Emergency contraception in pharmacies - changes

pow wow

I'm posting this for information for anyone who may find themselves in a similar situation and needing emergency contraception (these things do after all happen!).

On visiting a pharmacy today to get emergency contraception (Norlevo, which is the standard 'morning after pill') I was advised that due to studies showing reduced efficacy in women over a certain weight, pharmacists have been advised against dispensing this medication to women weighing over 75kg (and yes, they did weigh me to check!). Women over 75kg 'should' now to be referred to a GP for prescription of an alternative. I say 'should' because the only information I could find online (linked below) talks in guidance terms rather than rules as such. The pharmacist insisted there was a big publicity campaign about this and perhaps there was, but I didn't know anything about it. As I am currently staying up the country I couldn't visit my own GP but the pharmacist referred me to a local one and I got sorted in the end (with ellaOne).

Frantic googling didn't turn up anything of note (like a publicity campaign!) but there is an information sheet courtesy of the Irish College of General Practitioners here which explains in more detail. The pharmacy was a national chain and the pharmacist said this is uniform practice across their stores so just a heads up that if you're over 75kg you may encounter difficulties in obtaining the type of emergency contraception available at pharmacies and may be referred to a GP. It was a little upsetting for me at the time and knowledge is power...or so they say.

dharma200

have not heard a thing about this, that must have been a horrible experience. I am wondering is that standard now.... Very humiliating to have to be weighed and sounds wrong on a lot of levels, surely if it is ineffective at a certain weight ( like all medications I would presume) then the pharmacy should provide an alternative....
Glad you got sorted in the end... And I'll pass this information on...

eviltwin

Thanks for the heads up, I hadn't heard about it either tbh. That is a worry and I can see a good few women being badly affected by this. I don't understand why pharmacies can't offer an alternative.

contrary_mary

Yes this guidance should be followed by all pharmacies in Ireland - there was communication to pharmacists on this issue last year. New studies suggest it is less effective in women over 75kg and ineffective in women over 80kg so if you fall into those categories you really need to see your GP for an alternative. It must have been a shock today when it was already a stressful situation but be assured that by seeing a GP you have now received appropriate (and hopefully effective) medication for you (even though it's a pain having to go to the doctor).

contrary_mary

Sorry I only saw the other replies now. Norlevo is the only OTC emergency contraceptive available so unfortunately pharmacists can't offer an alternative without a prescription.

dharma200

What is worrying is the prohibitive cost to women if having to see gp. Fifty euro for gp visit, then the cost of the pill.... Also trying to get appointment with gp, all within the timeframe required. I hope that this is reviewed and that women are not penalised for being overweight and more otc options become available.

pow wow

Credit where credit is due the pharmacist went above and beyond for me and was very nice about the whole thing. I'm just concerned it doesn't seem to have been communicated to the general public - I'd consider myself reasonably 'up' on current events and although I had seen an article questionning its efficacy, I hadn't seen/heard anything about moves to restrict its use in certain women - even for their own welfare.

Gongoozler

Not a good time to find out about this but yeah I had heard of this a few times in the past. Thought it was pretty common knowledge tbh.

dharma200 wrote: »

What is worrying is the prohibitive cost to women if having to see gp. Fifty euro for gp visit, then the cost of the pill.... Also trying to get appointment with gp, all within the timeframe required. I hope that this is reviewed and that women are not penalised for being overweight and more otc options become available.

Nobody is penalising anyone, it's just that it doesn't work for people over that weight

dharma200

I'm not saying it is penalising by the pharmacies I mean to saythat the prohibitive price to see a gp is one of the main factors that resulted in the push for over the counter emergency contraception and it is a shame that there are no over the counter substitutes available for women over 11 st 11lbs.

MauraTheThird

This has been communicated in pharmacies for a while now and we've had to refer people to the doctor at work purely because it would be unethical to give someone a medicine that may not work for them because of their weight.

It is very difficult to do testing (clinical trials) on this sort of thing because of the fact, you don't want people to get be getting pregnant if it doesn't work as intended.

