emergency contraception Flashcards
EC should be offered after UPSI from day …. after childbirth, unless lactational amenorrhoea are met.
21
EC should be offered from day … after abortion, miscarriage, ectopic pregnancy or uterine evacuation for gestational trophoblastic disease
5
what is the most effective form of EC & who should it be offered to if appropriate
insertion of Cu-IUD
all women who have had UPSOi and do not wish to conceive
How long after the first UPSI in natural menstrual cycle, or earliest estimated date of ovulation (whichever is later) can Cu-IUD be inserted
can be inserted up to 120 hours (5 days) after the first UPSI in a natural menstrual cycle, or up to 5 days after the earliest estimated date of ovulation (i.e. within the minimum period before implantation), whichever is later.
T or F - abx cover may be considered for Cu-IUD insertion if significant risk of STI that could be associated with ascending pelvic infection
true
Effect of BMI, body weight, drugs on Cu-IUD
no effect
If a Cu-IUD is not appropriate or not acceptable to the patient and there has been UPSI within the last 5 days, what should you offer ASAP
oral EHC - ulipristal or levonorgestrel
Levonorgestrel is effective if taken…
within 72h (3 days) of UPSI
T or F - levonorgestrel is effective if taken within 72h of UPSI, but can also be used 72-120h after UPSI (unlicensed)
FALSE
Can be used unlicensed 72-96h after UPSI but efficacy decreases with time
Ulipristal is effective if taken within
120h (5d) of UPSI
which EHC is more effective than the other
ulipristal
What EHC to give if pt BMI >26 or body weight >70kg
ulipristal
double dose levonorgestrel (unlicensed)
True or False - ulipristal is more effective than a double dose of levonorgestrel (unlicensed) given if pt BMI >26 or body weight >70kg
false. unknown which is more effective
what is the menstrual cycle in terms of ovulation and period
28 day cycle
period day 1-5
ovulation is day 14 (you are most fertile and more likely to get pregnant near this)
When is ulipristal 1st line EHC
- UPSI within last 96-120 hours (even if they have also had addition instances of UPSI within the last 96h)
- UPSI within last 5 days if it is likely to have taken place during the 5 days before estimated day of ovulation
What EHC can be considered for oral EC in females on regular CHC who have missed contraception within he first week of restarting their contraceptive?
levonorgestrel can be considered
True or false - EHC cannot be used as oral EC more than once in the same cycle
False.
They can but there may be increased risk of SE (E.g. menstrual irregularities) with repeated administration of levonorgestrel as emergency contraception more than once in the same cycle
True or false - if ulipristal is used as EHC more than once in the same cycle there is increased risk of SE e.g. menstrual irregularities
false - this is the case with levonorgestrel, not known for ulipristal
T or F - copper intra-uterine device immediately provides effective ongoing contraception, whereas oral emergency hormonal contraception methods do not
true
After taking levonorgestrel, when should females start suitable hormonal contraception? And do they need to use any extra contraception?
Start suitable hormonal contraception immediately. They must use condoms reliably or abstain from intercourse until contraception becomes effective.
How long after taking ulipristal should females start suitable hormonal contraception (aka they are not already on regular CHC) ? and do they need to use any extra contraception?
5 days after taking it.
Use condoms reliably or abstain from intercourse during the 5 day waiting period and also until their contraceptive method is effective.
How long after taking ulipristal should patients restart their regular CHC who have missed contraception within the first week of restarting after scheduled hormone free interval? And is any other protection needed?
Start immediately
Use condoms reliably or abstain for 7 days until contraception becomes effective
licensing ages for levonelle and EllaOne
levonelle = 16
EllaOne = none, of CB age
