EHC

What is EHC?

EHC stands for emergency hormonal contraception and is sometimes referred to as “the morning-after pill”. EHC can prevent pregnancy after unprotected sex, or if contraception fails, e.g. a condom split or someone has missed a pill.

There are 3 methods of emergency contraception available:

• Levonelle – A pill that must be taken within 72 hours (3 days) of unprotected sex; the sooner it is taken, the more effective it will be.
• ellaOne – A pill that must be taken within 120 hours (5 days) of unprotected sex, ellaOne Is thought to remain up to 95% effective at 5 days.

Neither Levonelle nor ellaOne continue to protect against pregnancy; if a person has unprotected sex at any time after taking the emergency pill, they could become pregnant.

• Intrauterine Device (IUD) IUD – An IUD can be fitted up to 5 days after unprotected sex or up to 5 days after the earliest time a person could have ovulated; a consultation would be required to determine this. The IUD is the most effective form of emergency contraception; less than 1% of people who use the IUD get pregnant. The IUD also provides a long-lasting form of contraception once fitted.

EHC is not a form of termination as it prevents pregnancy from occurring rather than ending an existing pregnancy.

Who can access EHC?

EHC can be accessed by anyone 13 and over, including those who cannot take hormonal contraception. Trans men and non-binary people can use both oral EHC (pills) and IUDs (coil) without interfering with hormone regimens; testosterone is not thought to affect the efficacy of emergency hormonal contraception.

There are some conditions and medications which can make EHC unsuitable for a person, including:

• severe asthma
• the herbal medicine St John’s Wort
• some medicines used to treat epilepsy, HIV or tuberculosis (TB)
• medicine to make your stomach less acidic
• some less commonly used antibiotics (the professional will discuss any medication the person is taking with them before providing EHC)

ellaOne can’t be used if a person is already taking one of these medicines, as it may not work. Levonelle may still be used, but the dose must be increased.

The professional providing the EHC will ask questions beforehand to ensure that the type they are giving is suitable for each person and that there are no safeguarding or safety concerns.

What will they be asked?

Before a person can be given EHC, the professional will work through a series of questions with them to make sure it is safe for them to take EHC; these include:

• When did they have sex?
• Did they use any contraception?
• When was their last period?
• If their period is late, is there a chance they could already be pregnant?
• Have they taken emergency contraception before? If so, when?
• Any family history of specific health problems?
• Are they taking any other medication (tablets, etc)?
• Their name & postcode (this is not so that they can contact them)
• How old are they?

They may also be asked some questions about the person they had sex with and their relationship with that person.

Most professionals will request to see the person accessing EHC alone; this means that a friend, partner or another professional can support them to the venue but cannot be present during the consultation. This is to ensure that if there are any safeguarding or safety concerns, the person can discuss them in a safe, private space. It also allows the person to answer questions honestly and freely without thinking about what they would or wouldn’t want the person with them to know.

If supporting a client or service user to access EHC, it is essential to make them aware that you will not be in the room with them; this helps them know what to expect and can help ease the situation if they are nervous.

Provision of EHC is a confidential service, meaning that the person providing the EHC will not tell other professionals, parents or carers that they have provided the person with EHC. However, if the professional has reason to believe that the person accessing the EHC or others are at risk of harm or pose a risk to others, they will need to act on the information; this may mean sharing it with others. Wherever possible, the professional will discuss this with the person before sharing the information and explain the reason for their concern.

How much will it cost?

EHC can be obtained free from various venues, including GPs, some pharmacies and sexual health clinics; however, some venues charge for EHC, which can be over £20.

When signposting a person to access EHC, it is always advisable for them or you to call ahead and ensure that someone is available to give the EHC and that it can be provided free of charge.

If a person is attending a sexual health clinic to access EHC, it is crucial to remember that clinics operate a triage system, so advising the clinic staff that they require EHC is essential.

Where is EHC available?

A list of local EHC venues can be accessed here.

Emergency contraception services are commissioned by the Public Health Department of the local council; to become an EHC provider, venues can contact their local council Public Health representative.

Are there any side effects?

There can be side effects from all forms of EHC; there are no severe or long-term side effects from taking the emergency contraceptive pill.

But it can cause:

• headaches
• tummy pain
• changes to the person’s next period – it can be earlier, later or more painful than usual
• Feeling or being sick –if a person is sick within 2 hours of taking Levonelle or 3 hours of taking ellaOne, they will need to take another dose or have an IUD fitted

Complications after having an IUD fitted are rare, but can include:

• Pain
• Infection
• Heavier or longer periods
• The IUD coming out of place
• Damage to the womb

5 top tips for signposting a person to access EHC

1. Call the venue before the person attending
2. Ensure that the person knows the types of questions they will be asked so that they can work out things like their last period or how many hours it has been since they had sex
3. Inform the person that they will not be able to take a friend or partner into the consultation and why this is
4. If the person is attending a sexual health clinic, ensure that they are aware to inform clinic staff that they require EHC
5. Ensure that the person knows the names of any medication they are taking or takes the package with them to show the professional