Emergency contraception

Question 1

What are the main mechanisms of emergency contraception? What other effects does it have?

Answer 1

Main mechanism
- suppress or delay ovulation
- if ovulation occurs, it is not functional

Other mechanisms
- Effects on cervical mucous
- Corpus luteum sufficiency
- Endometrial receptivity
- zygote development, transport adhesion

Question 2

What are the options for EC (3)

Answer 2

1) hormonal (plan B)
- effective up to 5 days after sex
- COC regimens (yuzpe regimen, not labeled for EC)
- Progestin-only regimens (levonorgestrel)

2) Progesterone receptor modulator (Ella)
- Ulipristal acetate UPA - effective up to 5 days after intercourse

3) Copper IUD

Question 3

What is the MOA of progesterone receptor modulator?

Answer 3

Ulipristal acetate
When given before onset of LH surge, it inhibits 100% of follicular ruptures

Question 4

What is the MOA of Copper IUD

Answer 4

• Copper ions and by-products of inflammation are toxic for sperm/oocytes
• increase fallopian smooth muscle activity
• Stimulate myometrial contractility

Question 5

Explain the contents of plan B

Answer 5

Levonorgestrel LNG monotherapy
Single dose of 1.5mg or 2 0.75 mg 12 hours apart
- similar efficacy, no side effects difference

Question 6

Explain the Yuzpe Regimen
Administration
Side effects?

Answer 6

Admin.
- 2 doses of ethinyl estradiol (100mcg) and LNG (500mcg) 12 hours apart

Side effects
- Higher rates of N/V
- More cardiovascular concerns

Question 7

How soon can you start OC after
Hormonal EC
Ulipristal

Answer 7

Hormonal EC
- immediately
- barrier method for 7 days

Ulipristal
- 5 days after taking the dose
- barrier method if having sex

Question 8

When can you return to OC after pregnancy?

Answer 8

Not less than 6 weeks after giving birth
- can alter milk supply and inc risk of VTE

Question 9

If someone had a bariatric surgery (obesity treatment), can they use COC

Answer 9

No, use patch/ring/injection instead