Emergency contraception

Question 1

Progestogen-only EC - overview

Answer 1

1. Method = must be used within 72 hours, 0.75mg x 2 immediately or 1 tablet 12 hours apart (former has better compliance), no prescription needed
2. Failure = 1-2%. Prevents 85% of unexpected pregnancies
3. Side effects = nausea common, vomiting rare, erratic PV bleeding common in first 7d following tx
4. If woman vomits within 2h of ingestion, she should take a further dose as soon as possible
5. Follow-up = must do pregnancy test if period delayed by 1 week

Question 2

Combined emergency contraception (‘Yuzpe’ method) - overview

Answer 2

1. Largely superseded by more effective methods
2. Method = must be within 72 hours, 100mcg EE (ethinyl estradiol) and 0.5mg LNG administered 12 hours apart with antiemetic due to vomiting that can occur with high dose of E, must see a doctor for treatment
3. Failure = 2-3%, prevents 75% of expected pregnancies
4. Side effects = nausea, vomiting, breast tenderness, delay in return of menses
5. Follow-up = must do pregnancy test if period delayed by 1 week

Question 3

Copper IUD - overview

Answer 3

1. Method = up to 5 days after unprotected intercourse, can be used for ongoing contraception
2. Failure = very low, prevents 99% of expected pregnancies
3. Contraindications = undiagnosed suspicious vaginal bleeding, PID or cervicitis, marked distortion of uterine cavity
4. Side effects = bleeding, pain, increased volume of menstrual flow, dysmenorrhoea
5. Follow-up = must do pregnancy test if period delayed by 1 week

Question 4

Emergency contraception - counselling

Answer 4

1. Check if sex was consensual - rape/coerced sex
2. Ask if contraceptive was used and what type
3. Should discuss TOP if a method fails
4. Advice for future - need to have adequate ongoing contraception so that they are not using emergency contraception as a method of contraception
5. Referral to support services as appropriate