Hormonal emergency contraception in Europe : accessibility and availability

1
Hormonal emergency contraception in
Europe accessibility and availability

• Dr E. AUBENY
• French Association for Contraception
• (AFC) - Paris

2
Hormonal E. C. in Europe accessibility and
availability

• Techniques

• Yuzpe method (EE levonorgestrel). It has been
  abandoned
• lover efficacy and medical contra-indications

3
Hormonal E. C. in Europe accessibility and
availability
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
4
Hormonal E. C. in Europe accessibility and
availability

• 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)

5
Hormonal E. C. in Europe accessibility and
availability
Levonorgestrel E.C. availability

• Emergency contraception requires

Medical prescription causes delay and dicourages
the use of E.C.
6
Hormonal E. C. in Europe accessibility and
availability

• Levonorgestrel E.C. availability

So levonorgestrel E.C. is available in numerous
countries without a medical prescription France
since June 1999 (1st country)
7
Hormonal E. C. in Europe accessibility and
availability Levonorgestrel E.C.
availability Today without a medical
prescription

• Pharmacies
• Belgium
• Denmark
• Finland
• France
• Portugal
• Belgium
• U.K.
• Switzerland
• Slovenia
• Drugstores
• Norway
• Sweden

Europe

• Dr E. AUBENY - AFC, Paris

8
Hormonal E. C. in Europe accessibility and
availability

• Results of distribution without a medical
  prescription

• Dr.E. AUBENY - AFC, Paris

9
Hormonal E. C. in Europe accessibility
and availability Levonorgestrel E.C. without a
medical prescription
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)

• Dr E. AUBENY - AFC, Paris

? No increase of ectopic pregnancies

10
Hormonal E. C. in Europe accessibility and
availability

• Levonorgestrel E.C. without a medical
  prescription
• 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

11
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

• Dr.E. AUBENY - AFC, Paris

12
Hormonal E. C. in Europeaccessibility and
availability Levonorgestrel E.C. without a
medical prescription 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

13
Hormonal E. C. in Europe accessibility and
availability Levonorgestrel E.C. without a
medical prescription

• Results Role of doctors preventative
  distribution

• - Coraliance Study
• 23 of forgotten pills during the month
  preceeding the study
• 46 of these when starting again dangerous
  period
• 33 no precaution whatsoever

Preventive distribution does not result in a
decrease of the use of regular contraception
The "Coraliance Study" ESC Journal Oct.
2002,A. Glasier
14
Hormonal E. C. in Europe accessibility and
availability
In France two specific measures for
youngsters 1) Delivery of lévonorgestrel E.C. by
school nurses in case of emergency
? 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
15
Hormonal E. C. in Europe accessibility and
availability

• 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

• Dr E. AUBENY - AFC, Paris

16
Hormonal E. C. in Europe accessibility and
availability

• TO CONCLUDE

• Lévonorgestrel E. C. replaced by Yuzpe method

• It is available in most countries
• This E.C. has widely spread in Europe because it
  meets a need

• Dr E. AUBENY - AFC, Paris

17
Hormonal E. C. in Europe accessibility and
availability

• TO CONCLUDE
• Its delivery varies from one country to another
• Levonorgestrel E.C. without a medical
  prescription
• 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 EC.
• Dr E. AUBENY - AFC, Paris

18
Hormonal E. C. in Europe accessibility and
availability

• TO CONCLUDE

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

• No accident

• No decrease of regular contraception

• But under-used
• forgotten pill

unprotected intercourse

Insufficient information about E.C.