possible changes to uterine lining, or indeed any change other than delaying pregnancy. There is some speculation that it may cause some other changes, but this has not been proven or observed.The study that I read that looked at pre and post-ovulatory administration found that it only changed the likelihood of pregnancy in the pre ovulation group and had no effect in the post ovulatory.

On the basis of that, I would want to be told that if I had already ovulated, statically and based on the information we do have, the MAP would not prevent me from becoming pregnant.

OP posts:

Original poster

christmaselfie1 · 23/12/2020 09:20

Here is a link to the study, 'Efficacy of ulipristal acetate for emergency contraception and its effect on the subsequent bleeding pattern when administered before or after ovulation':

academic.oup.com/humrep/article/31/6/1200/1749657

OP posts:

Sway19 · 23/12/2020 09:23

Your post reminds me of Ross and the condoms from Friends

TrufflyPig · 23/12/2020 09:58

This is why I used the world 'could' the mechanism of action is still not fully understood. I agree with you that the important bit of information to be communicated is the pre ovulation effects.

Whilst it supports the primary mode of action theory the study doesn't exclude the possibility of secondary modes of action and is far too small to be stand alone data. It is hard to prove bevause there is no real test to determine its effects on implantation.

All the available data supports the idea that the primary mode of action is to delay ovulation and that's the main point of information to be given.

If this consultantion was a few years ago too it was fully accepted as one possible mode of action. I recall a question in my pre registration exam that asked what the FOUR modes of action were (can't for the life of me remember what the other two theories were, assume they've since been debunked).

Original poster

christmaselfie1 · 23/12/2020 10:27

I agree it's a small study, but it is only one of a few that we have.

Whilst it doesn't exclude the possibility of post-ovulation effects, it doesn't support the possibility of post-ovulation effects either. It is very much a 'we don't really know', leaning more towards it has little to no effect, based on the number of pregnancies that occurred post-ovulation having taken Ellaone. Furthermore, Ellaone's website also says it has no effect post ovulation and cannot prevent implantation, so this certainly isn't something that pharmacists should be telling women 'could be' or 'may be' a possibility.

Pharmacists shouldn't be telling women that it can have effects on sperm, tubes, womb lining. This misinformation has been told to women very recently as is evidenced from this thread. In my case I was given no information whatsoever, I wasn't even asked when my last period was. It was simply a case of 'take this pill, it is effective up to 5 days post unprotected sex.'

OP posts:

sashh · 23/12/2020 10:36

how many women who aren’t trying to get pregnant or using NFP know when they ovulate? Other than a vague idea?

Lots of women feel ovulation.

TrufflyPig · 23/12/2020 10:43

It was in the SPC for levonelle and in the training package one time (I'm sure I still have it somewhere, will try and dig it out) the poster did not say which pill she took or when. The pharmacist might not necessarily have been giving false information at that time.

Original poster

christmaselfie1 · 23/12/2020 10:48

There have been posters on this thread that have said they have taken the MAP recently and were told it does 'x' 'y' or 'z'.

OP posts:

TrufflyPig · 23/12/2020 10:55

I'll be honest I haven't read the whole thread. But it's been a while since I did the formal trainingso you've prompted me to look at more recent studies so thank you.

There should be a standard form that pharmacists go through though, it's pretty comprehensive and includes this info. I know COVID has forced a lot of phone rather than face to face consultations and there is a worry that with the current workload pharmacists have that consultations are being kept more brief.

Original poster

christmaselfie1 · 23/12/2020 11:06

@TrufflyPig

Sorry if I've bitten your head off a tad, I am very stressed. I've got myself into a real state over this . I am going to be making a formal complaint to Boots over this once Christmas is past and I've been able to ascertain the outcome of my MAP x

OP posts:

santabetterwashhishands · 23/12/2020 11:09

I think if you've taken the morning after pill three times already you seriously need to change your method of contraception and then you wouldn't have to give it so much thought 🤷‍♀️

TrufflyPig · 23/12/2020 11:10

You havent at all, nothing wrong with a healthy clinical debate, you've been dealing with a lot. If you've been misinformed then complain. I hope it might prompt a refreshing of their training courses.

This is the primary reference for pharmacist training:

www.fsrh.org/standards-and-guidance/documents/ceu-clinical-guidance-emergency-contraception-march-2017/

It says 2017 but was recently updated. Its still pretty sketchy on mode of action.

Nowaynothappening · 23/12/2020 11:14

The only time I took the MAP was after I’d had sex bang on ovulation day. I didn’t know this either and wasn’t told. Luckily didn’t get pregnant but I spent the next 2 weeks absolutely terrified.

yetanothernamitynamechange · 23/12/2020 11:17

@santabetterwashhishands

Thank you captain Hindsight, I am sure the OP and all the other posters on this thread greatly appreciate your assistance.

TrufflyPig · 23/12/2020 11:27

I really don't think there's any need for judgement regarding EHC use. It's a medicine, you never know when you'll need to use it.

yellowwhiteshoes · 23/12/2020 11:39

I'm a pharmacist and quite shocked that there are so many experiences on here of pharmacists not providing this information to patients. It is our job to ensure the safe and effective use of medicines and providing this information during counselling should be standard practice.

This is why I feel mixed about emergency hormonal contraception becoming a self selection product. I feel women should be able to get quick access to it without any barriers, but on the other hand by keeping it pharmacy only you are ensuring that the patient is getting not only the product they need but also the expert advice from a pharmacist. Although from this thread it doesn't seem all pharmacists are even providing that advice