EHC Flashcards
1
Q
What do combined oral contraceptives contain?
A
ethinylestradiol as the oestrogen component; mestranol and estradiol are also used. The ethinylestradiol content of COCs range from 20–40 micrograms
2
Q
What is Gedarel?
A
COC
3
Q
What is Femodette?
A
COC
4
Q
What is Yasmin?
A
COC
5
Q
What is Levest?
A
COC
6
Q
What is Microgynon ED?
A
COC
7
Q
What is Zoely?
A
COC
8
Q
What is Logynon ED?
A
COC
9
Q
What is Qlaira?
A
COC
10
Q
What is the contraceptive injection?
A
PO
Depo-Provera or Noristerat
11
Q
What is the implant?
A
PO
Nexplanon
12
Q
What is the hormonal IUD?
A
PO
Mirena
Jaydess
Levosert
13
Q
What is the non-hormonal IUD?
A
Copper IUD
14
Q
What is Micronor?
A
POP
15
Q
What is Noriday?
A
POP
16
Q
What is Norgeston?
A
POP
17
Q
What is Cerazette?
A
POP
18
Q
What is Cerelle?
A
POP
19
Q
What is the active ingredient in Levonelle?
A
Levonorgestrel 1.5mg
20
Q
What is the active ingredient in EllaOne?
A
Ulipristal Acetate
21
Q
What is a non-hormonal form of EHC?
A
Copper IUD
More effective than EllaOne and Levonelle but not available OTC
22
Q
When does ovulation most commonly occur?
A
Supposed to happen at day 14 but it can happen any time between 6-21 days. Very hard to predict and rely upon (possible to get pregnant at any part of the cycle)
23
Q
How does EHC work?
A
Delays ovulation
24
Q
When is EHC indicated? (7)
A
- After UPSI
- UPSI in the 28 days following the use of enzyme-inducing drugs
- UPSI from 21 days post-partum
- UPSI from 5 days post abortion/miscarriage/ectopic pregnancy
- After ejaculation onto external genitalia
- UPSI before new contraception is effective
- After contraceptive failure
25
What counts as contraceptive failure? (7)
- split condom
- missed pills
- DDI with hormonal contraception
- delayed contraceptive implant or injection
- detached contraceptive patch
- 7 days prior to IUD/IUI being dislodged/removed
- dislodged/early removal of diaphragm
26
Is copper IUD effected by enzyme-inducing drugs?
NO
27
What is the mechanism of action for levonelle?
(progestogen)
| (preovulation) - prevents ovulation and fertilisation and discourages implantation
28
What is the mechanism of action for EllaOne?
(progesterone receptor modulator) - delays ovulation and alters the endometrium
29
Who is levonelle licensed for ?
Licensed for OTC for ages 16 and over up to 72 hours after UPSI
30
Who is EllaOne licensed for ?
OTC for all women of childbearing age (use professional judgement) up to 120 hours after UPSI
31
What is the licensed framework for copper IUD?
10 days after UPSI
32
What is Levonelle's efficacy ?
95% (<24 hrs)
85% (25-48 hrs)
58% (49-72 hrs)
OVERALL EFFICACY 84%
33
What is EllaOne's efficacy?
- 1st line - slightly higher efficacy than levonelle
- lower pregnancy rate than levonelle within 72 hrs
- 48-120 hrs 2% pregnancy rate
- 98% effective
- efficacy of UPA reduced if any progesterone is taken i the 5 days post UPA
34
What is the weight restriction for Levonelle?
If BMI > 26 or >70kg, this may reduce efficacy
35
What are the adverse effects for Levonelle?
```
Headache
Nausea
Breast tenderness
Lower abdominal pain
Irregular bleeding
Fatigue
Increased risk of ectopic pregnancy
Dizziness
```
36
What are the adverse effects for EllaOne?
```
Headache
Nausea
Abdominal pain
Dysmenorrhea
Mild-moderate dizziness
```
37
Why is lower abdominal pain a red flag with taking Levonelle?
- Levonelle can cause ectopic pregnancy and lower abdominal pain is indicative of this (must be referred immediately)
38
What are the contraindications and interactions for Levonelle?
