Contraception - Emergency Flashcards
What is the purpose of emergency contraception?
Prevent pregnancy following sexual intercourse
How does emergency contraception differ from other forms of contraception?
It is used after sex, whereas other forms are used before or during sex
What are the indications for emergency contraception?
- Sexual intercourse without contraception
- Contraceptive method has failed
Give an example of how a contraceptive might fail
Condom torn
When might women using POP or COCP need emergency contraception?
If they miss pills, depending on how many pills have been missed
What are the types of emergency contraception?
- Emergency hormonal contraception (morning after pill)
- Intrauterine device
What are the types of morning after pill available in the UK?
- Levonorgestrel
- Ulipristal acetate
What is the brand name for Ulipristal acetate?
EllaOne
What is levonorgestrel?
Synthetic progesterone
How does levonorgestrel work?
It delays ovulation by 5-7 days, after which any sperm will be non-viable
What is ulipristal acetate?
A progesterone receptor modulator
How does ulipristal acetate work?
It delays ovulation for 5-7 days, after which any sperm will be non-viable
How long after unprotected sex can levonorgestrel be used?
Within 72 hours of unprotected sex
How long after unprotected sex can ulipristal acetate be used?
Within 120 hours of unprotected sex
Do hormonal emergency contraceptives have an effect on implantation?
No
What is the copper intrauterine device usually used as?
A method of long-term non-hormonal contraception
How long after unprotected sex can the copper coil be inserted to be used as emergency contraception?
Within 5 days
How does the copper coil work as emergency contraception?
Toxic to sperm, and may induce a sterile inflammatory response within the uterus that makes implantation impossible
How long does the copper coil provide contraception for if used as emergency contraception?
5-10 years (depending on type) as long as it remains in situ
How effective is the copper coil as emergency contraception?
99% effective
Who should the copper coil be offered to as emergency contraception?
All women presenting
What are the absolute contraindications to levonorgestrel as emergency contraception?
None
What reduces the efficacy of levonorgestrel as emergency contraception?
- Diseases of malabsorption
- Enzyme inducing drugs
Give an example of a disease of malabsorption
Crohn’s
Give an example of an enzyme inducing drug
Rifampicin
What should be done if a patient requiring emergency contraception who is on an enzyme inducing drug refuses the IUD?
Double dose of levonorgestrel, e.g. 3mg at once, may be taken.
Ulipristal acetate is absolutely contraindicated here
What are the contraindications to ulipristal acetate?
- Diseases of malabsorption
- Hypersensitivity to ulipristal acetate
- Severe hepatic dysfunction
- Enzyme inducing drugs
- Breast feeding
- Asthma insufficiently controlled by corticosteroids
- Drugs decreasing gastric pH
How long after taking ulipristal acetate should breastfeeding be avoided?
7 days
Give 2 examples of drugs reducing gastric pH
- Omeprazole
- Ranitidine
What are the contraindications to the copper IUD as emergency contraception?
- Uterine fibroids with distortion of uterine cavity
- Documented or suspected pelvic inflammatory disease
- Documented or suspected STI, especially chlamydia or gonorrhoea
What are the adverse effects of emergency hormonal contraception?
- Nausea
- Dizziness
- Menstrual disturbance
- Abdominal pain
What are the adverse effects of IUD?
- Pelvic infections
- Expulsion of IUD
- Bleeding
- Pelvic pain
In what forms should follow up advice be provided for emergency hormonal contraception?
- Verbal
- Written
What follow up advice should be given in a patient taking emergency hormonal contraception?
- Seek help if vomiting occurs within 2 hours of taking levonorgestrel, or 3 hours of taking ulipristal, as the medication may not have been absorbed adequately
- Effectiveness of hormonal methods decreases as the time since sexual intercourse increases
What follow up advice should be given in a patient using copper coil is emergency contraception?
Increased relative risk of ectopic pregnancy following insertion of IUD
What should the patient be alert to as signs fo ectopic pregnancy following IUD insertion for emergency contraception?
Next period is >5 days late with reduced bleeding, especially coupled with severe lower abdominal pain
