• Written by Mark Wilson, Associate professor, University of Wollongong
Contraception forms an integral element of health care for women. From shutterstock.com

Buying the contraceptive pill from the pharmacy without a prescription, as is being considered by Australia’s drug regulator, might be convenient for women or even save the health system money. But it risks women’s health for a number of reasons.

After determining the most appropriate form of contraception with each woman, it’s important for a doctor to monitor potential side effects. In bypassing their GPs to get the pill directly from the pharmacy, women could lose out on reproductive health care and preventive health care more broadly.

Read more: How to choose the right contraceptive pill for you

The Therapeutic Goods Administration (TGA) classifies medicines into schedules that determine whether they’re available “over the counter”, or can only be dispensed with a prescription. Currently, the contraceptive pill is Schedule 4. Women need a new prescription for the pill each year.

The TGA recently held consultations about whether the contraceptive pill, among other medicines, should be made available over the counter (Schedule 3).

Pharmacists have suggested reclassifying the contraceptive pill to Schedule 3 would reduce the need for trips to the doctor, saving time and lowering costs.

But to continue to provide a high standard of reproductive health care, Australian doctors should still be required to prescribe the pill.

Contraceptive choice

There are many different contraceptive pills, with varying dosage of synthetic hormones. These hormones “switch off” ovulation, preventing pregnancy (although not 100% of the time).

A GP consultation to discuss the pill requires considerable time taking the patient’s history, measuring her blood pressure and weight, and discussing contraceptive options.

There may be a number of reasons a particular woman should not take the pill. A doctor will work with the patient to determine the choice of contraception that’s going to best meet her needs. The pill is only one of many modern contraceptive options.

If a woman chooses the pill, regular monitoring by her GP is important.

While the pill is usually well tolerated and safe, common side effects can include bloating, fluid retention, breast tenderness and nausea. Serious complications from the pill are rare, but can include blood clots or, more rarely, heart attack and stroke.

Many women use the pill as their preferred form of contraception. From shutterstock.com

Although the risk of heart attack or stroke is small, it is heightened when the pill is prescribed without regular blood pressure monitoring.

One review of the results of 24 studies found the risk of high blood pressure increased by 13% for every five years a woman was on the pill.

An annual GP consultation offers an opportunity to discuss and monitor any pill side effects, as well as each woman’s individual contraceptive needs.

Continuity of care

When women visit the doctor to get a new prescription, it also offers an important opportunity to discuss reproductive health and general well-being.

The Royal Australian College of General Practitioners suggests a number of preventive activities should be provided for women of reproductive age, including blood pressure checks and discussions about weight and physical activity.

Read more: Making more drugs available 'over the counter' would be a win for the public and the health care system

GPs have also often developed a trusted therapeutic relationship with their patients over several years. This means they are well positioned to manage sensitive and interrelated issues, including relationships, mental health, sexual health, contraception, smoking, alcohol and drug use.

Annual consultations also offer an opportunity to provide education around women’s health issues such as cervical and breast cancer screening.

Health benefit versus risks in rescheduling the pill

The authors of a study published last month hypothesised that reclassifying the contraceptive pill from Schedule 4 to Schedule 3 might save the health system A$96 million a year and perhaps 22 lives over 35 years.

But they also acknowledged possible adverse health impacts from rescheduling the pill. These include 122 more cases of sexually transmitted infection, 97 more cases of depression, five more strokes and four more heart attacks each year.

Preventive health advice from the GP can have significant individual health benefits in the long term, which can also save the health system money.

For example, roughly 67% of Australians aged 18 and over are overweight or obese, including many women who take the pill.

Cost-effectiveness research on obesity has found interventions aimed at tackling obesity by improving diet and increasing physical activity through health education and counselling in primary care (that is, GP visits) are effective in improving health and longevity, and are more cost-effective than treating chronic diseases once they emerge.

Read more: Over-the-counter contraceptive pill could save the health system $96 million a year

Investment in women’s health has practical benefits across a range of areas, including nutrition, management of communicable and noncommunicable diseases, screening and management of cervical and breast cancer, gender-based violence prevention and response, and pre-pregnancy risk detection and management.

It is naive and potentially dangerous to attempt to separate the potential health and cost benefits derived from pharmacy access to the contraceptive pill from the health and cost benefit of comprehensive reproductive and broader health care provided for women in the primary care setting.

