Emergency contraception Flashcards
What methods of oral emergency contraception are available in Canada?
- Plan B (Levonorgestrel 0.75mg PO x 2)
2. Yuzpe regimen (combined - high dose norgestrel 250ug-ethinyl estradiol 50ug - 1, then 2nd 12h later)
How effective are oral emergency contraceptives at preventing pregnancy?
8% of women will become pregnant after a single unprotected sex
1-3% will become pregnant post progestin-only EC
3-7% will become pregnant post combined hormonal method
What are indications for EC?
- Totally unprotected intercourse
- Mistimed fertility awareness
- Ejaculation onto genitals
- Coitus interruptus
- Condom breakage, leakage or slippage
- Intrauterine contraceptive device expulsion or midcycle removal
- Dislodgement of diaphragm or cervical cap during intercourse
- Spermicide alone at midcycle
- One or more missed oral contraceptive pills during week 1 of the pill package, or more than two missed oral contraceptive pills during week 2 or 3 of the pill package
- One or more progesterone-only pills is missed or delayed by more than 3 h
- Depot medroxyprogesterone acetate shot is two or more weeks late
- Transdermal contraceptive patch is detached for 24 h or longer during week 1, or detachment of the transdermal contraceptive patch for 72 h or longer during week 2 or 3
- Vaginal contraceptive ring is expelled or removed for 3 h or longer during week 1, or removed for 72 h or longer during week 2 or 3
- Vaginal ring left in for more than five weeks in a row
- The start of a combined hormonal contraception is delayed by 24 h or more
- Sexual assault (not using reliable contraception)
- Condom alone or spermicide alone plus recent teratogen exposure (eg, Accutane)
- Advance prescription for any girl who does not want to become pregnant and who may find herself in one of the above situations
What are absolute contraindications to oral EC?
- Known pregnancy (makes EC ineffective)
2. Known allergy
What are relative contraindications to combined oral EC?
- hx DVT
- hx PE or stroke
- known thrombophilia
- Migraines with neurological symptoms
How long after unprotected sexual intercourse is oral EC effective?
Most effective within 72h, can still prevent pregnancy up to 120h
What are adverse effects of progestin-only oral EC?
- Headache 50%
- Fatigue 21%
- Nausea 38%
- Dizziness 27%
- Return of menses within 7d 62.5%
No teratogenic effect
What are adverse effects of combined oral EC?
Nausea and emesis are frequent
Which medications might reduce the efficacy of combined oral EC?
- Some antiepileptic drugs
- St. John’s wort
- HIV medications
- Rifampin
- Griseofulvin
What non-hormonal EC options are available?
Copper IUD
How long after unprotected sexual intercourse is the copper IUD effective?
Within 120h
For up to 7d in women who are in stable, mutually monogamous relationship at low risk for STI
What testing is recommended before use of copper-IUD?
- urine pregnancy test or serum hCG prior
- Endocervical specimens for gonorrhea and chlamydia at time of insertion
- Consider prophylactic antibiotics for gonorrhea and chlamydia
What should be included in a history of a patient requesting EC?
- Date and nature of LMP
- Timing of sexual intercourse
- History of contraceptive use
- History of contraindications to combined OC
What should be done on a physical examination for a patient requesting EC?
- BP
2. Pelvic exam if LMP unusual or if suspicion of pregnancy or STIs
What counselling should be provided with EC?
- Explain the method of EC
- Explain the possibility of failure of the method
- Explain that the next period might be early, on time or late
- Discuss options should she become pregnant
- If having sexual intercourse before her next period use a barrier method with spermicide (increased risk as EC delays ovulation)
- They can start a new pack of pills the day after she takes EC
- Warn that ECs do not prevent or treat STIs
- Advise to return for a pregnancy test if their period is >1 week late or if next period is unusual
- Advise to return if heavy bleeding or pain
