Emergency Contraception

Question 1

When is a COC classed as a missed pill?

Answer 1

12 hours late

Question 2

What should be done if 1 COC pill is missed?

Answer 2

Take ASAP and continue remaining pills at usual time. No EHC or barrier required.

Question 3

What should be done if 2 COC pills are missed?

Answer 3

Take missed pill ASAP (don’t double dose) and continue remaining pills at usual time.
HFI or day 1-7: EHC required
Day 8-14: no EHC. Continue taking as usual. Use barrier for 7 days
Day 15-21: no EHC: Continue taking as usual but omit HFI and continue taking next pack straight away. Use barrier for 7 days.

Question 4

When is a POP class as missed?

Answer 4

> 3 hours late
12 hours late - desogestrel
24 hours late - drospirenone

Question 5

What should be done if POP missed pill?

Answer 5

Take ASAP then continue at normal time.
Avoid UPSI/use barrier method for 2 days, or 7 if on drospirenone.

Question 6

What are the options for emergency contraception?

Answer 6

Cu-IUD
Ellaone - ulipristal acetate
Levonelle - Levonorgestrel

Question 7

Considerations for EC?

Answer 7

Age - referral and licensing
Time since UPSI
Stage of cycle - within 24h of ovulation and after EHC will not work.
Timing of missed pill

Question 8

Generally, when does ovulation occur?

Answer 8

14 days before next period

Question 9

How does Cu-IUD work?

Answer 9

Inhibits fertilisation by its toxic effects which cause reduced motility and viability of sperm and reduced viability and transport of ova. If fertilisation does occur, the local endometrial reaction resulting from the presence of Cu-IUD prevents implantation.

Question 10

How long can IUD be used for EC?

Answer 10

Within 5 days (120 hours) after UPSI in a cycle or within 5 days of the earliest estimated date of ovulation (14 days before next period), whichever is later.

Question 11

How does ellaOne work for EC?

Answer 11

By inhibiting or delaying ovulation by bind to the human progesterone receptor and suppressing the luteinizing hormone surge.

Question 12

How long can ellaOne be given for EC?

Answer 12

120 hours

Question 13

How does Levonelle work for EC?

Answer 13

by inhibiting ovulation, theyrby delaying or preventing follicular rupture and causing luteal dysfunction.

Question 14

How long can levonelle be given for EC?

Answer 14

72 hours

Question 15

Counselling for IUD EC?

Answer 15

Consider STI test
Not suitable if have STI, PID, or irregular vaginal bleeding.
Doesn’t use hormones
Provides long-term contraception
Can be painful when being inserted/removed.
Can cause some period-like pains, irregular bleeding, heavier periods.
Risk of infections such as thrush

Question 16

How effective is EC?

Answer 16

IUD 99.9% within 120h

ellaOne 98-99% within 120h

Levonelle:
Within 24h - 95%
Within 48h - 85%
Within 72h - 58%

Question 17

Referral points after IUD fitted?

Answer 17

Intense lower abdomen pain which painkillers don’t help.
Fever
Abnormal or odourous discharge
Very heavy vaginal bleeding
Suspected pregnancy
You can’t feel the threads/they feel different

Question 18

Counselling for EHC

Answer 18

Can cause: Headache, Nausea, Period-like pains/cramps, heavier period.

If you vomit within 2 hours, you need another one.

Take pregnancy test after 72 hours.

Consider an STI test

Question 19

Who shouldn’t use levonogestrel for EC?

Answer 19

<16
>165lbs / 75kg
UPSI >72 hours