Emergency Contraception

Question 1

What is emergency contraception used for?

Answer 1

Isolated episodes of unprotected sexual intercourse, should not be used regularly.

Question 2

What general measures are taken before emergency contraception is prescribed?

Answer 2

1. Arrange future contraception
2. Consider screening for STIs
3. If next period late, advise pregnancy test.

Question 3

When is an emergency IUD inserted and what is given with it?

Answer 3

1. Inserted up to 5 days after unprotected sexual intercourse or 5 days after ovulation or within 5 days of UPSI.
2. Antibiotic prophylaxis at time of insertion (Azithromycin 1g PO)

Question 4

What does the law state about when pregnancy starts in the UK?

Answer 4

Starts at implantation, not fertilisation.

Question 5

Which methods of contraception work whenever, and which only work pre-ovulation?

Answer 5

1. Whenever - IUD

2. Pre-ovulation - ullipristal acetate, levonorgestrel

Question 6

What type of medications are ullipristal acetate and levonorgestrel and what is their mechanism of action?

Answer 6

Emergency contraception:

1. Ullipristal acetate (EllaOne) - progesterone receptor modulator, inhibits ovulation
2. Levonorgestrel - progesterone, inhibits ovulation and stops implantation

Question 7

When should you start ullipristal acetate and levonorgestrel as emergency contraception?

Answer 7

1. Ullipristal acetate - within 120 hours of UPSI

2. Levonorgestrel - within 72 hours of UPSI

Question 8

What are the doses for ullipristal acetate and levonorgestrel as emergency contraceptives?

Answer 8

1. 30mg

2. 1.5mg

Question 9

What are the disadvantages of ullipristal acetate as an emergency contraceptive?

Answer 9

1. Can’t give if - within 28 days of enzyme inducer/antacids/severe asthma
2. Avoid breastfeeding 26 hours after
3. Can’t take COCP/POP for 5 days after

Question 10

What are the side effects of levonorgestrel as an emergency contraception?

Answer 10

Vomiting and menstrual disturbance