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Practice bulletins > #152 Emergency Contraception > Flashcards

#152 Emergency Contraception Flashcards

1
Q

What type of emergency contraception is available over the counter?

A

Progestin-only pill, which consists of 1.5mg of levonorgestrel

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2
Q

For how long after unprotected sex is levonorgestrel use for emergency contraception recommended?

A

Up to 72 hours, but best as soon as possible

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3
Q

What is the mechanism of action of ulipristal acetate?

A

Selective progesterone receptor modulator, or antiprogestin

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4
Q

What is the dose of ulipristal acetate?

A

30mg

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5
Q

For how long after unprotected sex is ulipristal acetate use for emergency contraception recommended?

A

Up to 120 hours

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6
Q

What regimens are approved by FDA for emergency contraception? And which are not?

A

Ulipristal acetate and levonorgestrel pill are FDA approved. Combined progestin-estrogen pills and copper IUD are not FDA approved

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7
Q

For how long after unprotected sex is a copper IUD useful for emergency contraception recommended?

A

Highly effective if placed within 5 days, some studies used it as many as 10 days later.

Levonorgestrel-containing IUDs are currently being investigated

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8
Q

How does ulipristal acetate work as an emergency contraception?

A

Inhibit or delay ovulation. Inhibits follicular rupture even after level of LH has started to increase

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9
Q

How does the levonorgestrel-only regimen work as an emergency contraception?

A

Inhibit or delay ovulation. Delays follicular development when administered before level of LH increases.

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10
Q

Does emergency contraception prevent implantation of a fertilized egg?

A

Unlikely

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11
Q

How does the copper IUD function as an emergency contraception?

A

Prevents fertilization by affecting sperm viability and function. May also affect the oocyte and endometrium.

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12
Q

Does emergency contraception confer risk to an established pregnancy or harm to developing embryo?

A

No, based off studies of teratogenic risk of contraception during daily use of oral contraceptives

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13
Q

Have any deaths or serious complications been linked to use of emergency contraceptive pills?

A

No

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14
Q

What are short-term adverse effects of emergency contraceptive use?

A

Nausea, headache, irregular bleeding, breast tenderness, abdominal pain, dizziness, and fatigue

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15
Q

What bleeding irregularities are common with emergency contraceptive use?

A

Menstrual period usually occurs within 1 week of expected time. Some will have irregular bleeding or spotting in the week or month after treatment. If taken earlier in the cycle will likely experience bleeding before expected menses.

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16
Q

What is the rate of uterine perforation with copper IUD insertion?

A

1/1,000

17
Q

Does making emergency contraception more available encourage risky sexual behavior or increase risk of unintended pregnancy?

A

No

18
Q

According to US medical Eligibility Criteria for Contraception Use, for which conditions do risks outweigh benefits of emergency contraception?

A

None

19
Q

What screening procedures are needed prior to provision of emergency contraception?

A

No clinical exam or pregnancy test needed, should not be denied based on timing during cycle

20
Q

What is the pregnancy rate when copper IUD is used for emergency contraception within 5 days of unprotected sex?

A

0-2%, largest study with 0.1%

21
Q

What is the pregnancy rate after use of ulipristal acetate for emergency contraception?

A

1.4%

22
Q

What is the pregnancy rate after use of levonorgestrel-only regimen for emergency contraception?

A

2.2%

23
Q

Is the levonorgestrel-only regimen or combined hormonal regimen more effective as emergency contraception?

A

Levonorgestrel-only regimen

24
Q

Which emergency contraceptive methods are affected by body weight?

A

Levonorgestrel and ulipristal acetate. Not copper IUD.

25
Q

Should levonorgestrel or ulipristal acetate be withheld from obese women?

A

No

26
Q

What clinical follow-up is needed after use of emergency contraception?

A

No scheduled follow-up is required. Clinical eval indicated if menses delayed by a week or more.

27
Q

True or false: women who have taken emergency contraceptive pills are not at risk of becoming pregnant later in the same menstrual cycle

A

False

28
Q

What type of contraception should be used immediately after oral emergency contraception?

A

Barrier contraception

29
Q

How soon after use of ulipristal acetate can you start hormonal contraceptives?

A

No sooner than 5 days after intake of ulipristal acetate

30
Q

How soon after levonorgestrel emergency contraception can women start regular contraception?

A

Can be started immediately after, but should abstain from sex or use barrier contraception for 7 days

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