As people all over the world observe lockdown and social distancing there are aspects of our health which remain priorities. Women who have been using contraception need to continue and anyone using hormonal products for gynaecological conditions, menopause or transgender need ongoing supplies of their medication.

We have been given advice on managing hormones and contraception from the Faculty of Sexual & Reproductive Health UK and UN Planned Parenthood. Here are the key points:

EMERGENCY CONTRACEPTION:
Women can access emergency contraception from any pharmacy. However it is important to be aware of two things:


1. Copper Coil is the most effective emergency contraceptive.
2. Ellaone(Ulipristal) can interfer with the efficacy of contraceptive pills for 2 weeks after using it. We would usually recommend that women use Levonorgestrel emergency pill if they have been taking a hormonal contraceptive pill in the days prior and plan to continue.
Neither of these pills are as effective as your regular pill and if anyone is delayed looking for Emergency contraception and it is 5 days+ but less than Day 19 of their cycle, then please contact us to discuss whether it might be sensible to arrange a Copper Coil insertion.


If any woman is on medication for other health problems and unsure of their options then please contact us and we will help you decide.

COMBINED ORAL CONTRACEPTIVE PILL:
Pharmacists can dispense 9 months on a 6 month prescription, but if you are due a repeat prescription, please contact us and we can email it to your pharmacy. Continue your pill as normal.

PROGESTERONE ONLY PILL (‘MINI PILL’)  : 
Pharmacists can dispense 9 months on a 6 month script but if your script is out of date then call us and we can arrange email of prescription to pharmacy.

IMPLANON  SUBDERMAL (THE BAR) : Limited evidence suggests that the risk of pregnancy in the 4th year of use of an ENG-IMP is likely to be very low. Replacement can be deferred for a year after expiry to avoid unnecessary face-to-face contact. Contraceptive efficacy cannot be guaranteed but is likely to be adequate. If someone is concerned we can prescribe a Progesterone only pill to continue until it is possible to make a face to face appointment. Please phone the surgery if you have any queries regarding this.

MIRENA (LEVONORGESTREL INTRAUTERINE DEVICE): 
Limited evidence suggests that the risk of pregnancy in the 6th year of use of the 52mg LNG-IUS is likely to be very low. 
Replacement can be deferred for a year after expiry to avoid unnecessary face-to-face contact at this time.  Contraceptive effectiveness cannot be guaranteed but is likely to be adequate; we can provide a  Progesterone only pill to use in addition without face to face assessment if preferable.

KYLEENA/JAYDESS ( LEVONORGESTREL INTRAUTERINE  DEVICE):
If your device has reached it’s expiry date we can prescribe a hormone pill until it is possible to have a face to face visit.

COPPER IUD :
If you have a 5 year device it is advisable to use condoms or add a contraceptive pill when it is due replacement. We can arrange a prescription and replace the device when a face to face visit is possible. If you have a device with a 10 year licence OR your IUD was inserted after the age of 40 then no extra contraceptive cover is required since studies have shown the TSafeCu380A to have efficacy for 12 years and women have a natural decline in fertility over 40 and therefore any copper device inserted after 40 is adequate to provide contraceptive cover until menopause

DEPO PROVERA:
If it is approaching 14 weeks since you had your last Depo Provera injection then contact us and we will provide a prescription for desogestrel Progesterone Only Pill for you to use until we are able to provide a face to face appointment

NEW CONTRACEPTIVE STARTERS:
If you need to start contraception now we can provide a prescription by email to your pharmacy for a Progesterone Only Pill. This pill can be exchanged if preferred when face to face visits are possible. Progesterone only pills are very safe and do not affect blood pressure, do not cause blood clots and can be used by women with a high BMI.

MENOPAUSE & HRT
Supplies of some types of HRT have been limited in the past 6 months and further affected by Covid-19. If you have been using a patch and your pharmacist is unable to source it we can prescribe an alternative combination of hormones until the pharmacies receive new deliveries of HRT. Some women have been prescribed patches or Gel type oestrogens as they are unsuited to tablet forms of HRT which can increase the risk of blood clots. It is very important to ensure that you receive an alternative patch or Gel if you have been advised to avoid tablets. It is also important to be aware that women who have used oestrogen in conjuction with a Mirena Intrauterine device must use an alternative progesterone if it is now more than 5 years since their Mirena was inserted. Any woman who has a womb must use a combination of oestrogen PLUS progesterone to protect the lining of their womb .

TRANSGENDER WOMEN:
For any transgender women who have been using depot injection hormone blockers and HRT we can liaise with them to ensure that they have ongoing hormonal support.Please telephone the surgery and a doctor will talk to you.

UNPLANNED PREGNANCY:
If a woman has discovered an unplanned pregnancy during Covid 19 please check out My Options  Ireland https://www2.hse.ie/unplanned-pregnancy or the My Options freephone line on 1800 828 010. If they reach a decision to end the pregnancy we can provide the service via Telemedicine. Please call us and we will help you. 01 2875932

SEXUAL ASSAULT:
During Covid 19 Sexual Assault & Treatment Units are working normally and Dublin Rape Crisis is available by telephone Freephone: 1800 77 88 88 (24-Hour helpline) . Women can attend SATU whether they report the incident to Gardai or not.If you are struggling to decide what to do contact SATU ( https://www2.hse.ie/services/sexual-assault-treatment-units/rape-sexual-assault-where-to-get-help.html )who can provide emergency contraception, antibiotic and/or HIV PEP and can collect forensic samples for storage while you decide whether to proceed with a report to Gardai (Emergencies 112 or 999 or contact your local Garda station https://www.garda.ie/en/Contact-Us/Station-Directory/. 
I