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Community pharmacy plays a crucial role in access to emergency contraception, commonly known as the 'morning-after pill'. As healthcare professionals, our work goes beyond mere supply: it involves rigorous and empathetic advice to ensure correct use and the patient's peace of mind.

What is Emergency Contraception and When is it Used?

Emergency contraception (EC) is a method to prevent pregnancy after unprotected sexual intercourse or when a regular contraceptive method has failed (e.g., condom breakage, missed pills). It is essential to understand that it is not an abortifacient method, but rather acts by delaying or inhibiting ovulation, or by altering the transport of sperm or ova. Its efficacy is higher the sooner it is taken after the risk-related intercourse.

There are two main active ingredients available in Spain for oral EC: levonorgestrel and ulipristal acetate. Both are accessible without a medical prescription in pharmacies, which underscores our responsibility in providing information and follow-up. It is vital to remind patients that EC does not protect against sexually transmitted infections (STIs).

Emergency contraception should not be confused with a regular contraceptive method. Its frequent use may be less effective and does not offer the same protection as hormonal or barrier methods.

Types of Oral Emergency Contraception and their Mechanism of Action

In Spain, we have two main options for oral emergency contraception, each with a slightly different mechanism of action and window of efficacy:

Levonorgestrel (1.5 mg)

Up to 72 hours

It acts primarily by inhibiting or delaying ovulation. Its efficacy decreases significantly as time passes, being maximal in the first 24 hours and maintained up to 72 hours (3 days) post-coitus. Brands such as Norlevo® (levonorgestrel) or Postinor® (levonorgestrel) are common examples. You can consult the technical data sheet on CIMA (the Spanish Agency of Medicines and Medical Devices database; please check your own national regulator for regulatory information) for more details.

Ulipristal acetate (30 mg)

Up to 120 hours

It is a selective progesterone receptor modulator that also acts by delaying or inhibiting ovulation, even when the ovulatory process has already begun. Its window of efficacy is wider, up to 120 hours (5 days) after unprotected sexual intercourse. EllaOne® (ulipristal acetate) is the best-known product with this active ingredient. The AEMPS (the Spanish Agency of Medicines and Medical Devices; please check your own national regulator for regulatory information) offers detailed information on its use.

It is crucial that the pharmacist informs the patient about these differences so that she can make an informed decision, always prioritising the most appropriate option according to the time elapsed since the risk-related intercourse.

The Role of the Pharmacist in Supply and Advice

Our intervention as pharmacists is fundamental. It is not just about handing over a medicine, but about offering a complete pharmaceutical care service. This includes:

  1. 1
    Assessment and Key Questions
    Ask about the timing of the risk-related intercourse, the date of the last menstrual period, and whether the patient is taking other medicines that may interact (e.g., enzyme inducers such as rifampicin, some antiepileptics, or St John's wort).
  2. 2
    Detailed Product Information
    Explain how to take the medicine, possible side effects (nausea, vomiting, headache, breast tenderness), and what to do in case of vomiting in the first few hours.
  3. 3
    Advice on Regular Contraception
    Take the opportunity to talk about regular contraceptive methods and the importance of family planning. We can refer the patient to her GP or health centre for a more in-depth consultation.
  4. 4
    Follow-up and Warning Signs
    Advise the patient that she should see a doctor if her period does not arrive on the expected date or if she experiences unusual bleeding. Remember that EC is not 100% effective.

This advice process is a pillar of pharmaceutical care and reinforces the public's trust in the pharmacy as an accessible and professional health point.

Myths and Realities about the Morning-After Pill

There are many myths surrounding emergency contraception that we must debunk to reassure patients and encourage responsible use. It is crucial to clarify that EC:

As pharmacists, our educational role is essential to combat misinformation and ensure that patients make decisions based on scientific evidence. The World Health Organization (WHO) offers valuable resources to educate on this topic.

Frequently Asked Questions about Emergency Contraception

What do I do if the patient has vomited after taking the pill?

If vomiting occurs within 3 hours of taking levonorgestrel or ulipristal, taking a new dose should be considered. It is important that the patient consults with the pharmacist or doctor to evaluate the situation.

Can the morning-after pill affect my menstrual cycle?

Yes, it is common for emergency contraception to temporarily alter the menstrual cycle. The next period may be earlier or later, and the bleeding may be different from usual. If the delay is more than a week, taking a pregnancy test is recommended.

Are there interactions with other medicines?

Yes, some medicines can reduce the efficacy of emergency contraception, such as certain antiepileptics (phenytoin, carbamazepine), rifampicin, ritonavir and products containing St. John's wort. The patient should always be asked about their usual medication.

Do you need to delve deeper into other aspects of pharmacology or pharmacy care? Explore our section of specialised articles to keep up to date with scientific evidence and best practice in community pharmacy.

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