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DipFSRH > Emergency Contraception > Flashcards

Emergency Contraception Flashcards

1
Q

What are the three forms of EC in the UK?

A
  • oral progestogen-only EC - levonorgestrel
  • oral selective progesterone receptor modulator - ulipristal acetate
  • copper IUD
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2
Q

Who should be offered the IUD as EC?

A

All women with no contraindications as it is the most effective method of EC

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3
Q

What are the contraindications to levonorgestrel EC?

A

None

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4
Q

In whom may the copper IUD not be suitable for EC?

A
  • More than 2 days but less than 4 weeks post-partum
  • Persistently elevated b-hCG levels following gestational trophoblastic or malignant disease
  • Uterine cavity distortion
  • current PID
  • history of copper allergy
  • known long QT syndrome
  • known symptomatic Chlamydia or Gonorrhoea infection
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5
Q

What types of EC may be affected by enzyme inducing drugs?

A

Levonorgestral and Ulipristal-acetate

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6
Q

What can you offer in someone wanting LNG EC but on enzyme inducing drugs?

A

Double dose of LNG can be prescribed off licence but explain that the effectiveness of this approach is not known. NOTE: a double dose of UPA is not recommended

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7
Q

In which women should UPA be avoided?

A
  • Hypersensitive to UPA
  • Severe asthmatics treated by oral glucocorticoids
  • Galactose intolerant, lactase deficient or have glucose-galactose malabsorption
  • Breasting (feeding not recommended for 7 days after UPA use - the milk should be expressed and discarded)
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8
Q

What is the MOA of the copper IUD?

A
  • Inhibition of fertilization
  • Anti-implantation effect
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9
Q

What is the MOA of levonorgestrel?

A
  • Delay or prevent ovulation
  • Ovulation is delayed for 5 days by which time any sperm in the reproductive tract will be non-viable
  • When taken prior to the onset of the LH surge, ovulation is delayed or inhibited
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10
Q

Up to what time period is levonorgestral licensed for as EC?

A

Up to 72 hours after UPSI. Off licence it may be taken up to 96 hours after UPSI.

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11
Q

What is the MOA of UPA?

A
  • Selective progesterone receptor modulator with antagonistic and partial agonistic effects
  • Binds to progesterone receptors in target tissues: the uterus, ovaries and hypothalamus
  • Delays ovulation for at least 5 days
  • If the LH surge has started but no peaked, ovulation can be inhibited, with up to a 5 day delay in follicular rupture.
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12
Q

Up till when can UPA be given as EC?

A

Up to 120 hours after UPSI

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13
Q

How long should women wait until resuming their normal contraception after taking UPA?

A

Wait 5 days. During this time and until effective contraceptive cover from their chosen method of contraception has been achieved, individuals should either abstain or use barrier methods.

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14
Q

What is the efficacy of LNG EC?

A

0.6-2.6% if UPSI occurred within the previous 72 hours

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15
Q

What is the efficacy of UPA EC?

A

1-2%

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16
Q

What is the efficacy of IUD EC?

A

<0.1%

17
Q

How may weight effect oral EC?

A
  • Women with a BMI >26 or a weight >70kg LNG is less effective
  • Women with BMI >30 or a weight >80kg, UPA less effective
18
Q

What should you offer as EC in women of greater weight?

A

Copper IUD
- If declines IUD, UPA can be offered
- If UPA not suitable, offer 3mg of LNG (double dose, both tablets taken at the same time) for women with BMI >26

19
Q

How do you calculate the earliest likely ovulation date?

A

Start date of the LMP plus 14 days less than the number of days in the shortest cycle

20
Q

How do you determine the latest date an IUD can be fitted?

A

The earliest likely ovulation date + 5 days.

21
Q

What must you consider before giving EC?

A
  • LMP date
  • Need for UPT
  • Earliest ovulation date
  • Timing of ALL episodes of UPSI in current cycle
  • Details of potential contraceptive failures, for example, how many missed pills and when in the packet
  • Previous EC use in the cycle
  • PMHx
  • Drug Hx
  • Need for ongoing contraception
  • Sexual Hx and STI screening
22
Q

In what circumstance can a Copper IUD not be inserted for EC if a woman has had multiple UPSI event within her current cycle?

A

If they have had multiple UPSI events >120 hours ago within the current cycle and >5 days since earliest ovulation date.

23
Q

If a woman has had UPSI within 120 hours and >5 days since her earliest ovulation date, can a Copper IUD still be inserted for EC?

A

Potentially yes if the following criteria met:

They have been correctly and consistently using a reliable method of contraception throughout the rest of their current cycle. (For the purposes of being reasonably certain that an individual is not currently pregnant, barrier methods of contraception can be considered reliable providing that they have been used consistently and correctly for every episode of intercourse.)

24
Q

When is EC indicated in a woman using CHC, POP or implant?

A

UPSI whilst using liver enzyme inducing medication or in the 28 days following their use

25
Q

When is EC indicated in a woman using COCP?

A
  • If two or more pills missed in week one and UPSI occured in that week or during HFI
  • If HFI is extended (an IUD can be fitted up to 13 days after the last active pill providing all other pills had been taken correctly)
26
Q

In what circumstance may UPA-EC effectiveness be reduced in women taking the CHC?

A

If CHC used in the 7 days prior to EC, therefore consider LNG-EC or an IUD

27
Q

When is EC indicated in women taking the CVR or CTP?

A
  • If UPSI occurred in an extended >48 hours HFI
  • If CVR or CTP removed >48 hours in week 1 and UPSI occurred in the HFI
28
Q

When is EC indicated in women taking the POP?

A

If missed pill and UPSI occurred since the missed pill and before efficacy is re-established (in the 48 hours after starting the POP)

29
Q

When is EC indicated in women taking the progestogen-only injectable?

A

If late injection more than 14 weeks since last DMPA injection and UPSI occurred in the last 5 days

30
Q

When is EC indicated in women with IUC?

A

If removal without immediate replacement, partial or complete expulsion and UPS occurred in the 5 days before removal or expulsion

31
Q

What should you do if a woman presents requiring EC between 72 and 120 hours after UPSI but UPA is contraindicated and an IUD is declined?

A

LNG may be offered but evidence shows it has no effect after 96 hours.
Offer immediate quick start of contraception with a f/u UPT in 3 weeks.

32
Q

If a woman has taken UPA-EC in her current cycle when should you not give LNG-EC?

A

LNG-EC should not be taken in the following 5 days.

33
Q

If a woman has taken LNG-EC in her current cycle when should you not give UPA-EC?

A

UPA-EC is less effective if taken in the following 7 days.

34
Q

What should you do if a woman selects an IUD for EC but it is not immediately available?

A

Offer oral EC in the interim

35
Q

How long should women wait to start their chosen method of contraception after taking UPA-EC?

A

5 days

36
Q

What aftercare should you advise following EC?

A
  • Do a UPT in 3 weeks’ time or if next menstrual period delayed by more than 7 days, is lighter than usual or is associated with abdo pain that is no typical of the woman’s usual dysmenorrhoea
  • Consider repeating offer of STI screening
  • If pregnancy occurs following oral EC, women can be reassured that evidence suggests no harmful effect on pregnancy outcomes
  • Once pregnancy excluded, IUD may be removed once ongoing contraception has been established or in line with standard IUD removal
37
Q

What should you advise if vomiting occurs within 3 hours of taking UPA or LNG?

A

A further dose of EC is needed or an IUD could be fitted

38
Q

What are common side effects of EC?

A
  • Headache
  • Dizziness
  • Diarrhoea
  • Breast tenderness

DipFSRH (14 decks)

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