emergency contraception

Question 1

EC should be offered after UPSI from day …. after childbirth, unless lactational amenorrhoea are met.

Answer 1

21

Question 2

EC should be offered from day … after abortion, miscarriage, ectopic pregnancy or uterine evacuation for gestational trophoblastic disease

Answer 2

5

Question 3

what is the most effective form of EC & who should it be offered to if appropriate

Answer 3

insertion of Cu-IUD
all women who have had UPSOi and do not wish to conceive

Question 4

How long after the first UPSI in natural menstrual cycle, or earliest estimated date of ovulation (whichever is later) can Cu-IUD be inserted

Answer 4

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.

Question 5

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

Answer 5

true

Question 6

Effect of BMI, body weight, drugs on Cu-IUD

Answer 6

no effect

Question 7

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

Answer 7

oral EHC - ulipristal or levonorgestrel

Question 8

Levonorgestrel is effective if taken…

Answer 8

within 72h (3 days) of UPSI

Question 9

T or F - levonorgestrel is effective if taken within 72h of UPSI, but can also be used 72-120h after UPSI (unlicensed)

Answer 9

FALSE
Can be used unlicensed 72-96h after UPSI but efficacy decreases with time

Question 10

Ulipristal is effective if taken within

Answer 10

120h (5d) of UPSI

Question 11

which EHC is more effective than the other

Answer 11

ulipristal

Question 12

What EHC to give if pt BMI >26 or body weight >70kg

Answer 12

ulipristal
double dose levonorgestrel (unlicensed)

Question 13

True or False - ulipristal is more effective than a double dose of levonorgestrel (unlicensed) given if pt BMI >26 or body weight >70kg

Answer 13

false. unknown which is more effective

Question 14

what is the menstrual cycle in terms of ovulation and period

Answer 14

28 day cycle
period day 1-5
ovulation is day 14 (you are most fertile and more likely to get pregnant near this)

Question 15

When is ulipristal 1st line EHC

Answer 15

• 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

Question 16

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?

Answer 16

levonorgestrel can be considered

Question 17

True or false - EHC cannot be used as oral EC more than once in the same cycle

Answer 17

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

Question 18

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

Answer 18

false - this is the case with levonorgestrel, not known for ulipristal

Question 19

T or F - copper intra-uterine device immediately provides effective ongoing contraception, whereas oral emergency hormonal contraception methods do not

Answer 19

true

Question 20

After taking levonorgestrel, when should females start suitable hormonal contraception? And do they need to use any extra contraception?

Answer 20

Start suitable hormonal contraception immediately. They must use condoms reliably or abstain from intercourse until contraception becomes effective.

Question 21

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?

Answer 21

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.

Question 22

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?

Answer 22

Start immediately
Use condoms reliably or abstain for 7 days until contraception becomes effective

Question 23

licensing ages for levonelle and EllaOne

Answer 23

levonelle = 16
EllaOne = none, of CB age