2.2. Contraception - Case Study

Question 1

What information is needed, with regards to Emergency Contraception?

Answer 1

1. Last Menstrual Period (LMP) / Regular Cycle
2. Usual Method of Contraception
3. Age of Partner (if underage)
4. Circumstances - Unprotected Sexual Intercourse (UPSI) / Condom Failure / Other Method Problem / Type of Sex / Time from 1st Episode of UPSI since LMP / Hormonal Method Failure

Question 2

In a 28 day Menstrual Cycle, when is a Woman most Fertile (at risk of Pregnancy)?

Answer 2

Days 10-17 = 20-30% Risk

Note - Days 1-9, and 18-28 are a 2-3% risk

Question 3

What Emergency Contraceptive Agents are available?

Answer 3

1. Levonelle (LNG)
2. Ullipristal / Ella One (UPA)
3. Copper Intrauterine Device (Cu IUD)

Question 4

When is Levonelle (LNG) effective as an Emergency Contraceptive?

Answer 4

0 - 72 hours after the First Episode of Unprotected Sexual Intercourse - 85% effective

Question 5

When is Ullipristal / Ella One (UPA) effective as an Emergency Contraceptive?

Answer 5

0 - 120 hours after the First Episode of Unprotected Sexual Intercourse - 60-80% effective

Question 6

When is a Copper Intrauterine Device (Cu IUD) effective as an Emergency Contraceptive?

Answer 6

0 - 120 hours after the First Episode of Unprotected Sexual Intercourse - >99% effective
OR
Up to 5 days after expected Ovulation

Question 7

What needs to be taken into consideration when discussing Emergency Contraceptive medication?

Answer 7

1. Pregnancy test in 3-4 weeks if no normal period
2. Future Contraception
3. STI Risk
4. < 16 years old assessment - Age of Partner
5. Medical History (Medications, Allergies, and BMI0
6. Any Emergency Contraceptive already in the Cycle

Question 8

How long would you need to wait after using the Levonelle (LNG) Emergency Contraceptive, before you can use the Ullipristal / Ella One Emergency Contraceptive?

Answer 8

You would need to wait for at least 1 week

Question 9

How long would you need to wait after using the Ullipristal / Ella One Emergency Contraceptive, before you can use the Levonelle (LNG) Emergency Contraceptive?

Answer 9

You would need to wait for at least 5 days

Question 10

What STI Testing can be offered, and when?

Answer 10

1. Lower Vaginal Swab - Chlamydia / Gonorrhoea - 10 days after Episode
2. Blood Testing - HIV / Symphilis - 2 months after Episode
3. If at High Risk of a Blood Borne Virus - Hepatitis B & C - 2 and 6 months after Episode

Question 11

What are the 2 Types of Hormonal Contraception, and their Methods of Delivery?

Answer 11

1. Combined Hormonal Methods - COC Pill / Patches (Evra) / and Vaginal Ring (NUVA)
2. Progesterone-Only Methods - PO Pill / Implant (NEXPLANON) / Injection (DEPO-PROVERA) / Intrauterine System (MIRENA)

Question 12

What are the 2 Types of Non-Hormonal Contraception, and their Methods of Delivery?

Answer 12

1. Barrier Method - Male or Female Condoms / Diaphragm

2. Intrauterine Device (Copper Intrauterine Device (Cu IUD))

Question 13

What is the order of preferred Contraceptive Methods for Females?

Answer 13

1. Any Combined Hormonal Method (unless contraindicated)

2. Any Progesterone Only method - with further consideration / discussion if Intrauterine System

Question 14

What needs to be assessed for Patients under 16 asking for Emergency Contraceptive Medication?

Answer 14

Fraser Guidelines - Child Protection Risk

Question 15

What are the 2 methods of Abortion available in the UK?

Answer 15

1. Medical

2. Surgical

Question 16

When is the Medical Abortion recommended?

Answer 16

Mifepristone / Misoprostol is up to 20 weeks (locally)

Question 17

When is the Surgical Abortion recommended?

Answer 17

1. Up to 12 weeks locally

2. Refer to other provider after 20 weeks until 24 weeks