Episode Transcript
[00:00:07] Speaker A: Welcome to the Irish Pharmacy Podcast. This podcast is brought to you by Total Health and Haven Pharmacies. There are 127 of our independently owned pharmacies located all over Ireland so that we can bring trusted local care to you in your community. And now, on the go with this podcast my name is Sheena Mitchell. I'm a pharmacist from Miltown Total Health Pharmacy. In each episode, I'll be chatting with one of my pharmacist colleagues from the Total Health and Haven Pharmacies, where they will blow your mind with all of the amazing information that they have. We aim to bring you reliable and useful health information that you can listen to conveniently at a time that suits you.
[00:00:44] Speaker B: In this episode, I chat with Alva Hayes from Hayes and Hayes Total Health Pharmacy in Portomna County, Galway. Like myself, Alva comes from a family steeped in pharmacy history. Alva's family is full of pharmacists and Alva loves being part of a trusted, caring and family business based in Portomna. Today, we talk all about the free contraceptive scheme. Alva also explains all of the different types of contraception that are available on the scheme. We chat about everything from the pill to the coil, to the patch, to the ring, to emergency contraception, to the copper coil. There are lots of options out there, and today Alva talks me through all of them. As we discuss in this episode, choosing contraception is not always a straightforward and easy thing to do. Sometimes you have to try a few different forms before you find one that suits you. There are also different types available for people who have different needs and wants from their contraception. But the thing that we can all agree on is that having a choice and making an informed decision as a female on your contraception is hugely important. So without further ado, we'll dive into my chat with Alva now.
[00:01:58] Speaker C: Thank you so much for joining us today. Alva.
[00:02:01] Speaker D: Welcome to Podcast. Thank you very much.
[00:02:04] Speaker C: Can you tell us a little bit about Portomna? What's your community like in your pharmacy?
[00:02:08] Speaker D: Portomna is a small enough little town. It's got about 2000 residents or so, pretty big, what I would call like a hinterland in the area. Our nearest towns, big towns, are all about half an hour away, so I suppose we'd be a very rural setting. It's a beautiful part of the world. If you haven't visited, you really should, because it is beautiful.
[00:02:27] Speaker C: Hashtag visit Portomna. Yeah.
[00:02:29] Speaker D: Visit portumna. And I work in the pharmacy alongside my mum, who's Noel, and another lot of other brilliant pharmacists who work for us as well. The pharmacy has been in my family for I'm the fourth generation now of pharmacists in it. So, yeah, we're fairly well embedded in our community at this stage. And, yeah, we're very lucky to have a lovely healthcare community around Protomna. So we're very happy here, which is brilliant.
[00:02:56] Speaker C: It's brilliant. You have kindly agreed to join me today to talk all about the free contraceptive scheme. We know that it was expanded recently from an upper limit of 25 to 30, but can you just make sense for people of who now qualifies for free contraception?
[00:03:14] Speaker D: Sure. So the free contraception scheme was widened on the 1 September, so that it now includes anybody from the age of 17 to 25 women, girls and other people who might be transgender and nonbinary, who are ordinarily resident in Ireland and who are deemed suitable for going on a contraceptive of their choice, essentially in consultation with a prescriber.
[00:03:36] Speaker C: Do people have to go to the GP? And if they do, do they have to pay?
[00:03:40] Speaker D: So they do have to go to the GP. They still have to have a consultation because all of the items that might be needed for contraception are on prescription, obviously, with the exception of condoms. But it would mean that they do need to go to a GP. But the consultation is covered by the scheme that's been rolled out. There would be no charge by the GP for that particular consultation.
[00:04:01] Speaker C: Okay. And I know that's something the Irish Pharmacy Union are fighting hard for, and rightly so, because definitely, as we've seen in other jurisdictions, irish pharmacists are more than capable of doing those consultations and freeing up the health service a little bit. So hopefully with time, that'll change. What do you do if you don't actually have a GP?
[00:04:23] Speaker D: If you don't have a GP, there are a couple of different options, and I suppose some of them would depend on your age in terms of if you're a student, you might have access to a student health center through your university or your It or anything like that. The doctors who are working in those health centers should be able to facilitate. And the other option would be going to a family planning clinic. So there's multiple family planning clinics all over the country, most of which have doctors that would be in a position to prescribe any form of contraception.
