h ormonal e mergency contraception in europe : accessibility and availability

Hormonal emergency contraception in Europe :

accessibility and availability

Dr E. AUBENY

French Association for Contraception(AFC) - Paris

Techniques :

Dr E. AUBENY - AFC, Paris

Levonorgestrel E.C. : more efficient and better tolerated

It has become the reference E.C.

Two hormonal methods are presently available

Hormonal E. C. in Europe : accessibility and availability

Yuzpe method (EE+ levonorgestrel). It has been abandoned :

lover efficacy and medical contra-indications


Reference as emergency contraception

Levonorgestrel E.C.

Reference method

Posology : 2 pills at 0.75 mg in one intake

When : as soon as possible, preferentialy before 120 h after unprotected intercourse

Efficacy : 80 %

Conter-indication : none


Levonorgestrel E.C. : accessibility



For some years only in Hungary

Nowadays widespread all over Europe under different names and by different laboratories :

Levonnelle (Schering), Norlévo, (HRA pharma), Postinor (Gédéon Ritcher)

Emergency contraception requires :


to take a pill quickly for a maximum efficacy

easy access to be used


Medical prescription causes delay and dicourages the use of E.C.

Levonorgestrel E.C. : availability

Levonorgestrel E.C. : availability


No contra indication

No need for a physical examination


So levonorgestrel E.C. is available

in numerous countries without a medical prescription

France since June 1999 (1st country)

Pharmacies Belgium Denmark Finland France

• Portugal• Belgium• U.K.• Switzerland• Slovenia•• Drugstores • Norway

• Sweden


Levonorgestrel E.C. availabilityToday without a medical prescription


Europe


ResultsResults of distribution of distribution without a medical without a medical

prescriptionprescription

Dr.E. AUBENY - AFC, Paris

Results : medical point of view

No major medical problem reported by pharmacovigilance

No reduction in hormonal contraception (rise in the sale of contraceptive pills in France)



Levonorgestrel E.C. without a medical prescription

No increase of ectopic pregnancies



Results : Use by women

Women use this emergency contraception very widely even information only goes through by the media and very little through by the doctors

In France and in U.K. 85 000 women use this drug each month even though it is not reimbursed by the Frech Social Security and it is very

expensive in the U.K.(18 euros).

E.C. meets a real need

Dr.E. AUBENY - AFC, Paris

Hormonal E. C. in Europe : accessibility and availability Levonorgestrel E.C. without a medical prescription

Results : Use by women

No medical prescription facilitates the use of E.C.

August 2002

E.C without medical prescription : France 80 000 sales, U.K. 80 000 (in spite of the price)

•E.C with medical prescription : Germany 9 000 sales, Austria 1 800

• Countries where levonorgestrel E.C. is distributed with a prescription women use it very little

E.C. meets a real need, it should be used very easily

Hormonal E. C. in Europe:accessibility and availability


Results : prevention of abortion

No figures yet

In France, in 2000, for the first time, one year after the

selling of levonorgestrel E.C.without a prescription a slight

decrease has been acknowledged in the number of

abortions

Coincidence or beneficial effect of levonorgestrel E.C ?

It is too early to conclude Dr E. AUBENY - AFC, Paris

Results : Role of doctors : preventative distribution

Dr. E. AUBENY - AFC, Paris

For condoms users

In case of a forgotten pill

Hormonal E. C. in Europe : accessibility and availability Levonorgestrel E.C. without a medical prescription

- Coraliance Study *

23 % of forgotten pills during the month preceeding the study

46 % of these when starting again : dangerous period

33 no precaution whatsoever

*The "Coraliance Study" ESC Journal Oct. 2002,**A. Glasier

Preventive distribution does not result

in a decrease of the use of regular contraception**


Results

September 2001/September 2002 : 15 125 pupils asked for it, 9 000 have received it, among them of 6 000 from a nurse

Teenagers talk about their sexuality and contraception problems


In France two specific measures for youngsters

1) Delivery of lévonorgestrel E.C. by school nurses in case of emergency


Teenagers ask for E.C. lévorgestrel (Norlévo)

no checking of age or identity

Pharmacist gives advice on the use of Norlévo and normal contraception

STD, medical follow-up gives a leaflet about Norlevo

reimbursed by Social Security


2) Free delivery of Levonorgestrel E.C. to teenagers in pharmacies

Difficulties of implantation : pharmacists are afraid to speak to youngsters

TO CONCLUDE


It is available in most countries

This E.C. has widely spread in Europe because

it meets a need

Lévonorgestrel E. C. replaced by Yuzpe method



TO CONCLUDE

• Its delivery varies from one country to another


is authorised in many countries in Europe

- No medical problem

- Facilitates its use

Levonorgestrel E.C. without a medical prescription has to be developed

Insufficient information about E:C.


TO CONCLUDE


In France levonorgestrel E.C. without a medical prescription :

unprotected intercourse


But under-used :

forgotten pill

No decrease of regular contraception

No accident

Insufficient information about E.C.

h ormonal e mergency contraception in europe : accessibility and availability

Documents