EHC Flashcards
What is used for emergency hormonal contraception?
Levonorgestrel within 72 hours
Ulipristal 120 hours
following unprotected sexual intercourse
Which is more effective and considered first line? is it suitable for women of child bearing age?
Ulipristal
Yes
What age group is levonorgestrel and ulipristal given to?
> 16 years of age
any age for ulipristal
What is the mode of action of ulipristal?
inhibits or delays ovulation via suppression of the LH surge
What is the mode of action of levonorgestrel?
- Before ovulation - prevents ovulation by delaying or inhibiting the release of the ovum from the ovary
- after ovulation - prevents fertilisation by affecting the motility of the fallopian tube and prevents sperm from meeting the ovum
- after fertilisation it induces changes in the endometrium that render it unreceptive to the ovum and prevent implantation
What % of expected pregnancies does it prevent if used within 72 hours of unprotected intercourse?
85% but effectiveness declines over time
When to refer?
- If ovulation has already occurred, EHC not thought to be effective therefore need IUD
- Hypersensitivity to ingredients
- Severe hepatic dysfunction
- Severe diarrhoea
- Crohns disease
- pt with asthma on oral glucocorticoid therapy
- Pt on ciclosporin therapy
What is the dose of levo and uli
uli - 30mg
levo - 1500micrograms
what interacts with both?
metabolised by the liver so drugs which induce liver enzymes will therefore increase metabolism and could reduce the effectiveness of the EHC
primidone, phenytoin, carbamazpine, st johns wort, griseofulvin, rifampcin, rifabutin, ritonavir
What side effects occur with ellaone?
headache
Nausea
ab pain
dysmenorrhoea
what side effects occur with levo?
nausea
headache
disturbed menstrual cycle
fatigue
Can both be used in BF or P?
P: limited info, not known to harmful
BF: yes for levo
BF: avoid for 1 week for ellaone
If pt vomits, what should you recommend?
if pts vomits within the first 3 hours of taking the pill, another tablet should be taken
What is the most effective type of contraceptive method?
IUD - first line
What questions about pregnancy and late period should be asked?
ask pt if already pregnant or symptoms of pregnancy
Details about last period should be asked last period? if late, how many days?
What else should be recommended after using the emergency contraceptive pill?
use barrier method until next menstrual period starts
if a woman takes ellaOne, does this interfere with normal hormonal contraception?
it reduces its contraceptive action
therefore, she can start taking hormonal contraception after using ellaOne BUT use reliable barrier method unti next menstrual period
when should pts be referred so that pregnancy is excluded?
- if menstrual period delayed by more than
- 5 days after taking levonelle one step or 7 days after taking ellaone
- or abnormal bleeding occurs at the expected date of menstrual periods or pregnancy
if pt misses one pill, what does this mean? What should they do?
if a pt misses one pill (a missed pill is defined as one that is more than 24 hours late) or starting a new pack 1 day late: no additional or EHC is required. Pt should take the missed pill and continue to take the rest of the pack as usual
if pt misses TWO or MORE pills or starting new pack 2 days or more late, should they use EHC?
take the last missed pill immediately and continue to take the rest of the pack as usual and use an extra method of contraception for the next 7 days
if pills are missed in first week, Pills 1-7, EHC?
Yes if unprotected sexual intercourse has occurred in the pill-free interval or in the first week of pill-taking
if pills are missed in the second week (pills 8-14), EHC?
No EHC - ensure pt takes the rest of the pills and extra protection
if pills are missed in the third week (pills 15-21), EHC?
omit the pill-free interval by finishing the pills in the current pack or discarding placebo - start new pack the next day
if pt is on POP, EHC?
12 hours late for cerazette - EHC
old POP 3 hours late - EHC
Can levo be repeated in the same cycle?
Yes
How effective is ulipristal?
95% effective
