emergency contraception Flashcards
When is emergency contraception used?
Prevent pregnancy after isolated episodes of unprotected intercourse
Sexual intercourse without contraception
Contraceptive method has failed
What are types of emergency contraception
Emergency hormonal contraception:
Levonogestrel
Ullipristal acetate (EllaOne)
IUCD
How does the IUCD work in emergency?
Copper IUD is inserted within 5 days of unprotected sex
Copper coil is toxic to sperm and may induce a sterile inflammatory response within the uterus that makes implantation impossible
Keep in until the next period (or longer)
Advantages of IUCD emergency contraception?
IF exposure was > 5 days previously it can be inserted up to 5 days after likely ovulation so is useful in women who present later
Provides protection past initial administration
Unaffected by enzyme inducers
What is ullpristal acetate? When can ullipristal acetate be given?
Progesterone receptor modulator
It can delay ovulation by 5 to 7 days after which any sperm will have become non-viable
Within 120 hours of unprotected sex
Can be used more than once in the same cycle
What are contraindication of ullpristal acetate?
Diseases of malabsorption
Hypersenstivity
Severe hepatic dysfunction
Enzyme inducing drugs: CRAB
Breast feeding - delay for one week after taking
Asthma insufficiently controlled by corticosteroids
Drugs increasing gastric pH - omeprazole, ranitidine
What is levonorgestrel? How does it work? When can it be used?
Synthetic progesterone
Delays ovulation for 5-7 days
Use within 72 hours of unprotected sex
Can be used more than once in a mentrual cycle
What are contraindications for levonorgestrel?
Disease’s of malabsorption
If on or within 28 days of taking enzyme inducer - if patient refuses IUCD - double dose
If vomiting occurs within 2 hours of taking dose, repeat immediately
What are CI to the copper IUD?
Uterine fibroids with distortion of uterine cavity
Documented or suspected PID
Documented or suspected STI
What follow up advice for emergency hormonal contraception?
Seek help if vomiting occurs within 2 hours of taking levonorgestrel or 3 hours of takin ullipristal acetate - inadequate absorption
IUD affords protection for the rest of the cycle
Advice use of effective contraception
Consider pregnancy test no sooner than 3 weeks after unprotected intercourse to exclude pregnancy
What advice for IUD?
Increased relative risk fo ectopic pregnancy
Be alert if next period is > 5 days late with reduced bleeding and severe abdominal pain
What should you offer on UPSI at day 20 of 28 day cycle?
IUD
Hormonal options less effective after ovulation - still give if IUD is declined in cause she ovulated late/has irregular cycles
