Emergency Contraception Flashcards
How many days after childbirth should emergency contraception be offered after UPSI?
21 days (unless the criteria for lactational amenorrhoea are met)
How many days after abortion, miscarriage, ectopic pregnancy or uterine evacuation for gestational trophoblastic disease, should emergency contraception be offered after UPSI?
5 days
What is the most effective form of emergency contraception?
Copper intra-uterine device
Up to how long after UPSI can a copper intra-uterine device be inserted?
120 hours (5 days)
OR
up to 5 days after the earliest estimated date of ovulation
Whichever is later
When inserting a copper intra-uterine device for emergency contraception, what other medication should be considered?
Antibacterial cover if there is a significant risk of STI that could be associated with ascending pelvic infection
Are copper intra-uterine devices affected by BMI, body weight or other drugs?
NO
Is oral emergency contraception administered after ovulation effective?
NO
How long after UPSI is levonorgestrel effective as emergency contraception?
Within 72 hours (3 days)
May be used between 72 and 96 hours (unlicensed) after UPSI but efficacy decreases with time
How long after UPSI is ulipristal acetate effective as emergency contraception?
Within 120 hours (5 days)
Which oral hormonal emergency contraception more effective: levonorgestrel or ulipristal acetate?
Ulipristal acetate
The efficacy of which oral hormonal emergency contraception is reduced by higher body weight or BMI?
Levonorgestrel
If the patient’s BMI is greater than 26 kg/m2 or their body-weight is greater than 70 kg, it is recommended that either ulipristal acetate or a double dose of levonorgestrel [unlicensed indication] is given
Is the effectiveness of oral hormonal emergency contraception affected by higher body weight or BMI?
Yes, particularly levonorgestrel
If the patient’s BMI is greater than 26 kg/m2 or their body-weight is greater than 70 kg, it is recommended that either ulipristal acetate or a double dose of levonorgestrel [unlicensed indication] is given
If a patient has a BMI > 26 or a body weight > 70 kg and the copper intra-uterine device is inappropriate, what two options for emergency contraception are appropriate following UPSI?
Ulipristal acetate
OR
Double dose of levonorgestrel (unlicensed)
What is the first-line oral emergency contraceptive for females who have had UPSI within the last 96-120 hours?
Ulipristal acetate
- Oral: 30 mg for 1 dose
Can ulipristal and levonorgestrel be used more than once in the same menstrual cycle?
Yes
Note that the manufacturer of levonorgestrel advises that there may be an increased risk of side-effects (such as menstrual irregularities) with repeated administration of levonorgestrel as emergency contraception more than once in the same cycle.
How long after taking levonorgestrel as emergency contraception should a patient wait before starting hormonal contraception?
Start immediately
They must use condoms reliably or abstain from intercourse until contraception becomes effective.
How long after taking ulipristal acetate as emergency contraception should a patient wait before starting hormonal contraception for the first time?
5 days
They must use condoms reliably or abstain from intercourse during the 5 day waiting period and also until their contraceptive method is effective.
However, hormonal contraception can be started immediately in females who are on a regular combined hormonal contraceptive who have missed contraception within the first week of restarting after a scheduled hormone-free interval, and have taken ulipristal acetate as emergency contraception; they must use condoms reliably or abstain from intercourse for 7 days until contraception becomes effective.