PP+401+-+6

=Prescription: Levonorgestrel=

//Jane is a 27 year old woman new to your pharmacy (no dispensing record). She presents with a prescription as follows:

Rx Levonorgestrel 30 mcg Mitte 4x28 Sig. 1 od mdu Rpt x 1//

Problem
Patient has brought in a prescription for levonorgestrel and needs counselling Patient is currently breastfeeding and wants to know why she has been switched to levonorgestrel for contraception

Questions to Ask
- What has the doctor told you about the medication? //he said it was like the pill I was taking before// - Which one was that? //it was the combined pill// - Why did he switch you to the other contraceptive pill? //I am currently breastfeeding and the doctor said it was inappropriate// - Are you on any other medications? //no// - Do you have any other medical conditions? //no// - Do you have any allergies? //no//

What to do
refer to Levonorgestrel and [|SHine SA] //-// Explain that the combined pill contains oestrogen and progesterone, where the oestrogen affects the ability of the body to produce breast milk. The doctor has switched you to a pill without the oestrogen. - Unfortunately, because this only contains one type of hormone, the dosing regimen is stricter to ensure that it provides adequate contraception. - This is similar to the combined pill, where you need to take it every day. However, it takes 48 hours before it can provide adequate contraception (on the 3rd day of taking the pill), unless you begin taking it on the day of your period (or if you are not having any periods due to breastfeeding) where it will be adequate straight away. - Choose a time of the day where you are most likely to remember to take the pill. - There is a 3 hour allowance, therefore if you take your pill at 9am and you forget by 12pm, that pill is considered 'missed' and you will not be adequately covered and will require another form of contraception (i.e. condoms). You will then need to wait 48hrs before the pills will provide coverage again. (i.e. take the pill at 1pm, then 9am the next morning, and 9am the morning after - then you will be covered by 1pm, but to be safe, wait till you take the pill at 9am the next morning) - Vomiting, very severe diarrhoea, and other medications may stop the pill from working. Effective contraception will be assured 48 hours after restarting the pill; use another contraceptive method in the meantime. - Side effects include nausea, vomiting, headache and if you having your period, you may experience prolonged bleeding, spotting and menstrual irregularity. These may occur initially as your body is not used to the change in hormones, but should subside within 3 months. If you find that these side effects still trouble you, speak to your doctor who can organise an alternative for you.

Questions asked by patient
- **What is the difference between the two types of contraceptive pill?** there is the combined pill, which contains oestrogen and progesterone and the mini-pill which contains only progesterone. The combined pill is more effective due to the combined action, meaning that a day can be missed without loss of contraceptive action but it also means more side effects/contraindications. - **I am considering giving up breastfeeding.** Explain that there are many benefits to breastfeeding your child which include prevention of many health conditions such as infections, asthma, obesity, diabetes and SIDS. It is recommended that exclusive breastfeeding should occur for the first 6 months, a gradual introduction of solids for the next 6 months, with ongoing breastfeeding for 2 years or beyond. However, when to wean is a decision that the mother and the baby decide for themselves

Resources
[|Better Health Channel - Breastfeeding] [|SHine SA - Progestogen only pill]