Rising obesity in Ireland (not that 75kg is obese for most people) is causing issues for medicines that weren't considered when they were developing the drug such as intramuscular injections not being able to reach the site of injection due to excess fat. I don't think the intention is to embarrass anyone by weighing them and making them to go to the doctor because they are over the weight limit for the drug. Excess weight means a possible dilution of the plasma concentrations of the blood and it would be unethical to give it knowing that it could be ineffective.

I'd personally rather be weighed, embarrassed and get a medicine that would work as opposed to the alternative.

akamossy

Is this a fairly new thing? Cuz I weigh over that and I never had any problem getting the morning after pill when I did have to get it before.

Addle

akamossy wrote: »

Is this a fairly new thing? Cuz I weigh over that and I never had any problem getting the morning after pill when I did have to get it before.

The information in the link was issued in January.

Did the MOP work for you?

I am someone who weighs over that and who the MOP didn't work for. So I wish I, and my pharmacist, was aware of the issue at the time.

eviltwin

MauraTheThird wrote: »

This has been communicated in pharmacies for a while now and we've had to refer people to the doctor at work purely because it would be unethical to give someone a medicine that may not work for them because of their weight.

It is very difficult to do testing (clinical trials) on this sort of thing because of the fact, you don't want people to get be getting pregnant if it doesn't work as intended.

Rising obesity in Ireland (not that 75kg is obese for most people) is causing issues for medicines that weren't considered when they were developing the drug such as intramuscular injections not being able to reach the site of injection due to excess fat. I don't think the intention is to embarrass anyone by weighing them and making them to go to the doctor because they are over the weight limit for the drug. Excess weight means a possible dilution of the plasma concentrations of the blood and it would be unethical to give it knowing that it could be ineffective.

I'd personally rather be weighed, embarrassed and get a medicine that would work as opposed to the alternative.

Totally agree, it's a necessary evil but I've seen nothing in the way of information from the HSE, family planning or pharmacies about it which is poor form. As Dharma says if you are over the limit and they won't sell it to you that could leave you in a difficult position.

Addle

eviltwin wrote: »

Totally agree, it's a necessary evil but I've seen nothing in the way of information from the HSE, family planning or pharmacies about it which is poor form. As Dharma says if you are over the limit and they won't sell it to you that could leave you in a difficult position.

As long as your pharmacist knows about it, what difference does it make to you whether you know about it in advance of having to take the MAP?

eviltwin

Addle wrote: »

As long as your pharmacist knows about it, what difference does it make to you whether you know about it in advance of having to take the MOP?

Big difference.

I can go to a pharmacy now and get the MAP over the counter but if they deem me too heavy according to their scales then I have to find 50-60 euros to see my doctor, try and get an appointment which isn't always easy and then pay the extra money for the alternative medication..its extra time, money and stress that we don't need and hadn't expected when we're stressed out enough as it is. Why make it so hard for people?

Addle

eviltwin wrote: »

Big difference.

I can go to a pharmacy now and get the MAP over the counter but if they deem me too heavy according to their scales then I have to find 50-60 euros to see my doctor, try and get an appointment which isn't always easy and then pay the extra money for the alternative medication..its extra time, money and stress that we don't need and hadn't expected when we're stressed out enough as it is. Why make it so hard for people?

Well maybe we make it harder for ourselves by being overweight.

It's a serious medication.
We do feel the we need it if we take it.
It's a lot less stressful than dealing with the consequences of it not working.

eviltwin

Addle wrote: »

Well maybe we make it harder for ourselves by being overweight.

It's a serious medication.
We do feel the we need it if we take it.
It's a lot less stressful than dealing with the consequences of it not working.

Not quite sure what to make of your first comment

I'm not saying pharmacies should give it out just saying it would be helpful if they could inform the public of this so that women know they may not be able to access it as easily as they had thought.

Everyone was delighted when the MAP finally became available over the counter because it took away all that hassle and stress, now it seems for some women at least nothing has changed. They deserve to know that, I'd hate to see women left high and dry because of a lack of information.

akamossy

Addle wrote: »

The information in the link was issued in January.

Did the MOP work for you?

I am someone who weighs over that and who the MOP didn't work for. So I wish I, and my pharmacist, was aware of the issue at the time.

