Emergency Contraception

Question 1

What are the 3 methods of emergency contraception?

Answer 1

• Hormonal
  
  1. Levonorgestrel
  2. Ulipristal
• IUD

Question 2

Tell me about Levonorgestrel.

(Dose, How to take, Mode of action, S/E)

Answer 2

1. Should be taken as soon as possible - efficacy decreases with time
2. Must be taken within 72 hrs of unprotected sexual intercourse (UPSI)*
3. Single dose of levonorgestrel 1.5mg (a progesterone)
4. Mode of action not fully understood - acts both to stop ovulation and inhibit implantation
5. 84% effective is used within 72 hours of UPSI
6. Levonorgestrel is safe and well tolerated. Disturbance of the current menstrual cycle is seen in a significant minority of women. Vomiting occurs in around 1%
7. If vomiting occurs within 2 hours then the dose should be repeated
8. Can be used more than once in a menstrual cycle if clinically indicated

Question 3

Tell me about Ulipristal.

(Dose, How to take, Mode of action, S/E)

Answer 3

• A progesterone receptor modulator currently marketed as EllaOne. The primary mode of action is thought to be inhibition of ovulation
• 30mg oral dose taken as soon as possible, no later than 120 hours after intercourse
• Concomitant use with levonorgestrel is not recommended
• May reduce the effectiveness of combined oral contraceptive pills and progesterone only pills
• Caution should be exercised in patients with severe asthma
• Repeated dosing within the same menstrual cycle is not recommended
• Breastfeeding should be delayed for one week after taking ulipristal. There are no such restrictions on the use of levonorgestrel

Question 4

Tell me about the IUD as an emergency contraceptive.

(Dose, How to take, Mode of action, S/E)

Answer 4

• Must be inserted within 5 days of UPSI OR If a women presents after more than 5 days then an IUD may be fitted up to 5 days after the likely ovulation date.
• May inhibit fertilisation or implantation
• Prophylactic antibiotics may be given if the patient is considered to be at high-risk of STI.
• Is 99% effective regardless of where it is used in the cycle
• May be left in-situ to provide long-term contraception. If the client wishes for the IUD to be removed it should be at least kept in until the next period

Question 5

After giving brith, a lady comes to you & asks about the chancing of getting pregnant again. She is breastfeeding. When is the lactational amenorrhoea method (LAM) most effective?

Answer 5

• It is 98% effective if the woman is:
  
  • < 6 months postpartum
  • Amenorrhoeic
  • Fully breastfeeding
• These criteria should be met otherwise emergency contraception is needed.

Question 6

If a mother is breastfeeding, what is the more ideal emergency contraception?

Answer 6

Levonorgestrel as it can be used whilst breastfeeding.

HOWEVER: if it is a delayed presentation Ulipristal can be used

BUT breastfeeding should be delayed for 1 week after taking ulipristal.