[00:04:50] Speaker C: Okay. And in terms of contraception, everyone has their own choices to make. But even once you've made the decision that you want to use contraception, it can feel a bit overwhelming because there's so many different types of contraception available. Yeah. So how do people make that choice? Can you just give us a little breakdown, maybe, on what types of contraception are covered under this scheme so that people can actually be aware of what they can access for free?
[00:05:20] Speaker D: Absolutely. Yeah. I feel really passionate about this particular subject because as females, we are basically going to have to deal with the issue of contraception and whether or not we want to have children or whether we're in a position to do that kind of thing for about 30 years of our lives. So you really do need to be acquainted with how they work and what they're for, how to use them. What might suit you in one phase of your life might not suit you in another phase of your life. And I suppose that's another important feature of this is that it's not a case of, oh, well, pick one and stick with it because your body evolves over time, so does technology, so do medication. So we don't know what might happen in the future in this space, but I just think it's important for people to remember that they do have a choice in this and it can change with time as well. In broad strokes, there's two categories of contraception available. There's what would be considered non hormonal contraception and hormonal contraception. The majority of people would be on hormonal versions of contraception. So these contain natural hormones, so your progesterone and your oestrogen, which are natural in female bodies. And the ambition of that medication is to prevent you from releasing an egg. So that's the primary focus of the majority of the hormonal types of medication. The majority of what we would see in pharmacies would be using the pill, the patch, the coil, the injection, sometimes the ring as well. I don't think I'm forgetting any of them there, but they would be the most commonly used ones. In terms of non hormonal contraception. You're really talking about condoms, female condoms, diaphragms, and then the other option would be the copper coil to go back to the most commonly used stuff might make the most sense to start with the hormonal types. You can divide them into essentially two groups. So if you've got a hormone in the medication, you would be looking at long acting versions of the hormone versus short acting versions of the hormones. The most commonly used things would be the likes of the pill would be known as short acting. So these are things that rely on you taking them on a regular basis in order for the medication to be in your system so that it works. And that's why they're called short acting, is that they don't stay in your body for a long period of time. The ones that you'd be most commonly seeing would be the pill, the patch, the nouvering would be another one. And then you also have then the progesterone only pill, which would be slightly different to the combined hormone pill.
[00:07:41] Speaker C: A lot of people don't really understand the implant, they don't really know how that works or pros and cons, I suppose.
[00:07:50] Speaker D: Absolutely. And I suppose there's the injected of the depoprovira as well. And then you've got the inserted bar, which people would refer to, that would sit in the arm as well. Now, they would be more long acting ones, those particular two. So the first one that we were talking about there is the contraceptive implant, so that would be known as the bar. Colloquially, I suppose, have people having a bar inserted into their arm. And what it really is, is a tiny little rod that is inserted into the skin under the arm, very, very tiny. And basically it can only be inserted by specially trained doctors, obviously, because it does require a very specific technique. And what it does is release the hormone progesterogen over a period of time. That hormone that is creating the contraceptive effect that is effective in this case. And what it does is it stops the ovulation. So the process of releasing an egg from the ovary and it also thickens the mucus of the cervix, and that helps to reduce the chances of sperm getting through and being able to fertilize an egg as well. So it has a dual mode of action, I suppose, which is responsible for its pretty high effectiveness of about 99%. It works for about three years once it's inserted. It also has one advantage to people who might be experiencing painful periods. It can actually reduce those issues in that person as well, which can be very helpful if somebody has very heavy, very painful periods. And compared to other methods of contraception, there's no need for it to interrupt with the process of sex in any way. It's in your arm, it's already there, and you can go about your hormonal business as you wish, essentially.
[00:09:26] Speaker C: So that's a good option for people who maybe struggle to remember to take one of the short.
[00:09:30] Speaker D: Yeah, like you put in the bar, and it's good for three years. So the most important thing is to remember when that three years is up and making sure that you come up with an alternative plan, whether it's getting it replaced or choosing a different form of contraception when you get to the end of that phase. Some people would have questions, I suppose, if you're a bit older and considering the bar around fertility, and if somebody is considering whether they should get the bar removed because they want to have a child. And that is certainly something that if it is something that you'd be looking at within a three year window, it probably wouldn't be the most ideal form of contraception for you in that it can take a little bit of time for your body to reset once the bar is removed. Usually three to six months is what they commonly say.
[00:10:12] Speaker C: And I've seen a lot of women maybe go and get it removed early if their circumstances change, and then maybe rely on barrier methods like condoms until they're ready to try and conceive.
