Emergency Contraception Flashcards
1
Q
Who May Benefit from EC?
A
Any woman of reproductive age experiencing…
- Contraceptive failure
- No contraception used
- Sexual assault
- Exposure to teratogen
2
Q
EC Options
A
- Levonorgestrel (LNG, Plan B One-Step®)
- Ulipristal acetate (UPA, ella®)
- Combined (estrogen/progestin) oral contraceptives taken in larger quantities (COCs, “Yuzpe regimen”)
- Copper intrauterine device (IUD, Paragard®)
3
Q
Levonorgestrel (dosing, reduced efficacy, MOA, AE, DDI)
A
- Progestin
- Regimen: LNG 1.5 mg po x 1, within 120 hours (ASAP)
- MOA: Delays ovulation when taken before LH surge
- Efficacy: may decrease after 72 hours or may be reduced if body weight > 165 pounds, BMI > 26
- AE: nausea, abdominal pain, fatigue, headache, vomiting, next menses bleeding duration may be longer
- DDI: CYP3A4 substrate, potential for reduced effectiveness with inducers
- OTC
4
Q
Ulipristal Acetate (dosing, MOA, efficacy, AE, DDI)
A
- Progesterone receptor agonist/antagonist
- Regimen: 30 mg po x 1, within 120 hours (ASAP)
- MOA: Delays ovulation
- Efficacy: *More effective than LNG
- ADR: headache, nausea, abdominal pain, may delay next menses
- DDI: CYP3A4 substrate, potential for reduced effectiveness with inducers
- Requires RX
- Discard breastmilk for 24 hours after use
5
Q
Copper Intrauterine Device (dosing, MOA, efficacy, AE)
A
- Paragard®, Copper T 380A
- Regimen: insert when UPI occurs within 5 days of ovulation or when pregnancy can be ruled out
**Leave in place until next mensural cycle occurs, longer if desired - MOA: reduce sperm function & egg transit thru FT → prevents fertilization + implantation
- Efficacy: >99%
- AE: heavier menstrual bleeding and increase in
menstrual cramping (uterine perforation) - Requires placement by clinician
6
Q
Levonorgestrel 52 mg Intrauterine Device
A
- Liletta, Mirena
- Regimen: insert when UPI occurs within 5 days of ovulation or when pregnancy can be ruled out
- *Leave in place until next mensural cycle occurs, longer if desired
- MOA: Unknown = Efficacy: >99%
7
Q
Repeat EC Use
A
- Recommend the most effective method (Cu IUD)
- No need to repeat oral EC within 24 hours
- Don’t mix LNG and UPA EC within 5 days
- OK to repeat same ECP within cycle
8
Q
Effectiveness: BMI
A
- No loss of effectiveness for IUD
- Offer most effective methods (IUD & UPA) for all women
- Don’t withhold ECPs due to body weight if options are limited
9
Q
Patient Counseling (Preg? STIs? Sex? Vomit?)
A
Explain mechanism…
- Will not affect an established pregnancy
- NOT teratogenic
- EC does not protect from STI’s (refer for screening)
- Will not protect against further acts of unprotected intercourse after EC → must start birth control method
- EC NOT as effective as other methods of birth control
Side effects…
- Nausea/vomiting, abdominal pain, headaches, breast
tenderness, and dizziness have been reported
- If vomit within 2-3 hours of EC dose, may need to repeat
10
Q
What to Expect
A
- Next period may be earlier or later than usual
- Recommend pregnancy test and medical follow up if:
- Menses delayed more than 1 week from expected
- No menses 3 weeks after EC
- Medical attention if abdominal pain
11
Q
Initiating Contraception After LNG
A
Jump/Quick start
= Start contraceptive method the same day
= Use backup method for 7 days
12
Q
Hormonal Contraception before/after UPA
A
- UPA and initiating HC -> wait 5 days
- UPA and resuming HC after ≤ 3 days of missed doses -> immediate restart
- Can change the start of the 5-day waiting period from the day UPA taken to the day that unprotected sex occurred since sperm only viable for 5 days
- Barrier method recommended for 7 days (not until next menstrual period)
13
Q
How to Obtain EC
A
- LNG – originally “dual-label” status
1. Over-the-counter for people of any age or gender
2. Rx for patients of any age (by pharmacist) - Ulipristal – Rx only
- IUD – Clinic visit only
14
Q
Adolescent Access
A
- There is no age minimum or limit for OTC LNG purchase
Adolescents still face barriers when seeking EC
- Incorrect point-of-sale restrictions
- EC located in restrictive store locations
- Asked personal questions
15
Q
California Statewide Protocol for EC
A
- Training Requirement
- Methods (Levonorgestrel EC, Ulipristal acetate EC, Condoms)
- Age
- Screening
- Fact Sheet
