Emergency Contraception Flashcards
What is emergency contraception?
- Levonorgestrel should be taken within 72 hours of UPSI
- Ulipristal should be taken within 120 hours of UPSI
- Copper coil can be inserted within 5 days of UPSI, or within 5 days of the estimated date of ovulation
What are the different types of emergency contraception?
Levonorgestrel should be taken within 72 hours of UPSI
Ulipristal should be taken within 120 hours of UPSI
Copper coil can be inserted within 5 days of UPSI, or within 5 days of the estimated date of ovulation
What is the most common effective type of emergency contraception? What is the advantage of it?
The copper coil is the most effective. It is also not affected by BMI, enzyme-inducing drugs or malabsorption, all of which can significantly reduce the effectiveness of oral methods.
When is oral emergency contraception unlikely to work?
- With oral emergency contraception, the sooner it is taken, the more effective it is.
- Oral emergency contraception is unlikely to be effective after ovulation has occurred; however, it is offered after UPSI on any day of the menstrual cycle.
- The woman needs to take a pregnancy test if her period is delayed.
Oral emergency contraception does not protect against further episodes of UPSI. The FSRH guidelines (2017) state that both levonorgestrel and ulipristal can be used more than once in a menstrual cycle.
What things should we consider when starting emergency contraception?
- Reassure about confidentiality
- Sexually transmitted infections
- Future contraception plans
- Safeguarding, rape and abuse
When can the copper coil be used?
- The copper coil can be used as an emergency contraception up to 5 days after unprotected intercourse, or within 5 days after the earliest estimated date of ovulation.
- Ovulation occurs 14 days before the end of the cycle, so if a woman’s shortest cycle length is 28 days, the earliest estimated date of ovulation is day 14. It would be day 12 for a 26-day cycle, or day 16 for a 30-day cycle.
How does the copper coil work? How effective is it?
- The copper coil is toxic to the ovum and sperm, and also inhibits implantation.
- It is the most effective emergency contraception, being over 99% effective.
- The FSRH guidelines (2017) advised offering the copper coil first line for emergency contraception.
What is the risk of inserting the copper coil?
Insertion may lead to pelvic inflammatory disease, particularly in women that are high risk of sexually transmitted infections. Consider empirical treatment of pelvic infections where the risk is higher.
How long does the coil need to be kept in?
The coil should be kept in until at least the next period, after which it can be removed. Alternatively, it can be left in long-term as contraception.
What is the MOA of levonorgestrel?
- Levonorgestrel is a type of progestogen. It works by preventing or delaying ovulation. It is the same hormone found in the intrauterine system (hormonal coil).
- It is not known to be harmful to the pregnancy if pregnancy does occur.
How long after UPSI can levonorgestrel be used? How effective is it?
Must be within 72 hours of UPSI (95% effective in first 24 hours, 84% effective over 48 hours)
What dose of levonorgestrel must be given? What are the side effects? What should we warn about?
Levonorgestrel is licensed for use up to 72 hours post intercourse. The dose listed in the BNF is:
- 1.5mg as a single dose
- 3mg as a single dose in women above 70kg or BMI above 26
Nausea and vomiting are common side effects. Warning: If vomiting occurs within 2 hours of dose, should be repeated
- Spotting and changes to the next menstrual period
- Diarrhoea
- Breast tenderness
- Dizziness
- Depressed mood
Is levonorgestrel harmful when breastfeeding?
Levonorgestrel is not known to be harmful when breastfeeding, and breastfeeding can continue (unlikely ulipristal).
The NICE CKS advise that breastfeeding is avoided for 8 hours after taking the dose to reduce the exposure to the infant.
How long after levonorgestrel can the COCP or POP be used? What advice should be given?
The combined pill or progestogen-only pill can be started immediatelyafter taking levonorgestrel. Extra contraception (i.e. condoms) is required for the first 7 days of the combined pill or the first 2 days of the progestogen-only pill
How does Ulipristal acetate work?
Ulipristal acetate is a selective progesterone receptor modulator (SERM) that works by delaying ovulation.
Progesterone receptor modulator – inhibits ovulation