[00:10:21] Speaker D: There's so many options, like you could go on an oral form if you needed to, temporarily while you've got everything in order to be able to try and conceive. So, yeah, it's definitely an option.
[00:10:31] Speaker C: Okay, so, Alvar, what about the copper coil? How does that work and is it covered on the scheme?
[00:10:37] Speaker D: So the copper coil is one of the kind of oldest methods, I suppose, of contraception, really. The way it works is it's, as it says, a coil of copper that is inserted into the uterus and behind the cervix, if you can picture that. So it sits well away from through the vagina, through the cervix and in the uterus. Essentially. Copper is toxic to both sperm and eggs, so it reduces the chance of anything surviving once it hits the copper. So that is why it is such an effective method and it is actually one of the only methods of emergency contraception as well. It's an important arsenal in the emergency contraception scheme as well, because there's certain things that would mean that only the copper coil is appropriate for emergency contraception as well. One particular brand of it is covered in the free contraception scheme. So I suppose it is important to talk to your prescriber about it and make sure that that's the one that they believe would be best for you. The ballerine is the name of that particular one and it is provided by and inserted by a GP. So that would be another important thing to remember, is that it requires two consultations, effectively, because you will be going to the GP to assess your suitability for it and then you'll also have to make an appointment for it to be inserted as well.
[00:11:52] Speaker C: That might be a welcome method for people who don't tolerate hormonal treatment.
[00:11:57] Speaker D: Absolutely, yeah. And in my experience, I suppose people don't tend to go for the copper coil in their first years of contraception use. It tends to be something that they gravitate towards later on, as you say, if people have issues with the side effects, maybe of hormonal contraception, and also for people who are looking for more long term solutions that are contraceptive. So the copper coil can last anywhere from five to ten years, depending on which brand it is that you get inserted. So that's a huge advantage for people who are looking for long term family planning. They won't have to take something every day or put a patch on or take an injection, it's just done for them after the copper coil is inserted for at least five years. And it can actually stay in there the whole way up to menopause then as well, which is fantastic for people who might be concerned about their contraception as they reach perimenopause. It works immediately, there's no time to wait for it to be effective, which is fantastic as well. And as with the bar that we were talking about, the implant like that, you don't have to be faffing around if you're having sex with condoms and other things like that. It is a one stop shop for contraception, which is fantastic warned, I suppose, to say.
[00:13:06] Speaker C: There just on that for people listening who have multiple partners. The only disadvantage of these not using barrier methods is that they don't protect against STIs.
[00:13:16] Speaker D: And that goes for every single method we're going to be discussing today, apart from condoms. So essentially, regardless of whether someone is on the pill, the patch, the nouvering or an implant or a coil, all of them do not protect from STIs. So it is still incredibly important to take those precautions separately to what you're doing for your contraception.
[00:13:36] Speaker C: Just to highlight for people that condoms aren't covered under this scheme, but they are available from a lot of student unions and also from women's health and family planning clinics as well, for free. So if you're say a student in university, just ring up and ask what the story is. Go in Hunt because they are available for free, because they can be quite expensive. And the last thing that we want is for contraception to be out with of your budget because that's the whole point of this scheme, really.
[00:14:06] Speaker D: It's an important thing to remember that contraception does not mean the same thing as preventing STIs and that the two have to go hand in hand. So, yeah, it's very important for people to remember to use condoms if they need to.
[00:14:20] Speaker C: Also then we have kind of similar but a hormonal version of the coil.
[00:14:25] Speaker D: So the Hormonal coil, the Hormonal coil is also known as intrauterine system. So people might see them abbreviated as IUs, which is the intrauterine system. And essentially they designed this based on the copper coil. But what they added in was hormones in on top of it. So like the bar that goes into the arm, it also contains progesterogen, which is an artificial form of progesterone which is in every human body. And it works again by stopping the sperm from reaching the egg and also from just because of its physical presence in the uterus, it stops the sperm from reaching the egg and it also thins the lining of the womb as well. So the progesterogen that's in it effectively reduces the lining that is around the womb. And that means that if for some reason a sperm did manage to get through and reach an egg, that it wouldn't be able to actually settle into the uterus and form a viable pregnancy. So that's the two methods by which that works. One of the advantages of the Hormonal coil is that it can protect you from anywhere between three and six years, depending on which brand you get. You can also get it taken out sooner. So if your lifestyle changes, if something happens that makes you believe that you don't need it anymore, or if you are trying to conceive or anything like that, you can get it out sooner if necessary. Similar to the copper coil has to be inserted by a licensed professional. So by generally GPS as well, sometimes you can get it done in hospital as well. Another advantage is that it can make your period lighter, similar to what we spoke about with the bar, and it can stay in right up until menopause as well. A lot of intrauterine systems are actually prescribed for perimenopause as well. So it can carry you through. For example, if you believe that you've had your family and you want contraception going forward as you get older, continuing into perimenopause, it can be a great choice. That means you don't have to take anything orally. The job is done once it's inserted and you just have to replace it at the appropriate period, depending on which brand you're on.