Pregnancy
Bowel disease
Hepatic impairment
Enzyme inducers* - rifampicin, St John’s Wort, ritonavir, ciclosporin, griseofulvin, phenytoin, carbamazepine, barbiturates
39
What are the contraindications and interactions for EllaOne?
```
Pregnancy/suspected pregnancy
Severe hepatic impairment
Severe asthma uncontrolled by oral steroids
Breastfeeding (express and discard for 1 week)*
Drug interactions
CYP3A4 inducers*
Ritonavir (long term)
Levonorgestrel
Hormonal contraception
Progestogen containing drugs
Option to REFER - Cu-IUD
```
40
What action is needed if the next menstrual period after EHC is lighter/unusual?
If next menstrual period is lighter, shorter or more than 5 (levonelle)/7 (ella one) days late pregnancy test is needed at least 3 weeks after UPSI
41
What advice can you give for continuing contraception post UPSI and EHC?
Use a barrier method (condoms) for at least 14 days or until the next menstrual period
42
Do EHCs protect against STIs?
NO - STI screening may be needed
43
Which is the cheapest EHC?
Levonelle
44
Can you use multiple EHCs per cycle?
YES as long as its the same type
45
How long do extra precautions need to be carried out after EHC?
7 day rule – takes 7 days for contraception to be re-established for COC (2 days for POP) with the exception being COC Qlaira which takes 9 days
POCs can be implant or injection – tends to be 7 days (slightly different rule)
46
Advice for starting a COC?
- First and last 7 important (active pills)
- Starting COC – day 6 or later? Add precautions for 7 days (ideally start on day 1-5 of natural cycle)
QS – quick start method starting on different day of cycle (barrier method needed)
47
Changing COC to POP advice ?
- COC-POP- ensure previous contraception taken effectively or exclude pregnancy; use additional precautions for 2/7, if pill-free period
- COC(ED) to POP – use addition precaution for 2/7, if ED/placebo pills taken
- COC(non-ED) to POP – for immediate cover, omit pill-free period, start POP immediately
- COC to Cerazette (POP) – for immediate cover, omit pill-free period.
- For immediate cover: when they reach last COC pill, they do not have 7 day break and immediately start taking POP )no withdrawal bleed) (no barrier method needed)
48
Starting a POP advice?
- (Cerazette) start within days 1-5 & no additional precautions needed (day 6 onwards, use additional precautions for 2/7 (Quick-start)
- (Micronor/Noriday) – no add precautions days 1-5**
- POP needs to be taken every day at same time
49
Changing POP to COC?
POP – Qlaira (COC) (additional precautions for 9 days)
POP – Zoely (additional precautions for 7 days)
POP-COC (add precautions for 7/7)
50
Missed pill advice for COC?
- >24 hrs LATE
- If starting on day 6 or later, add precautions for 7 days
Critical at end or start of cycles as PF period elongated
- EHC indicated if 2 or more missed (>24 hrs)*
- except Zoely24+4 and Qlaira26+2 – where EHC indicated if 1 or more missed (>12 hrs)*
Vomiting within 2 hours or persistent diarrhoea over 24 hours, use additional precautions for 7/9 or 2 days
51
Missed pill advice for POP?
- >3 hrs late [Micronor/Noriday]
- >12hrs late [*Cerazette Cerrelle]
- Continue pills with 2 days extra precautions
- EHC indicated if 1 or more pills missed (>3/12hrs) [and UPSI before 2 more tablets taken correctly]
Vomiting within 2 hours or persistent diarrhoea over 24 hours, use additional precautions for 7/9 or 2 days
52
Continuing contraception advice after EHC?
TODAY
Omit regular dose of usual hormonal contraception
TOMORROW ONWARDS
Following LNG,
additional contraceptive precautions for 7 days [COC] OR (2 days for POP, 9 days for Qlaira®)- see BNF
Following ellaOne® Omit for COC/POP FOR 5 days and use additional precautions until next menstrual period or for at least the next 14 days
In future, correct/effective contraceptive use or abstinence to avoid further risk of pregnancy.
53
How to exclude pregnancy in an EHC consultation?
- ask about last menstrual period (was it normal?)
| - ask if there has been any other occasions of UPSI in between
