EC - Emergency contraception

Question 1

Methods of emergency

Answer 1

Most effective is IUD, Most effective hormonal is ellaone (Ulipristal acetate 30mg).

Treatment Pathway
1st line - Copper IUD - can be used 120 hrs (5 days after sex)
ALT Hormonal oral contraception (Levonorgestrel 1.5mg/ Ulipristal acetate 30mg)
- Ulipristal acetate first choice

Question 2

Copper IUD (Non hormonal)

Answer 2

ABx is given if STI risk. Copper not affected by BMI, Weight or other drugs.

Its non Hormonal

Question 3

EHC (EXAM Q)

Answer 3

Check table more detail - Summary:
Levonorgestrel:
2nd line
- 72 hrs (3 days) [96hrs/4 days unlicensed use]
- Affected by BMI>26 or BW 70kg give ellaone instead or double dose (3mg unlicensed)
- Can use >1 in same cycle but not advised
- Start hormonal contraception immediately after

Ulipristal acetate: (ellaone)
1st line - More effective
120 hrs (5 days)
- BF avoid for 1 week after use as its found in milk.
- Can use >1 in same cycle

BOTH:
- vomiting within 3 hrs take another pill
- Affected by enzyme inducers
- Wait for 5 days to take normal contraception - they reduce effect of ellaone

Question 4

When Emergency contraception can be used?

Answer 4

To stop pregnancy after sex.
Offer to women who dont want to conceive
Offer Emergency contraception:
- From day 21 after child birth.
- From day 5 after abortion, miscarriage, & ectopic pregnancy
- IF regular contraception has been compromised.

Question 5

Counselling

Answer 5

If vomit within 3 hrs take another pill.

When taking:
- Next period may be few days early/late
- Seek medical attention if lower abdo pain - could be ectopic pregnancy
- Perform pregnancy test if next period is delayed >7 days, lighter than usual, or have abnormal abdo pain.

INTERACTIONS
Check table in pics - gives solutions if interactions occur.
- Rifampicin/ Rifabutin very strong enzyme inducers so change to IUD

• if enzyme inducers are used also use ALT contraception like condoms progestogens injections or IUD Required for up till 4 weeks after stopping enzyme inducing drugs OR can just increase levo dose to 3mg

Question 6

Methods unaffected by enzyme inducers

Answer 6

Some Parenteral POC
Norethisterone
IUD
non hormonal contraception

NO precaution needed when COCs used with antibiotics that aren’t inducers unless diarrhoea/vomiting happens