Following on from the September issue Continuing Professional Development on the Pharmacy Role in Emergency Contraception, this 5-Minute Learning Module is designed to enhance the community pharmacy team understanding and ask further questions as to how you can support and advise patients.
After completing this module, you should recognise the different types of emergency contraceptives available, indications and suitability for patients that may present to the pharmacy and appropriate advice and counselling to be given for each.
A community pharmacy environment that fosters teamwork ensured high levels of consumer satisfaction. This series of articles is designed for you to use as guide to assist your team in focusing on meeting ongoing CPD targets and to identify any training needs in order to keep the knowledge and skills of you and your team up to date.
This module focuses on the three main methods of EHC: ulipristal acetate, levonorgestrel, and the copper intrauterine device (Cu-IUD).
1. Ulipristal Acetate (UPA) – eg ellaOne®
How it works: A selective progesterone receptor modulator, UPA delays ovulation even if the LH surge has already begun, giving a longer window of effectiveness than LNG.
Dose and timing:
• 30 mg single oral dose
• Effective up to 120 hours (5 days) post-UPSI
• Repeat dose if vomiting within 3 hours
Effectiveness:
• Maintains consistently high efficacy across the full 5-day window
• More effective than LNG between 72–120 hours post-UPSI
• Less impacted by body weight, though some data suggest modest reduction in higher BMI
2. Levonorgestrel (LNG) –NorLevo®
How it works: A synthetic progestogen, LNG prevents or delays ovulation by blocking the luteinising hormone (LH) surge.
It only works if taken before ovulation; it does not affect an existing pregnancy.
Dose and timing:
• 1.5 mg single oral dose
• Licensed up to 72 hours postUPSI (most effective within 12 hours)
• Repeat the dose if vomiting occurs within 3 hours
Effectiveness:
• About 84% overall; best within the first 12 hours
• Reduced efficacy in women with BMI ≥26 kg/m2 or weight >70 kg – UPA or Cu-IUD may be more suitable
3. Copper Intrauterine Device (Cu-IUD)
How it works:
Copper ions impair sperm motility and viability, preventing fertilisation. If fertilisation has already occurred, implantation may also be inhibited.
Timing:
• Can be fitted up to 5 days after UPSI or up to 5 days after the earliest possible ovulation date
Effectiveness:
• Over 99% – the most reliable option for emergency contraception
Advantages:
• Provides long-term contraception (5–10 years)
• Hormone-free, suitable for those who cannot use hormonal methods
• Works regardless of BMI or timing in the cycle
Counselling Priorities for Pharmacists
For pharmacists, counselling priorities around emergency hormonal contraception (EHC) focus on several key considerations. Timing is critical, as the sooner EHC is taken, the more effective it will be. The choice of method depends on a range of factors, including the time since unprotected sexual intercourse (with ulipristal acetate [UPA] being most effective after 72 hours), cycle timing (UPA is preferred when closer to ovulation), and BMI or weight (where a copper IUD or UPA is recommended if BMI is ≥26 kg/m2 or weight exceeds 70 kg). Breastfeeding status should also be taken into account, as levonorgestrel (LNG) is preferred in this situation, and potential drug interactions should be considered, with a copper IUD being the best option for those taking enzyme inducers.
3. Side effects – mostly mild and short-lived. Nausea is common with LNG; insertion discomfort with Cu-IUD.
4. Contraceptive cover afterwards:
o After LNG: start/continue contraception immediately; condoms for 7 days (9 for Qlaira®).
o After UPA: delay hormones for 5 days, then use condoms until effective.
5. STI protection – remind patients that EHC does not prevent infections; offer screening referral.
6. Confidential, supportive environment – especially important for younger patients.
Special Considerations
• Free contraception scheme: Available to patients aged 17–35
(or with medical card).
• Aged under 17: Pharmacists must consider consent and safeguarding obligations.
• Drug shortages: Always check HPRA/IPU updates. If UPA unavailable, consider LNG (if within 72h) or refer for Cu-IUD. Common Causes of EHC Failure
• Delayed use after UPSI
• Ovulation already occurred
• Further UPSI after taking EHC
• Enzyme-inducing drugs reducing efficacy
• High BMI (LNG particularly affected)
• Vomiting within 3 hours without repeating the dose
Key Takeaway for Teams
Pharmacists play a pivotal role in preventing unintended pregnancies through timely supply of EHC. Successful consultations rely on:
• Prompt access
• Accurate method selection
• Clear, non-judgmental counselling
• Awareness of supply schemes and shortages
Encourage your team to rehearse scenarios, stay familiar with counselling points, and create a supportive environment for every patient.
Consider:
Reflect on the following in assessing your own knowledge and your team’s training:
Is your knowledge up to date on all methods of emergency contraception?
Are you aware of all cases where referral to GP or sexual health clinic are required?
Do you know what advice should be given to all patients provided with emergency contraception?
Have you details of sources for further support that may be required, either for STIs or crisis situations?
Are you confident explaining the options for ongoing contraception?
Key Points:
Always refer requests for emergency contraception directly to the pharmacist –no exceptions.
Be able to explain the consultation process clearly if patients ask what to expect.
Understand the differences between the emergency contraception options available and when each is most appropriate.
Be familiar with the relevant SOP sections that cover emergency contraception supply.
Maintain strict confidentiality at all times when handling requests for EHC.
Communicate with professionalism, empathy, and sensitivity in every patient interaction.
Actions:
Keep your knowledge current on all methods of EHC that can be supplied from the pharmacy.
Review contraindications, drug interactions, and side effects regularly so you can advise confidently.
Know the decision points for recommending one method over another (e.g., time since UPSI, BMI, drug interactions, breastfeeding).
Deliver and document regular team training on EHC, with assessment to confirm understanding.
Have a clear SOP in place and ensure all staff follow it consistently.
Use a structured consultation tool – such as a questionnaire or assessment form – to guide patient discussions and ensure key safety questions are covered.
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