Yup it worked. I never had any problems with it and I've had to take it a couple of times and it was fine and the weight thing was never mentioned to me

Gongoozler

Education of anything important in this country seems ridiculously lacking. I'm not sure how I knew about this, but I'm guessing it's not everywhere as most in here didn't seem to know. Every pharmacy should have a sign up or a leaflet at the counter. Or doctors office, same.

catallus

The cynic in me looks at this and sees the oft-cited "conspiracy of the professions against the common man": since the wide availability of the map has eaten into the profits of both pharmacists and doctors they have conspired to make the product less available to women over 11st 11lb. Now, I know that these types of medications are precisely calibrated and all that but the bottom line is that there should be some sort of action taken to make an effective pill available no matter what the circumstances are; a campaign should be started to make the professions take note that the whole idea of the map (an easily available affordable pill, which is the whole bloody idea behind the idea of the otc map) is being undermined if you walk in and are told you can't have it.

That said, the Op's pharmacist did try and make things easier and was obviously acting in good faith, so maybe there is no huge plot behind this, but still; the fact that there was no option for her but to go to the doctor makes the whole idea of the map less effective for people.

Gongoozler

So you're saying doctors are making this up to get more money out of people?

catallus

It is a bit more complex than that; I'm saying that they are taking advantage of the limitations of the available medicines to put barriers between women and the map, for the purpose of profit and control. And I'm saying this undermines the principle of the map, which is that it is easily available in an emergency.

Gongoozler

So you don't think they're making it up, just that they're taking advantage of the limitations there? Sorry, but how do you purpose this widespread change was implemented if not genuine, they all voted to do this at the last IMO meeting?

catallus

Would you not expect them to vote for something that made them more money?

Gongoozler

Oh I absolutely would, but something they could back up. Sure if they were trying to make money purely, why not lower the weight threshold even more?

catallus

Because the limitations they are working from are the ones which are being brought up in actual medical trials; to be clear, I'm not saying they are making anything up about the effectiveness of the medication, just that they are using the actual limitations to keep the product that one step more away from women; and given that the nature of the demand for the pill is one of immediate necessity, this action by pharmacists and doctors makes pill less available.

Gongoozler

So you agree there's a need for a different pill but what do you think they should be doing instead? Just have the pharmacist give the other one suitable for those above that weight presumably?

catallus

Yep

Gongoozler

I would just presume there's a reason for not doing so. Just like there's meant to be a reason for pharmacists not being able to dispense other drugs without prescription.

catallus

I'm sure there is a reason; I'm just saying they are not taking responsibility by putting the barrier there; they should be made to be proactive on this so that the map is easily available without having to fork out €50 to a doctor after getting an appointment, when a pharmacist could just dispense it! I'm sure there would be some circumstances in which a pharmacist would be on the fence about giving a specific pill to a specific person, and that's the privilege of the professional and who can argue with that. But the default position at this stage is that a pharmacist can't, even if he wants to, dispense a provably effective pill to a woman over 11-11. Which just seems to be red-tape for the sake of it.

Either a map is there or it isn't. It's a rights issue at the end of the day. It shouldn't be pushed further from women just because they couldn't be bothered working out the ins and outs of it. And it really isn't something people should have to deal with in a time-critical situation.

eviltwin

Is there any reason why the one the GP prescribes to heavier women isn't available over the counter?

Penny Tration

Hmm. I was much heavier than that a few years ago (over 100kg) and took the MAP twice with no issues. My sister is over 75kg and got it last year and it worked fine for her.

Addle

eviltwin wrote: »

Is there any reason why the one the GP prescribes to heavier women isn't available over the counter?

Probably just because it's a much stronger treatment.

There are lots of otc medications.
When you need a stronger treatment, you get a prescription.

suds1984

It's the manufacturer that makes Norlevo that brought in the restriction about it being not made available for over 75kg ladies without prescription. The companies that make other MAP for ladies over 75kg presumably haven't applied for a license to have it available without prescription. As far as I know a product has to be available for a certain period of time before such a license would be considered. I would think that EllaOne would fall into this category as it has not been available for a long period of time. I know it can be frustrating and embarrassing to go talk to pharmacist and discover that you can't buy it anymore but hopefully in time other MAP will be made available without prescription.

woodchuck

green_screen wrote: »

Hmm. I was much heavier than that a few years ago (over 100kg) and took the MAP twice with no issues. My sister is over 75kg and got it last year and it worked fine for her.

