Emergency contraception

Question 1

What should you assess when a patient younger than 16 years requires contraception / EC?

Answer 1

Fraser criteria

Question 2

What is the Fraser criteria?

Answer 2

Children under the age of 16 must demonstrate that they are competent to consent to medical treatment- As opposed to presumed competency.

Contraceptive advice and treatment can be provided to children younger than 16 without parental consent if they meet Fraser criteria for competence:

• Young person UNDERSTANDS the practitioner’s advice
• Practitioner cannot persuade YP to inform their PARENTS, or allow you to inform their parents, that contraceptive advice has been sought
• YP is likely to begin or CONTINUE having SI with or without contraceptive treatment
• YP MENTAL or PHYSICAL HEALTH is likely to suffer without contraceptive advice or treatment
• The YP BEST INTERESTS requires the practitioner to give contraceptive advice or treatment without parental consent

Question 3

Which situations would you need to consider EC?

Answer 3

If woman not wishing to conceive and had UPSI:

• On any day of a natural menstrual cycle
• After regular hormonal contraception has been compromised or used incorrectly
• From 21 days after childbirth
  — Unless LAM criteria are met [complete amenorrhea, fully breastfeeding (>85% feeds are BM), 6 months or less post partum]
• From day 5 after miscarriage, abortion, ectopic, or uterine evacuation for gestational trophoblastic disease

Question 4

How do you calculate the earliest likely date of ovulation?

Answer 4

• Estimated date of the start of the LMP
• Plus the number of days in the shortest cycle
• Minus 14

Question 5

What factors affect the choice of EC?

Answer 5

• Whether post partum or breastfeeding
• Current medications (liver enzyme-inducing drugs and progestogens)
• Contradictions / restrictions

Question 6

EC option when no additional barrier contraception used with CHC whilst using liver anzyme-inducing meds.

Answer 6

• Additional barrier required for duration of treatment, as well as for 28 days after
• If requiring EC, offer
  – Cu-IUD, or
  – Double dose levonogestrel (3 mg)

NOT ulipristal