[00:16:23] Speaker C: One big thing there that I just kind of was thinking about was the difference between the copper and the hormonal intrauterine systems is really if you have a heavy menstrual cycle, then the copper 1 may worsen that, whereas the hormonal one is more likely to lighten or slap your periods.
One reason for choosing one over the other.
[00:16:43] Speaker D: Absolutely. And similarly, then if you know from maybe being on other types of contraception that you're particularly hormone sensitive, that might be the thing that puts you towards the copper coil then. Because if you know that you'd rather avoid hormones, you have that option. There's two great options there that are more long term that mean you can get it inserted and not have to worry about your contraception for a minimum of three to six years. And as I said, up as far as ten in the case of the copper coil. So there's something to suit everyone. And that's why it's really important to discuss the options with your prescriber pharmacist, because it is important to recognize that your needs might change as well. So what might suit you when you are in your younger years might not suit you as you get older. So have those discussions with your healthcare practitioners in your community and they can help you pick something that will work for you.
[00:17:31] Speaker C: Yeah, I know you spoke about the bar, the concept of injection.
[00:17:36] Speaker D: Yes.
This is just sort of semi long acting is kind of how I like to describe it, because it's not like the pill which needs to be taken every single day, but it is not as long acting as the ones we've just discussed, which at a minimum cover you for three years. So the injection is an artificial form of progesterone. Again, so it's a progesterogen injection and it's injected every three months into either the leg or the bum generally or the arm either. So again, similar to what we spoke about with the other forms of the progesterogen, the way in which this works is to stop the ovulation process. So to stop an egg being released from an ovary, and it also, like the other ones, reduces the lining of the womb so that its implantation is harder. And it also thickens the mucus of the cervix, making it harder for any sperm to reach an egg. The way in which it works that makes it long acting is that the progesterone is slowly absorbed from the muscle into the blood over the course of twelve weeks. So that's why the injection needs to be replaced every twelve weeks, then you need to go back to your GP to get it injected again or else the effect of it has disappeared and you no longer are covered again.
[00:18:46] Speaker C: Another really reliable one.
[00:18:48] Speaker D: Yeah. When it's used correctly, if you're able to get those injections at the correct intervals and everything, you're talking 99% effectiveness. And they do say that with typical use, so where there might be slightly less perfect use, it is more likely to be about a 94% cover in terms of your contraception. So the advantages of it, I suppose, compared to the others, it's not as long acting as the ones we previously discussed, but you don't need to take something every day. So for someone again who might be a little bit forgetful or might have a bit of an ad hoc schedule where they might be able to reliably take something or put something on every day, it can be a really useful one to consider. One of the other advantages about this particular product as well is that where some people may not be suitable for combined hormonal contraception, it can be considered. So, for example, people who are over 35, who are smokers are generally not advised to stay on the combined hormonal pill. And that's one of the groups that can get this medication, for example. And it can still offer them a good form of contraception while not increasing risk of clots, which is a huge concern to some people, I suppose, who've got risk factors in that direction.
[00:20:01] Speaker C: Okay, that's the main of the long acting. Well, as you said, medium to long.
Yeah.
So I suppose moving on then to what I'm going to say, well, they were more common, but now there's definitely more and more women choosing long acting reverse.
[00:20:20] Speaker D: Sure.
[00:20:21] Speaker C: But I know even like a decade ago, people were fairly stuck on just taking the pill what they thought their only option was. So on the short acting ones, the contraceptive patch is a handy one as well. Can you explain that?
