Emergency Contraceptives: Not All Options are Discussed
Pharmacists say it is difficult to discuss a full range of emergency contraceptives options with women according to a study led by several University of Toronto Department of Family and Community Medicine researchers.
Karen Wong, a medical student at the time of the study and now a resident at Memorial University of Newfoundland, Drs. Sheila Dunn, Susan Hum, and Lisa McCarthy conducted a qualitative study with 20 pharmacists who shed some light on their practice and challenges when discussing other options than levonorgestrel (LNG-EC, also sold under the brand name Plan B®). In their discussion, they discovered that very few women know that copper IUD is a more effective option to prevent pregnancy after intercourse.
Pharmacists have been able to provide LNG-EC for a decade. Previously, the treatment required a physicians’ prescription. IUDs are also available in pharmacies but need a doctor or nurse practitioner to insert them, a conundrum that, at times, impedes pharmacists’ practice.
“Women often go to the pharmacy with a contraceptive in mind, so many do not approach pharmacists to discuss the most effective treatment options,” says Dr. McCarthy. “People may also be reluctant to ask pharmacists about options because they feel vulnerable trying to have a personal conversation in a pharmacy. Pharmacies have private spaces where these conversations can occur – but many people do not know that.”
IUDs, as an emergency contraceptive, are highly effective and can reduce the chance of pregnancy when inserted within 7 days of intercourse by more than 99 percent. Emergency contraceptive pills are less effective and must be used within 5 days of intercourse to have any effect. The IUD is effective regardless of weight and can be left in place for ongoing contraception. The problem often lies with arranging to have an IUD inserted, a process that is, at times, foreign for some pharmacists and patients.
“Realistically, if you recommend an IUD to someone, it is optimal to refer them to a clinic where they can have it inserted in a timely way. As pharmacists, we cannot insert IUDs ourselves, so this extra referral step may prevent some from recommending IUDs as an option,” says Dr. McCarthy.
Dr. Dunn suggests that knowledge sharing is required on both sides: The pharmacists and consumers. That is why she, along with her team and a public focus group, developed What’s Next for Me. It is a patient education website which outlines the various options available to women who seek emergency contraceptives. Developed and maintained without funding from pharmaceutical companies, the site is continuously updated to highlight the newer options available to women. Dr. McCarthy says that “What’s Next for Me” is an excellent resource that answers many questions about how each contraceptive compares. Comparisons can be drawn regarding price, effectiveness and use. It also provides additional resources for women in Toronto including nearby clinics they can visit to access care.
Wong admits that there is much work to do within the profession to encourage pharmacists to promote a full range of options for emergency contraceptive to patients.
“As a former pharmacist, now physician, I have seen the numerous ways accessing therapies and resources can be difficult for patients, and felt uniquely positioned to explore some of them,” says Wong. “Pharmacists are knowledgeable and readily accessible to people. This study tells us there is much work to be done helping pharmacists overcome knowledge and other gaps concerning emergency contraception. In the end, we all want to ensure that our patients are receiving the best treatment for their needs.”