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.
A patient who regularly takes hormonal contraception has missed a dose in the first week of restarting after a scheduled hormone-free interval and has UPSI. If they are given ulipristal acetate as emergency contraception, how long do they have to wait before restarting hormonal contraception?
Restart immediately
But use condoms reliable or abstain from intercourse for 7 days until contraception become effective
What are the two indications for use of oral levonorgestrel?
Emergency contraception
- Oral: 1.5 mg for 1 dose
Contraception
- Oral: 30 micrograms daily
At what body weight or BMI would you consider using a higher dose of levonorgestrel for emergency contraception?
Weight > 70 kg
BMI > 26 kg/m^2
If using levonorgestrel for regular contraception, how many hours delay in taking the pill is considered a “missed pill”?
3 hours or more
Do CYP450 enzyme inducing or inhibiting drugs reduce the effectiveness of levorgestrel as emergency contraception?
CYP450 enzyme inducing drugs
If a patient taking an enzyme-inducing drug has had UPSI, what dose of levonorgestrel should be given?
Assume the copper intra-uterine device is inappropriate or undesirable
Increase dose to a total of 3 mg (single dose)
Regular dose is 1.5 mg (single dose)
What are the common side effects of oral levonorgestrel? (11)
- GI discomfort
- Headaches
- Menstrual cycle irregularities
- Nausea
- Skin reactions
- Breast tenderness
- Diarrhoea
- Dizziness
- Fatigue
- Haemorrhage
- Vomiting
Does levonorgestrel affect lactation?
No
Progestogen-only contraceptive do not affect lactation
What advice do you give if patient starts vomiting within 3 hours of taking levonorgestrel as emergency contraception?
Take another pill as soon as possible
What information do you need to give to a patient who is going to take oral levonorgestrel or ulipristal acetate as emergency contraception? (6)
- If vomiting occurs within 3 hours, a replacement dose should be taken
- Their next period may be early or late
- Seek medical attention promptly if any lower abdominal pain occurs (ectopic pregnancy)
- Barrier method of contraception needs to be used
- A pregnancy test should be performed if the next menstrual period is delayed by more than 7 days, is lighter than usual or is associated with abdominal pain not typical of usual dysmenorrhoea
- A pregnancy test should be performed if hormonal contraception is started soon after use of emergency contraception even if they have bleeding
Over what age can pharmacists sell the emergency contraception Levonelle One Step to women?
16 years
(drug?) is a synthetic, selective progesterone receptor modulator with a partial progesterone antagonist effect.
Ulipristal acetate
Ulipristal acetate is a synthetic, selective (?) receptor modulator with a partial progesterone antagonist effect.
progesterone
Ulipristal acetate is a synthetic, selective progesterone receptor modulator with a partial (?) antagonist effect.
progesterone
What are the two indications for the use of ulipristal acetate?
- Emergency contraception
2. Uterine fibroids
What is the dose of ulipristal acetate for emergency contraception?
30 mg for 1 dose
Taken within 120 hours after UPSI
What are the contra-indications for the use of ulipristal acetate?
- Breast cancer
- Cervical cancer
- Ovarian cancer
- Severe asthma controlled by oral glucocorticoids
- Undiagnosed vaginal bleeding
- Uterine cancer
What are the common side effects of ulipristal acetate? (18)
- Asthenia
- Breast abnormalities
- Dizziness
- Endometrial thickening
- GI discomfort
- Headaches
- Hot flush
- Menstrual cycle irregularities
- Mood altered
- Myalgia
- Nausea
- Ovarian and fallopian tube disorders
- Pain
- Pelvic pain
- Skin reactions
- Vertigo
- Vomiting
- Weight increased
Can a patient breast feed if they take ulipristal acetate as emergency contraception?
No for 1 week after administration
Present in milk
Can a woman with hepatic impairment use ulipristal acetate as emergency contraception?
No (avoid)
What advice do you need to give a patient regarding driving if they are prescribed ulipristal acetate for emergency contraception?
Increased risk of dizziness may effect driving and performance of skilled tasks
Which patients have an increased risk of uterine perforation when the copper intra-uterine device is inserted?
- Up to 36 weeks postpartum
2. Breastfeeding
Perforation occurs in how many insertions of the copper intra-uterine device?
1 in every 1000 insertions
Signs and symptoms:
- Severe pelvic pain after insertion
- Pain or increased bleeding after insertion which continues for more than a few weeks
- Sudden changes in periods
- Pain during intercourse
- Unable to feel the threads
What are the signs and symptoms of uterine perforation following the insertion of the copper intra-uterine device? (5)
- Severe pelvic pain after insertion
- Pain or increased bleeding after insertion which continues for more than a few weeks
- Sudden changes in periods
- Pain during intercourse
- Unable to feel the threads
What are the contra-indications to the use of the copper intra-uterine device?
- Active trophoblastic disease
- Genital malignancy
- Medical diathermy
- Pelvic inflammatory disease
- Post-abortion sepsis
- Postpartum sepsis
- Recent sexually transmitted infection (if not fully investigated and treated)
- Severe anaemia
- Unexplained uterine bleeding
- Wilson’s disease
What is considered the main cause of pelvic infection within the first 20 days of a copper intra-uterine device insertion?
Existing carriage of a STI
What monitoring is required if a copper intra-uterine device is inserted?
Gynaecological exam:
- Before insertion
- 6-8 weeks after insertion
- Annually