Just because someone takes it and doesn't get pregnant, doesn't mean it actually worked. Plenty of people have unprotected sex without getting pregnant... not that this is something I would encourage of course!! Just that there is no way to know if the MAP was actually effective or if you weren't going to get pregnant that time anyway.

Penny Tration

woodchuck wrote: »

Just because someone takes it and doesn't get pregnant, doesn't mean it actually worked. Plenty of people have unprotected sex without getting pregnant... not that this is something I would encourage of course!! Just that there is no way to know if the MAP was actually effective or if you weren't going to get pregnant that time anyway.

Oh, I know, especially for me as I have PCOS. others were talking about not getting pregnant on it, even being over the threshold, so thought I'd share my experience with it.

woodchuck

green_screen wrote: »

Oh, I know, especially for me as I have PCOS. others were talking about not getting pregnant on it, even being over the threshold, so thought I'd share my experience with it.

Ah no worries I just think it could be a dangerous way of thinking that just because a woman is over 75kg and the MAP 'worked' before that it's actually effective for them. I know it must be a pain to have to go to the GP, but better than taking something that may not be effective and end up with a baby on the way

Penny Tration

woodchuck wrote: »

Ah no worries I just think it could be a dangerous way of thinking that just because a woman is over 75kg and the MAP 'worked' before that it's actually effective for them. I know it must be a pain to have to go to the GP, but better than taking something that may not be effective and end up with a baby on the way

Oh god no, I wasn't advocating just using it! Thankfully, I'm under the weight threshold now, so i should be grand if i ever need it.

Must be hard for women who need it on a weekend though, with gp surgeries being closed.

panda100

Addle wrote: »

Well maybe we make it harder for ourselves by being overweight.

75kg is not overweight for everyone. I'm 6'1 and that is standard weight for female of my height. I am underweight for my height at under 11 stone!

First thing I've heared about this. Thanks for heads up op

Addle

panda100 wrote: »

75kg is not overweight for everyone. I'm 6'1 and that is standard weight for female of my height. I am underweight for my height at under 11 stone!

Sorry; overweight and/or tall.

Morag

http://realproductivehealth.com/ is a good recourse, they also collect people's experiences.

I had heard stuff re it being an issue but seriously weighing women, WTF!

Ocean Blue

green_screen wrote: »

Oh god no, I wasn't advocating just using it! Thankfully, I'm under the weight threshold now, so i should be grand if i ever need it.

Must be hard for women who need it on a weekend though, with gp surgeries being closed.

Time is not as much of an issue with the alternative options..........They can be taken for up to 5 days post intercourse and effectiveness of Ella One is 99% effective right through the 5 days. It doesn't drop off in the same manner as Norlevo.

lilmissprincess

I got given out to by the GP for going in instead of getting it OTC, or rather, she was ranting that the pharmacist wouldn't give it to me (very slightly over the weight limit). Not sure if its bad on the GPs part for not knowing, or the pharmacist for not giving it to me, however the cost difference was close on eighty euro so if the pharmacist was over-reacting it makes for a very expensive difference!

Penny Tration

lilmissprincess wrote: »

I got given out to by the GP for going in instead of getting it OTC, or rather, she was ranting that the pharmacist wouldn't give it to me (very slightly over the weight limit). Not sure if its bad on the GPs part for not knowing, or the pharmacist for not giving it to me, however the cost difference was close on eighty euro so if the pharmacist was over-reacting it makes for a very expensive difference!

If you were a little over the threshold, your pharmacist was right to send you to the GP. Your GP shouldn't 'rant' at you for being careful!


I collected my pill prescription yesterday, and was asked to fill out a survey. Seems pharmacies are trying to get the normal pill available OTC. That's what their survey was all about, asking how willing would I be to get it without a prescription. Odd.

skallywag

Morag wrote: »

...I had heard stuff re it being an issue but seriously weighing women, WTF!...

Do you expect a pharmacist to have the ability to accurately know a customer's weight by looking at them?

In cases where such regulations exist, then it is the pharmacist's obligation to make sure that they are enforced. To be frank, I would find it very concerning if the medication was being dispensed over-the-counter without such control being mandatory.

skallywag

Gongoozler wrote: »

...Every pharmacy should have a sign up or a leaflet at the counter. Or doctors office, same...