Doctors and pharmacists have a role

Australian pharmacists are not trained to conduct consultations regarding contraceptive options and reproductive health. These are more appropriately conducted in mainstream general practice, or in specialised women’s health clinics.

But pharmacists do know a great deal about the range of contraceptive medications that are prescribed by doctors, and have an important role in educating women about correct medication use and potential side effects.

Education by both GPs and pharmacists is vital for Australian women to understand the diverse range of contraceptive options available to them, and how their informed choice of contraceptive method can best fit into a healthy lifestyle during their reproductive years.

Read more: Freer sex and family planning: a short history of the contraceptive pill

Mark Wilson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Authors: Mark Wilson, Associate professor, University of Wollongong

Read more http://theconversation.com/leave-pill-prescribing-to-gps-not-pharmacists-for-the-sake-of-womens-health-118120

Should all aged-care residents with COVID-19 be moved to hospital? Probably, but there are drawbacks too

COVID-19 is continuing to devastate Victorian aged-care homes, with 1,435 active cases now linked to the sector, and at least 130 residents having died.The question of whether to automatically move re...

Jed Montayre, Senior Lecturer (Nursing), Western Sydney University - avatar Jed Montayre, Senior Lecturer (Nursing), Western Sydney University

how New Zealand got rid of a virus that keeps spreading across the world

On SundaYour heading here, New Zealand will mark 100 days without community transmission of COVID-19.From the first known case imported into New Zealand on February 26 to the last case of community tr...

Michael Baker, Professor of Public Health, University of Otago - avatar Michael Baker, Professor of Public Health, University of Otago


Delivering project outcomes on time and on budget comes down to two things: efficiency and effectiveness of resources utilised. This could not be more true for the mining & resources sector ...

News Company - avatar News Company

We need to Close the Gap on health. But even official dietary advice disadvantages Indigenous people

ShutterstockRecently announced Closing the Gap targets aim to improve the health and well-being of Indigenous people.But if that’s to happen, we need to provide health advice suitable for First ...

Odette Best, Professor, Nursing, University of Southern Queensland - avatar Odette Best, Professor, Nursing, University of Southern Queensland

How should I clean my cloth mask?

ShutterstockFace coverings, such as cloth masks, are mandatory for all Victorians and are being recommended for public use in some other parts of the country.Wearing a face covering helps prevent the ...

Brett Mitchell, Professor of Nursing, University of Newcastle - avatar Brett Mitchell, Professor of Nursing, University of Newcastle

why are Melbourne's COVID-19 numbers so stubbornly high?

Melburnians have now been wearing mandatory face coverings in public for two weeks. Yet Premier Daniel Andrews yesterday announced another grim milestone in Victoria’s second wave of COVID-19 in...

Erin Smith, Associate Professor in Disaster and Emergency Response, School of Medical and Health Sciences, Edith Cowan University - avatar Erin Smith, Associate Professor in Disaster and Emergency Response, School of Medical and Health Sciences, Edith Cowan University

Tested positive for COVID-19? Here's what happens next – and why day 5 is crucial

With cases of COVID-19 on the rise, many Australians are asking: what happens if I test positive? With no known cure and no vaccine, what are my treatment options?Finding trusted answers amid the wide...

Julian Elliott, Executive Director, National COVID-19 Clinical Evidence Taskforce, and Associate Professor, School of Public Health and Preventive Medicine, Monash University - avatar Julian Elliott, Executive Director, National COVID-19 Clinical Evidence Taskforce, and Associate Professor, School of Public Health and Preventive Medicine, Monash University

Sweden eschewed lockdowns. It's too early to be certain it was wrong

Per Bengtsson/ShutterstockSweden has become something of a cautionary tale for what happens when you attempt to tackle coronavirus without lockdowns.In The Conversation last week The Grattan Institute...

Andreas Ortmann, Professor, UNSW - avatar Andreas Ortmann, Professor, UNSW

Remote interpreting services are essential for people with limited English — during COVID-19 and beyond

ShutterstockAccording to 2016 Census data, 3.5% of Australians have limited English proficiency.When they’re receiving health care, it’s essential these Australians have access to interpre...

Judy Mullan, Associate Professor, School of Medicine, University of Wollongong - avatar Judy Mullan, Associate Professor, School of Medicine, University of Wollongong

News Company Media Core

Content & Technology Connecting Global Audiences

More Information - Less Opinion