[00:20:37] Speaker D: Sure, yeah, that's no problem. So the patch is essentially like a little plaster, so you just apply it to the skin. It lasts for one week. So the important thing to remember here is what day you put it on and making sure you remove the old one and replace the new one every single week so that you're fully covered at all times. You do that for three weeks consecutively, and then on the fourth week you take your break and that's when you'll have a withdrawal bleed. So anybody who's familiar with the pill will understand that pattern. It's 21 days of the medication being absorbed through the skin, providing contraception cover. And then you've got your seven day break to allow for the withdrawal bleed, through which time you're still covered from a contraception point of view. And then you reapply the patch again on the next week of your cycle. So it releases the artificial form of two different hormones. So your oestrogen and progesterone like substances essentially are released by the patch and it works in the same way as the other ones we discussed already, where its job is to stop ovulation. And then, similar to the others, it also thins the lining of the womb and also increases the cervical mucus. So it's providing kind of a physical barrier there as well, similar to the ones we've just discussed. The efficacy is really high when it's used correctly, like 100% correctly, it's about 99%. And again, they do say that more imperfect use, which is usually normal humans using things instead of being in a clinical trial, it has a success rate of about 91%. So I suppose that's an important thing is just you would want to make sure that you're the kind of person who can stick to the schedule that's required for this to make sure that you're getting the maximum effect from it.
[00:22:16] Speaker C: There might be, some say, extremely sporty people who sweat a lot or have a lot of friction on their bodies. There's so many reasons why this might be suitable.
[00:22:26] Speaker D: I was about to say that because a lot of people, depending on your lifestyle and even I had some people coming in both with contraceptive patches and HRT patches when we had that really good weather recently saying just they weren't able to stay on because they were sweating so much more than usual as well. So, like you said, people who might be very active, very sporty, or there might be people who don't like things being on their skin who might be very sensitive to plasters and any adhesives and things like that as well. So anybody with an allergy like that, like if you know that you react to putting a plaster on, chances are you'll not be suitable for this particular method. And it's also not suitable if you're a smoker and over 35 as well. It is one of the methods that contains oestrogen. So from a kind of clot perspective, they do recommend avoiding that if you're over 35 and a smoker, just because that's a particularly high risk group for clots. Other people over age 35 could continue to take this and other combined hormonal contraceptives past the age of 35. Another disadvantage, I suppose, of the contraceptive patch is that it isn't suitable for people who are very obese or people who are breastfeeding either. So those would be two categories of people who would just need to speak to a GP about more suitable options.
[00:23:40] Speaker C: Okay. And another option that I definitely know from my experience in the pharmacy isn't as popular as others. And I think that's just because people don't understand it. So the Vaginal ring, so you mentioned earlier the Nouveau ring brand.
[00:23:54] Speaker D: Yeah. The Vaginal ring is a small silicone ring that is inserted much like you would insert a tampon or something like that into the vagina and it slides into the vagina and it sits at the mouth of the cervix. And what it does there is it releases the same two hormones that we just spoke about in the patch, are released from the ring. So it works in the exact same way. But I guess there are some advantages in this method compared to the patch. So one of those things would be that this only needs to be inserted once every 21 days. So once you've inserted it, it covers you for the three weeks that you would say in the patch. For example, be applying a plaster every week. That would be an important difference with this one. So you just remove it on your day 21, and you get your withdrawal bleed at that stage, and you insert a new one then following your seven day break. So that is an advantage. And I suppose, as we were speaking about people who might not be suitable for the patch, if you've got allergies to adhesives, if you've got a particularly active lifestyle that might result in you sweating a lot or making the patch less likely to stay on you, this could be a really good alternative. The advantage of it really is that once it's in for those 21 days, you can forget about it. So you just set a reminder in the phone to take it out at the right time, get your break, and then insert it again and go through the same cycle. So it is a nice option. Similar to the patch, there are some groups of people that aren't eligible for it. Again, if you are breastfeeding or very obese, these would be particular issues with that particular one. And I suppose the effectiveness can be reduced by taking certain medications. But that goes for all of the combined contraceptives that we're speaking about. There are certain medicines that reduce the effect of those particular forms of contraception.
[00:25:35] Speaker C: As you described it there. Anyone who is familiar with using tampons, really, this is an option for them and not be scared of it. You're absolutely right. Okay, so then the more traditional, I suppose the most traditional over the last maybe two decades, the combined contraceptive pill, how does that work?
