Oral Presentation

The EC wheel: A tool to promote choice and evidence-based counselling on emergency contraception

Cristina Puig Borràs (ES)

[Puig Borràs] European Consortium for Emergency Contraception

Context Since mid-2015, in all European Union (EU) countries, except Hungary, women can access 2 different post-coital hormonal contraceptives directly from the pharmacy. In 2015 the World Health Organisation (WHO) published the 5th edition of the Medical Eligibility Criteria for Contraceptive Use (MEC), which includes recommendations on levonorgestrel (LNG) and ulipristal acetate (UPA) EC pills, the Yuzpe method and the copper IUD (Cu-IUD). The MEC confirms the safety of all methods, but does not guide in choosing the most appropriate method. It is unclear whether women and health providers (including pharmacists) have all the information necessary to make the best post-coital contraceptive choice for an individual woman when EC is needed. Objective To developed an EC counselling tool to enhance evidence-based counselling and enable choice in post coital contraception. Method With guidance from WHO, and financial support from the European Society of Contraception and Reproductive Health (ESCRH), we reviewed the most relevant literature and developed the content. An internal review committee, with experts from Karolinska Institutet (Sweden), Clinical Effectiveness Unit of the UK Faculty of Sexual & Reproductive Health (UK); WHO; the American Society for EC / Office of Population Research at Princeton University; (USA) the International Consortium for EC; and the East European Institute for Reproductive Health reviewed the first pilot. The wheel was endorsed by the ESCRH. In February 2017, WHO and the United Nations Commission on Live-Saving Commodities for Women and Children, provided support to develop an electronic version of the wheel, available on line at http://www.ec-ec.org/ecmethod/. Results The wheel offers recommendations for the use of LNG and UPA EC pills, and the Cu-IUD, setting 3 categories: green (method can be used); orange (method can generally be used but there may be a more effective method or additional information needs to be considered); and red (method is not recommended or clinical assessment is required). The wheel offers recommendations for 15 conditions and includes advice on quick-starting hormonal contraception after LNG and UPA. The EC wheel summarises the recommendations made by authoritative sources, in an easy to use tool that allows all audiences to assess what EC method is best for a given situation.