Emergency contraception

Question 1

What counselling is needed if giving ECP and how is it given

Answer 1

• Advise and administration in a setting the preserves confidentiality, privacy and dignity
• Provision and advice about ongoing contraception
• Provision, and access to STI screening
• Medical review if delayed pregnancy to r/o menses
• advice about if pregnancy occurs
• OK for pharmacist dispensing

Question 2

Copper IUCD
Success
benefits
limitations 
how does it work 
When do you give it 
PID risk

Answer 2

• Pregnancy 0.1%
• Continues to provide contraception
• Toxic to sperm and ovum, prevents implantation
• legally pregnancy starts at implantation not fertilization so therefore it is not a termination
• Most effective
• 0-120 hours of UPSI OR within 5 days or expected ovulation
• 380mm copper has the lowest failure rate
• Increased risk of PID for 3 weeks after insertion
• No data about the mirena

Question 3

Ulipristal acetate 
Success
benefits
limitations 
how does it work 
When do you give it

Answer 3

30mg
• Most effective ECP
can use for up to 120 hours post UPSI
• Pregnancy rate 1.8% - no drop in efficacy over the 5 days
• progesterone receptor modulator that is synthetic steroid derived from 19-norprogesterone
• Prevents ovulation either pre ovulatory or even once the LH surg has stared - slightly extended compared to LNG as this cannot stop the surg once begun
• If it is the day of the LH peak then cannot stop ovulation
• Excreted in breast milk so not recommended for 1 week after taking UPA - pump and dump
• Not available in NZ

Question 4

Levonorgestrel (LNG) 
Success
benefits
limitations 
how does it work 
When do you give it

Answer 4

• 1.5 mg dose
1.7-2.6%
• If taken preovulatory Inhibits ovulation for 5-7 days therefore any present sperm will die before ovulation occurs. It inhibits the LH surg.
• If it is the day of the LH peak then cannot stop ovulation
• Taken ASAP - within 72 hours 95% effective, 85% 25-48 hours 58% 49-72
• some effect still 3-4 days
• If the woman vomits within 1 hour then repeat the dose
• Can be reused in a cycle but need to consider more reliable contraception
• If used in woman on liver inducers can give 2 tablets 3mg (spec book says three tabs) - but the CuIUCD would be better
• Spec book says maybe an increased risk of ectopic if pregnancy persists so need an early scan if becomes pregnant
• failure greater in higher BMI woman - ulipristal or CuIUD is better for them

Question 5

Mifepristone RU486

Success
benefits
limitations 
how does it work 
When do you give it

Answer 5

• better then Yuzpe
• 35-50mg - china, Russia, Vietnam
• Binds to progesterone receptors and blocks progesterone’s effects, Prevents ovulation.
• Disrupts luteal phase events and endometrial development
• can use up until 5 days

Question 6

Yuzpe method 
What is it 
Success
benefits
limitations 
how does it work 
When do you give it

Answer 6

• prevents 75% of pregnancies
• 100mcg ethinyl estradiol and 0.5mg LNG repeated after 12 hours - less effective and more SAs - widely available and low cost - good for limited access and privacy
• If you have the pill anyway you can take this dose
• within 72 hours
• Inhibits ovulation
• Not as effective as any of the other options - progesterone on its own has higher efficacy with lower side affects