[00:25:56] Speaker D: They all work in a really similar way, because what this is, is a medicine that you take every single day at approximately the same time. And the idea of it is that, again, like the other ones we discussed, it releases two different hormones that are similar to ones that the female body already makes. So you essentially have to take it every single day for 21 days in a row and then take your seven day break after that. So it releases both the medications from the body, from the stomach, they get absorbed into the blood system, and they go and do their job of like the other ones, preventing ovulation and thickening the mucus of the cervix as well as then. Thinning out the lining of the womb so that you are less likely to become pregnant. And with perfect use. You've got a 99% success rate. With this medication, if it isn't used perfectly, it's about 91%. And I guess one of the things that people sometimes don't think about in the context of this one would be if you're the kind of person who might have a very sensitive stomach, suffer from diarrhea, vomiting, things like that, because this needs to stay in the stomach and be absorbed for it to be working. That would be an important thing to make sure your doctor knows about because the medication needs to be absorbed from the pill in order for it to be effective. So if you get sick or if you were to have bad diarrhea and your gastric emptying kind of happened quicker, then it might reduce its effectiveness. So that's just something to bear in mind. For people who've got very sensitive stomachs.
[00:27:24] Speaker C: There's a lot of people who mightn't be very good at remembering to take it at the same time every day. There is a certain thing, look, we're two pharmacists, this is easier for us to figure out, but it's important for people to ask their pharmacist at the time of collecting it. What happens if I'm 3 hours late? What happens if I'm 6 hours late?
[00:27:42] Speaker D: What happens if I miss a whole? To be fair, as they've gone on and studied these further and further, when the combined hormonal contraceptive pill came out, it was believed that you had to take it at the exact same time every day. And now within you studies, what they've really discovered is that there's about a twelve hour forgiveness window in at least your first week and third week of the cycle that you're on. So it isn't quite as dramatic as the one that we're going to be coming to, which is the progesterone only pill that is a lot more time specific. The other thing that's important to note about the contraceptive pill is that no two of them are the same. They all have different amounts of progesterone, different amounts of oestrogen, and prescribers are generally encouraged to use the one that has the least amount of the hormones in it as possible. And that's really with regard to reducing side effects for patients. So I suppose if one of them doesn't feel good for you, it doesn't mean that all of them won't feel good. You've got lots of other options and it's important to discuss those with your prescriber and make sure that you might change if something changes for you. It's not a one size fits all type of thing, whereas with all of the other devices we discussed, there might be a couple of different brands, but they all really do very similar things. Whereas the combined contraceptive pill is very much there is a big variety in how much hormone is in each of them and therefore how suitable they might be for a particular person. Along with that, each brand has a different scheme to follow if you miss a pill or if you are sick while you're on the pill or anything like that. So it's very important that you read the information that comes with it or discuss it with your pharmacist when you're picking it up so that you fully understand what to do in those circumstances. Because the reality is they will happen for some reason or another that you are likely to, at some stage, forget to take it at the right time.
[00:29:29] Speaker C: So it's always good to know what to do. People should be aware that the emergency hormonal contraception may be recommended in a particular situation like that, depending on how many days you've missed or when you've had sex. So that is available without prescription in community pharmacy and under this scheme. So it's good for people to know that and not to put your head in the sand.
[00:29:56] Speaker D: It's so much better for you to come in and ask, say, oh, I forgot my pill yesterday, and I've just realized it now, and we can sit down and have a discussion with you and see at what point are you in your cycle at that time in the 21 days of your pill? Because that dictates what the reaction is essentially to what you would do to that miss Pill. And obviously in the pharmacy we can offer you the option of the morning after pill emergency contraception, and it is covered by the free contraception scheme as well for anybody under the age of 30.
[00:30:26] Speaker C: A lot of younger people mightn't be aware that in community pharmacies we all have private consultation rooms now, so you don't even have to come up to the counterinsistant and say, I need the morning, April or emergency contraception. You can actually just say, I'd like to speak to the pharmacist in the consultation room. So even if you're in a community where everyone knows everyone, we can offer a private space and there's no judgment. We'd much rather that everyone had access to the proper health care that they need and we're there to support them with that in a confidential manner.
Okay. The progesterone only pill.
