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PHA332 > EHC > Flashcards

EHC Flashcards

1
Q

Define EC

A

Intervention aimed at preventing unintended pregnancy after unprotected sexual intercourse or potential contraceptive failure

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1
Q

List 2 indications for EC

A
  • When the patient has a natural cycle and no contraception has been used
  • When there is incorrect use or potential failure of hormonal contraception
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2
Q

What day of the cycle is the first day of menstruation?

A

Day 1 of the cycle

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3
Q

What is the menstrual cycle?

A

The first day of menstruation to the day before the next menstruation

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4
Q

How does EC work?

A

Delays ovulation

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5
Q

When does ovulation occur?

A

14 days before menstruation starts

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6
Q

How do we calculate estimated ovulation date?

A

Determining length of cycle and subtracting 14

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7
Q

When is the fertile period?

A

5 days leading up to and including the estimated ovulation day (6 days) - 30% chance of pregnancy

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8
Q

How long are sperm viable in the female genital tract for?

A

5 days after UPSI

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9
Q

How long can an unfertilised egg survive for?

A

Approx 12-24 hours

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10
Q

List reasons for EC

A

If a woman does not wish to conceive and has had UPSI
- on any day of a natural menstrual cycle (particularly in the fertile window)
- after regular HC used incorrectly
- from day 21 after childbirth unless LAM method met
- from day 5 after miscarriage, abortion, ectopic pregnancy

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11
Q

What is the most effective method of EC

A

Cu-IUD (99% effective)

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12
Q

What is the MOA of the copper IUD?

A

Pre and post ferilisation mechanisms of action
- Causes a local endometrial inflammatory reaction which prevents implantation

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13
Q

How long after UPSI can a copper IUD be inserted?

A

Up to 5 days (120 hours) or up to 5 days after the earliest estimated day of ovulation whichever is LATER

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14
Q

What are the rules for a Cu-IUD after missed pill?

A
  • CHC: Earliest observed ovulation occured 8 days after stopping CHC
    Cu-IUD inserted up to 13 days after the start of HFI
  • POP: Cu-IUD inserted up to 5 days after the first UPSI following the first missed POP
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15
Q

What is the MOA of levonogestrel?

A

Delays follicular development when administered before the level of LH increases

16
Q

How many hours is levonogestrel licensed for use up to?

A

72 hours

17
Q

How many hours does it matter if vomited after administration?

A

3 hours

18
Q

What is EllaOne and its MOA?

A
  • Selective progesterone receptor modulator
    MOA: inhibits follicular rupture even after the level of LH has started to increase
19
Q

How long can EllaOne be used up to?

A

120 hours
First choice if UPSI during the fertile period

20
Q

How long after EllaOne can you restart HC?

A

5 days

21
Q

How does the Cu-IUD work?

A

Prevents implantation

22
Q

What age is a PGD from for EHC?

A

13 (14 in some areas) provided they are Fraser competent

23
Q

What is the legal age of sexual activity?

A

16 in UK

24
Q

What to do if children under the age of 13?

A

Treat cases seriously and report to social services

25
Q

What is Fraser guidance?

A

Patients under 16 to decide if they consent to contraceptive or sexual health advice and treatment

26
Q

What is the missed pill guidance?

A
  • CHC: 2 or more active pills missed
  • POP: Traditional (>3hrs late, last pill>27 hrs ago), (Desogestrel POP >12hrs late, last pill> 36 hrs ago)
  • Depo injection > 14 weeks ago
  • Transdermal patch off 48 hours
  • Expired IUC/lost threads
  • Expired sub dermal implant
27
Q

When taking a COC - is EC needed?

A

Pills 1-7: EC may be required in pill-free interval/first week of pill
Pills 8-14: EC not required if pills in last 7 days have been taken correct
Pills 15-21: Finish the pills in current pack and start a new pack the next day provided pill-free interval omitted
More than 7 COC pills missed: Restart COC as though never used before

28
Q

How long to discard breastmilk after taking ulipristal?

A

7 days

29
Q

What weight effects Levonogestrel?

A

Over 70kg (BMI > 26kg/m2)
FSRH advices give double dose if this is the case
REFER as this is ‘off label’

30
Q

Is ulipristal affected by BMI?

A

No

31
Q

What medical conditions should levonogestrel and EllaOne not be given to patients with?

A

Liver dysfunction

32
Q

What drugs affect the efficacy of EC?

A

Enzyme inducing drugs, guidance advises using Cu-IUD however FSRH advises double dose of levonogestrel if unwilling to use Cu-IUD

33
Q

What to do if progesterone has been taken in 7 days prior?

A

FSRH advises against use of ulipristal

34
Q

What methods of EC can transgender people use?

A

All

35
Q

What to advise regarding cycle disruption?

A
  • Advise patient menstrual cycle may be altered, next period early/late
  • Pregnancy test recommended if menses delayed by more than 7 days after EC

PHA332 (14 decks)

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