Emergency Contraception Flashcards
GENERAL
What are some reasons for needing to use emergency contraception?
When contraception hasn’t been used at all, or hasn’t been used correctly
Before a new contraception has a chance to become effective
If more than 1 COCP has been missed or a patch/ring has been off/out for > 48 hours
GENERAL
Where can you get emergency contraception?
Pharmacy
Sexual health clinic
GP
Gynaecology assessment unit
GENERAL
What are the three main types of emergency contraception?
Copper coil
Levonorgestrel EC (pill)
Ulipristal acetate EC (pill)
GENERAL
What is the most effective emergency contraception that should be offered to all women requesting emergency contraception?
Why is this so good?
Copper IUD
Has both pre and post fertilisation effects i.e. toxic to egg and sperm, but also prevents fertilisation
COPPER-IUD
When can this be used?
Up to 120 hours post UPSI
OR
Up to 5 days after earliest expected date of ovulation
COPPER-IUD
When can this be used for ongoing contraception following its use as emergency contraaception?
If there is a negative pregnancy test 3 weeks later
COPPER-IUD
What should you do before inserting this as emergency contraception?
Screen high risk women for STIs and treat if there
LEVONORGESTREL PILL
What is this?
When can this be given a) on license? b) off license?
High dose progestogen
a) Up to 72 hours post UPSI b) up to 96 hours post UPSI (uneffective after that)
ULIPRISTAL ACETATE PILL
What is this?
When can this be used?
Anti-progestogen
Up to 120 hours post UPSI
EC PILLS
How do both of these work?
Are they abortifactant?
When (in terms of the menstrual cycle) do both pills work?
By delaying ovulation
No
Only before ovulation, not after
EC PILLS
Describe the effectiveness of both pills?
Levonorgestrel pill is 85% effective in the first 24 hours, reducing after that to 58%
Ulipristal acetate pill is 85% effective across 5 days
EC PILLS
What are the cautions/contraindications for each type of pill?
Liver enzyme inducers for Levonorgestrel pill
Liver enzyme inducers, breastfeeding, drugs that affect gastric pH and ongoing contraception for ulipristal acetate pill
EC PILLS
If someone comes wanting emergency contraception and weights > 70kg or has a BMI > 26, what should happen to the dose of each type of pill?
Levonorgestrel pill dose should be doubled, ulipristal acetate pill dose stays the same
ULIPRISTAL ACETATE PILL
When should this method of contraception be avoided?
If wishing to ‘quickstart’ hormonal contraception
If hormonal contraception has been used in the last 7 days
If the patient has acute severe asthma, uncontrolled by oral steroids
ULIPRISTAL ACETATE PILL
If the person is already taking ongoing contraception and they use this pill, what should be done?
Ongoing contraception must be delayed for 5 days