Pharmacies dispense 1,000s of different drugs, many of which have specific caveats when it comes to the actual user, be it tied to age, weight, etc, etc. It's down to the pharmacist to carefully inform the user of the same, and to provide the required information before making the sale.

While what you suggest sounds like a fine idea in theory, I do not think that this could be implemented in a practical way, due to the vast amouts of information which would need to be published / signposted / leafleted, in order to treat each drug / condition equally.

pow wow

lilmissprincess wrote: »

I got given out to by the GP for going in instead of getting it OTC, or rather, she was ranting that the pharmacist wouldn't give it to me (very slightly over the weight limit). Not sure if its bad on the GPs part for not knowing, or the pharmacist for not giving it to me, however the cost difference was close on eighty euro so if the pharmacist was over-reacting it makes for a very expensive difference!

Have to say the GP I was referred to knew nothing about it either and actually spoke to the pharmacist to find out what they were to prescribe me instead! I think it's been massively under-communicated hence my original post.

I think there should be a publicity campaign tbh, to communicate to women over 75kgs that the otc emergency contraception facility which had previously been available to them has now been withdrawn due to concerns over efficacy. It's kind of a big deal.

angeldelight

pow wow wrote: »

Have to say the GP I was referred to knew nothing about it either and actually spoke to the pharmacist to find out what they were to prescribe me instead! I think it's been massively under-communicated hence my original post.

I think there should be a publicity campaign tbh, to communicate to women over 75kgs that the otc emergency contraception facility which had previously been available to them has now been withdrawn due to concerns over efficacy. It's kind of a big deal.

The part about that I personally find most worrying is how many women over the recommended weight limit has the GP prescribed Levonelle/Norlevo in the last few months and they didn't even know there could be an issue!

Full disclosure - I'm a pharmacist. Our union and the Pharmaceutical Society both communicated with us about the changes in December, I wonder did the doctors organisations not, or did the doctor just not read them

eviltwin

Its quite shocking to think that informaton so vital as the MAP possibly not working is being treated in such a blase way. I was in a pharmacist on Saturday and there was nothing in the way of a sign on the counter or a flyer to alert women to the changes. This in a pharmacy that has flyers up for all sorts of health related issues and some from local groups.

Ocean Blue

eviltwin wrote: »

Its quite shocking to think that informaton so vital as the MAP possibly not working is being treated in such a blase way. I was in a pharmacist on Saturday and there was nothing in the way of a sign on the counter or a flyer to alert women to the changes. This in a pharmacy that has flyers up for all sorts of health related issues and some from local groups.

It's not possible to have every precaution for every drug advertised in a pharmacy. Weight isn't the only thing that affects MAP safety and efficacy. Being over the weight threshold is one of a number of issues that may require a patient to be referred to a GP. I wouldn't have the space in my pharmacy to advertise every possible issue unfortunately. It would be different if Norlevo could be picked up off the shelf, then of course it would be wrong for the information not to be clearly highlighted. But it can't be self - selected, it is only sold after a private consultation with the pharmacist.

I spend a significant amount of time with any patient who needs to be referred on - I explain why the rules have changed, what it means for them, I facilitate them as much as possible by helping them find a convenient & available GP etc. I'm happy that I provide adequate transparent information and I always acknowledge how frustrating the situation is, for the patient and myself. Beyond that I can't practically do much more.

eviltwin

Ocean Blue wrote: »

It's not possible to have every precaution for every drug advertised in a pharmacy. Weight isn't the only thing that affects MAP safety and efficacy. Being over the weight threshold is one of a number of issues that may require a patient to be referred to a GP. I wouldn't have the space in my pharmacy to advertise every possible issue unfortunately. I spend a significant amount of time with any patient who needs to be referred on - I explain why the rules have changed, what it means for them, I facilitate them as much as possible by helping them find a convenient & available GP etc. I'm happy that I provide adequate transparent information and I always acknowledge how frustrating the situation is, for the patient and myself. Beyond that I can't practically do much more.

Well judging from the replies here very few people know about it even though it was communicated to pharmacies back in December so something has failed in terms of public awareness.