[00:31:01] Speaker D: So the Progesterone Only pill some people might know this as the mini pill, which is what it was referred to back in the day when it first was launched. I suppose it was really brought out to deal with the fact that Oestrogen, that's in the combined contraceptive pill was seen to have some negative effects in some people. So it was really just a way of providing a form of contraception that didn't involve including Oestrogen. Unlike the previous pill that we were discussing, this one contains only one hormone, so it's only releasing a progesterogen. So it's much more in line with the bar that we discussed earlier or the injection or the coils as well that contain the hormone because it's only releasing that one particular hormone, a progesterone based hormone. One of the big differences between progesterone only pill versus the combined contraceptive pill is that there isn't a seven day break in it. So you take this one continuously. And one of the big groups that would find this an advantage are people who coming off it for the week might disturb their pattern and they might forget to start back on it on time. So the fact that it is every day is very helpful to those kind of people. And similarly, it is also very helpful for people with very heavy bleeding because progesterone can reduce very heavy bleeding, which is one of the groups of women that we would see go on. It could be people who suffer from very bad bleeds. Another advantage of this particular one, the progesterone only pill, is that it can be suitable for people who are breastfeeding. So because it doesn't contain oestrogen, it is allowed for people who are breastfeeding because it's progesterone only. So that is a great thing to know.
[00:32:29] Speaker C: Yeah, it is, because that's a large group of people and hopefully growing. Just want to ask you, Alva, you were talking there about how the combined pill obviously you take a seven day break and I don't know about you, but I've been finding in practice in my own community pharmacy that more and more I'm seeing a reduction in the break. So a lot of prescribers aren't saying you have to take seven day breaks. They're maybe saying just take a three day break.
[00:32:55] Speaker D: What is no break at all? So we're seeing a lot more of that as well, where essentially the inu studies that they have done have shown that there isn't really an advantage to taking that seven day break. That was built into the trials when these medications were first released. That is being supported by guidelines that are coming out throughout the world that if it is more effective for a person to take something continuously and it doesn't cause any harm to not take the break, then why bother taking it, or at least, as you say, to reduce the break. I think the reduced breaks are generally being used in circumstances where somebody is aware that their natural cycle is short. Because if your natural cycle is less than 28 days and you're then taking a seven day break, there is a chance that you could start ovulating at the back end of that seven day break, which could then increase your risk of pregnancy despite the use of the pill. That's something I'm always very passionate about. Talking about to people who are starting on the pill as well is to understand your own cycle before you start on it. If you can from the start of your menstruating years, we really should be knowledgeable of how regular is our cycle, how long is our cycle? Are you a 29 day person? Are you a 23 day person, because there's lots of different people and there's some people who can't find a pattern at all. And I think that those are really important things to know about your body, because everyone is different. And to go in with that information to your doctor is really important when you're making decisions about contraception.
[00:34:19] Speaker C: A problem we've come across, though, is that the HSE will only pay for 21 days a month.
[00:34:25] Speaker D: Yes.
I've been on to the HSE about this myself and inquired about it. So the answer I received back was that they will pay for 13 pill packs per year, per person. And obviously that means that there are some people who want to take it continuously, or they might only want to take it continuously in fits and starts. For example, you might have some leaving search students who want to avoid having their period during their leaving search or college exams, or a very important event in your life, whatever that might be. We all know people who they're getting married or they're going on their hen party or they're going on holidays, and they just don't want to have their period for that reason.
[00:35:05] Speaker C: Running a marathon, running them, exactly.
[00:35:08] Speaker D: There's so many reasons why you might decide to extend your cycle, essentially on the pill and not have your withdrawal bleed. So it is quite an unrealistic thing that the HSE are only choosing to pay for 13 packs per year. It is quite unreasonable, and I think it's a bit demoralizing, I suppose, as females, to think that Big Brother is watching exactly how many you're getting.
I don't feel that it really helps our health care system overall to be that restrictive about it.
[00:35:40] Speaker C: No. And it's so annoying because they've done so great to bring out free contraception, but there's still just an element of backwardness about it. It's like, lads, seriously.
[00:35:51] Speaker D: I mean, for 90% of women, that could be fine. It could be fine that they can only get 13 packs per year. But there are a growing group of people who that isn't suitable for and who are getting it prescribed in a method that has either no break or reduced breaks. It's not as though these people are necessarily making up their own mind to do it that way. They've been told to do it by a prescriber, and yet it's not supported by the HSE. So, to my mind, if a prescriber is advising this and it can't actually be actioned upon because of a payment issue, that seems a bit unreasonable. So I'd love if that got resolved. Yeah.
[00:36:27] Speaker C: So, everyone, can you please write to your local politicians?
I know you mightn't want to.
I can't get the extra seven days of for free. But, look, we'll do what we can.
[00:36:39] Speaker D: Everyone should just raising awareness about it, because I just think it's something that hasn't been spoken about much and it's often a shock to patients as well. When you tell them, oh, sorry, you're going to have to pay for a pack now because you've already received six packs in the last six months, or whatever the case might be.
