Emergency Contraception

Question 1

‘Two rules’ of EC

Answer 1

Was the earliest episode of UPSI within 120 hours? YES = fit the IUD

Multiple episodes/ >120 hours ago = ovulation + 5

Question 2

Latest date for different ECs to be effective

Answer 2

Levonelle: 72 hours
EllaOne (ullipristal acetate): 120 hours
IUD: 120 hours

Question 3

LEVONELLE:
MOA
What if pt is on an enzyme-inducer or BMI >26?
Limitation

Answer 3

Inhibits ovulation

Double dose!!

Less effective if UPSI near ovulation

Question 4

ELLAONE (UPA):
MOA
More or less effective than levonelle?
CI in women on what?

Answer 4

More effective!

Not effective in women using progesterone (7 days prior or 5 days after)

Question 5

COPPER IUD:
How long does it need to be in for

When does it have to be inserted by to be effective?

Answer 5

At least until the next period

As long as insertion is within ovulation + 5, will be effective

Question 6

COC: when to offer EC

Answer 6

If >2 pills missed in week 1 or 3 and there has been UPSI in pill-free interval or week 1

Question 7

POP: what is a missed pill?

Answer 7

If taken >3 hours late (or >12 hours with desogestrel)

Question 8

When is EC indicated:
Natural menstrual cycle
After childbirth
After TOP/ miscarriage/ ectopic

Answer 8

UPSI:

Any day of natural menstrual cycle

From day 21 after childbirth

From day 5 after TOP/ miscariage/ ectopic

Question 9

When can IUD be offered?

Answer 9

5 days after first UPSI or up to 5 days after ovulation