EHC Flashcards
Define EC
Intervention aimed at preventing unintended pregnancy after unprotected sexual intercourse or potential contraceptive failure
List 2 indications for EC
- When the patient has a natural cycle and no contraception has been used
- When there is incorrect use or potential failure of hormonal contraception
What day of the cycle is the first day of menstruation?
Day 1 of the cycle
What is the menstrual cycle?
The first day of menstruation to the day before the next menstruation
How does EC work?
Delays ovulation
When does ovulation occur?
14 days before menstruation starts
How do we calculate estimated ovulation date?
Determining length of cycle and subtracting 14
When is the fertile period?
5 days leading up to and including the estimated ovulation day (6 days) - 30% chance of pregnancy
How long are sperm viable in the female genital tract for?
5 days after UPSI
How long can an unfertilised egg survive for?
Approx 12-24 hours
List reasons for EC
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
What is the most effective method of EC
Cu-IUD (99% effective)
What is the MOA of the copper IUD?
Pre and post ferilisation mechanisms of action
- Causes a local endometrial inflammatory reaction which prevents implantation
How long after UPSI can a copper IUD be inserted?
Up to 5 days (120 hours) or up to 5 days after the earliest estimated day of ovulation whichever is LATER
What are the rules for a Cu-IUD after missed pill?
- 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
What is the MOA of levonogestrel?
Delays follicular development when administered before the level of LH increases
How many hours is levonogestrel licensed for use up to?
72 hours
How many hours does it matter if vomited after administration?
3 hours
What is EllaOne and its MOA?
- Selective progesterone receptor modulator
MOA: inhibits follicular rupture even after the level of LH has started to increase
How long can EllaOne be used up to?
120 hours
First choice if UPSI during the fertile period
How long after EllaOne can you restart HC?
5 days
How does the Cu-IUD work?
Prevents implantation
What age is a PGD from for EHC?
13 (14 in some areas) provided they are Fraser competent
What is the legal age of sexual activity?
16 in UK
What to do if children under the age of 13?
Treat cases seriously and report to social services
What is Fraser guidance?
Patients under 16 to decide if they consent to contraceptive or sexual health advice and treatment
What is the missed pill guidance?
- 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
When taking a COC - is EC needed?
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
How long to discard breastmilk after taking ulipristal?
7 days
What weight effects Levonogestrel?
Over 70kg (BMI > 26kg/m2)
FSRH advices give double dose if this is the case
REFER as this is ‘off label’
Is ulipristal affected by BMI?
No
What medical conditions should levonogestrel and EllaOne not be given to patients with?
Liver dysfunction
What drugs affect the efficacy of EC?
Enzyme inducing drugs, guidance advises using Cu-IUD however FSRH advises double dose of levonogestrel if unwilling to use Cu-IUD
What to do if progesterone has been taken in 7 days prior?
FSRH advises against use of ulipristal
What methods of EC can transgender people use?
All
What to advise regarding cycle disruption?
- Advise patient menstrual cycle may be altered, next period early/late
- Pregnancy test recommended if menses delayed by more than 7 days after EC
