Emergency Contraception

Question 1

Facilitate timely access to Levonorgestrel

Answer 1

5 days
 Regimen: LNG 1.5mg po x 1, within 120hours (ASAP)
 Efficacy decreases after 72 hours
 Timing: Most effective from day 1 to 12 of cycle; before LH surge

Question 2

Facilitate timely access to Uliprista

Answer 2

5 days
 Regimen: 30mg po x 1, within 120hrs (ASAP)
 Best efficacy within 72hrs
 Timing: Most effective from day 1 to 14 of cycle, before ovulation

Question 3

Facilitate timely access to Copper IUD

Answer 3

 Copper: insert when UPI occurs within 5 days of ovulation or when pregnancy can be ruled out
• May use for up to 10-12 years
• High efficacy (>99%)
• Timing: N/A

Question 4

Facilitate timely access to Levonorgestrel IUD

Answer 4

 Insert when UPI occurs within 5 days of ovulation or when pregnancy can be ruled out
• High efficacy (>99%)
• Timing: N/A

Question 5

Provide accurate patient education regarding the mechanism, effectiveness, and side effects of Levonorgestrel

Answer 5

Brand: Plan B One-Step

Regimen: 1.5mg po x 1, within 120hrs (ASAP)

MOA: Delays ovulation when taken before LH surge

      - If close to surge, may result in ova resistance fertilization
      - If day of/after ovulation, will not be effective, so take ASAP

Effectiveness: Highly dependent on risk of contraception, timing, and other modeling assumptions
- May be reduced if body wt. >165lb, BMI > 26kg/m^2

AEs: Nausea, abdominal pain, fatigue, headache, vomiting, next menses bleeding duration may be longer

CIs: CYP3A4 substrate, potential for reduced effectiveness with inducers

Question 6

What is the dosing regimen for Levonorgestrel?

Answer 6

1.5mg po x 1, within 120hrs (ASAP)

Question 7

What is the mechanism of action for Levonorgestrel?

Answer 7

Delays ovulation when taken before LH surge

 - If close to surge, may result in ova resistance to fertilization
 - If day of/after ovulation, will not be effective, so take ASAP

Question 8

What is the effectiveness for Levonorgestrel?

Answer 8

Highly dependent on risk of conception, timing, and other modeling assumptions
- May be reduced if body wt. >165lb, BMI > 26kg/m^2

Question 9

What is the adverse effects associated with Levonorgestrel?

Answer 9

Nausea, abdominal pain, fatigue, headache, vomiting, next menses bleeding duration may be longer

Question 10

What are the contraindications for Levonorgestrel?

Answer 10

CP3A4 substrate, potential for reduced effectiveness with inducers

Question 11

Provide accurate patient education regarding the mechanism, effectiveness, and side effects of Uliprista (UPA)

Answer 11

Brand: ella

Regimen: 30mg po x 1, within 120hrs (ASAP)

MOA: Delays ovulation

     - If taken before LH surge --> effectively delays ovulation
     - If LH surge has initiated but ovulation has not yet occurred --> may delay ovulation

Effectiveness: More effective than LNG, epspecially if:

    - May be reduced if bod

Question 12

Provide accurate patient education regarding the mechanism, effectiveness, and side effects of Uliprista (UPA)

Answer 12

Brand: ella

Regimen: 30mg po x 1, within 120hrs (ASAP)

MOA: Delays ovulation

     - If taken before LH surge --> effectively delays ovulation
     - If LH surge has initiated but ovulation has not yet occurred --> may delay ovulation

Effectiveness: More effective than LNG, especially if:

    - more than 72 hours since UPI
    - patient has body wt >165lb, BMI > 26kg/m^2

AEs: Headache, nausea, abdominal pain, may delay next menses 2 +/- 8 days

CIs: CYP3A4 substrate, potential for reduced effectiveness with inducers

Question 13

What are the dosing regimen for Ulipristal?

Answer 13

30mg po x 1, within 120hrs (ASAP)

Question 14

What are the mechanism of action for Ulipristal?

Answer 14

Delays ovulation

 - If taken before LH surge --> effectively delays ovulation
 - if LH surge has initiated but ovulation has not yet occurred --> may delay ovulation

Question 15

What are the effectiveness of Ulipristal?

Answer 15

More effective than LNG, especially if:

  - more than 72 hours since UPI
  - patient has body wt > 165lb, BMI > 16 kg/m^2

Question 16

What are the adverse effects of Ulipristal?

Answer 16

Headache, nausea, abdominal pain, may delay next menses by 2 +/- 8 days

Question 17

What are the contraindications of Ulipristal?

Answer 17

CYP3A4 substrate, potential for reduced effectiveness with inducers

Question 18

Provide accurate patient education regarding the mechanism, effectiveness, and side effects of Copper Intrauterine Device (IUD)

Answer 18

Brand: Paragard, Copper T 380A

Regimen: N/A

MOA: Effects of copper ions

  - reduce sperm function and egg transit through fallopian tube --> prevents fertilization 
  - Local inflammatory response --> prevents implantation

Effectiveness: >99%

AEs: Common: heavier menstrual bleeding and increases in menstrual cramping, particularly in the first 6 months
Rare: uterine perforation during insertion (<1:1000)
CIs: None