[00:36:55] Speaker C: Before I move on to emergency hormonal contraception, I'm just going to briefly mention other methods that aren't included in the scheme, because I know today we're kind of focusing mostly on the contraception scheme, but there's obviously condoms, external male condoms. You can also get internal female condoms and you can also use a diaphragm or a cap, so they are also good for people to look into. Who do you want to use barrier methods instead of going down? The contraceptive or the copper? The copper ballerine device. So the emergency contraceptive pill, I know there's two different types, so can you just explain to people what maybe the benefits and the differences are?
[00:37:40] Speaker D: Sure, I'll do my best.
So the older of the two pills that are available as the morning after pill is one that can be used for 72 hours, so three days following unprotected sex. So that's probably the one that most people are aware of already. It's called Levonorgestral, is the name of the drug that's in that and it does work more effectively the sooner you take it. So while that 72 hours window is there, it is still very important to take it as soon as you get an opportunity to visit a healthcare practitioner, whether that be your pharmacist or GP. The five day pill is called Ulipristal and that can be used, as it says, for five days. So you've got a slightly longer window with that one, which can be an advantage. It is very important to remember again that it is more effective the earlier you take it. So as soon as you believe you need the morning after pill, you should be making time to get to a pharmacy or GP in order to discuss your options. Both of these options are covered by the free contraception scheme, so neither of them will cost you anything, neither the consultation nor the drug itself will cost you anything. If you're between the ages of 17 and 30, there's one particular disadvantage, which is that if you're on a progesterone containing medication, one of those medicines isn't suitable. So that's maybe something to bear in mind when you're making your contraceptive choices is by being on progesterone, you are limiting your morning after pill options to just one of the two. So it's just useful to be aware of that and not to be surprised by it. Then, if it does come up in a conversation with your GP or your pharmacist, but both of them are very easy to take, you just simply take one pill as soon as you can. The emergency contraception pills are slightly different to all of the other contraceptive pills we've discussed, because the ones we discussed earlier, the contraceptive pills, their job is to prevent Ovulation, whereas these are to prevent implantation essentially of the fertilized egg into the uterus. So unfortunately, what this means is that if you have already ovulated, or if you're likely to have already ovulated, they may not be suitable for you because their effectiveness is reduced if you have already ovulated. So that is just something to be aware of. And if that does occur with you, there are other options available in terms of you'd have the copper coil as an option in terms of emergency contraception. And obviously there's other options. If you do discover that you are pregnant, you can discuss your options with your GP as well with regard to medical methods of abortion as well. Another thing that you can do to inform yourself about the options available in Ireland is to go to sexualwhellbeing Ie. So this is the HSE's website with regard to contraception in Ireland and it explains in good detail all of the different methods available. It goes through the contraception scheme as well, so that you can understand exactly what you're entitled to. Just an important thing, if you are a person who's never been taking contraception before, or it's your first time to get it for free from your local pharmacy, bring along your PPS number and your date of birth, because that's what's required by your pharmacist in order to put you through on the system. So if you rock up with just your prescription and you don't know your PPS number, they won't be able to facilitate it on the free scheme immediately. So come with your PPS number, come with your prescription, and you can get sorted. And another thing that I think people don't necessarily know is that you can actually get all six months on a prescription at once as well. So you don't necessarily need to come and get one each month like you may have done in the past. You can get maybe three months, six month, whatever duration you would like to get, and at least then you'll have it all in your hands for that period of time.
[00:41:12] Speaker C: Yeah, and that's really handy, other than maybe if someone's starting on a new one, maybe just to get one or two months to see how they get on.
[00:41:20] Speaker D: Very important to make sure that it agrees with you before you go taking the full six months, because you don't necessarily know that it's going to. So I'd always advise people who come in with a new pill or who are starting out on it just to take the first month, see how they get on, and provided they settle into it nice and easy, then they can come back and get the remaining five months after that.
[00:41:37] Speaker C: Alva, thank you so, so much for joining us today. And just to say to people that there are total Health and Haven stores all over the country with pharmacists just as friendly as Alva.
Don't be afraid and definitely don't be shy about talking contraception, because I think we're all aware that this is an important topic and women absolutely should have control and a voice in their choice of contraception. Thank you so much, Alva. You've been a wealth of knowledge, and.
[00:42:06] Speaker D: It'S been a pleasure. Thanks.
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