Emergency Contraception

Question 1

What options are there?

Answer 1

Levonorgestrel - levonelle
Ulipristal acetate - ellaOne
Copper IUD

Question 2

How does levonorgestrel work?

Answer 2

Mode of action not fully understood

Acts to both stop ovulation and inhibit implantation

Question 3

When should levonorgestrel be taken?

Answer 3

As soon as possible

Within 3 days of unprotected sex

Question 4

What dose of levonorgestrel is used?

Answer 4

Single dose 1.5mg

Doubled if BMI more than 26 or weight over 70kg

Question 5

What is the effectiveness of levonorgestrel?

Answer 5

95% if 24 hours
85% if 24-48 hours
58% if 48-72 hours

Question 6

What are the contraindications for levonorgestrel?

Answer 6

Pregnancy
Porphyria
May be less effective if taking enzyme inducing medications

Question 7

What are the side effects of levonorgestrel?

Answer 7

PV bleeding
Nausea/ vomiting - if vomiting occurs within 2 hours repeat dose
Headache
Breast/ pelvic pain

Question 8

How does ulipristal work?

Answer 8

A selective progesterone receptor modulator

Primary mode: inhibition of ovulation

Question 9

When should ulipristal be taken?

Answer 9

As soon as possible

Within 5 days of unprotected sex

Question 10

What dose of ulipristal should be taken?

Answer 10

Single dose

30mg

Question 11

How effective is ulipristal?

Answer 11

98%

Question 12

When should contraception be started after taking ulipristal?

Answer 12

Ulipristal may reduce effectiveness of hormonal contraception, so restart 5 days after having ulipristal. Barrier methods used in meantime

Question 13

What are the contraindications for ulipristal?

Answer 13

Pregnancy
Less than 18
Severe asthma or liver disease
May be less effective if taking enzyme inducing medications

Question 14

Can levonorgestrel and ulipristal be taken more than once in same cycle?

Answer 14

Yes

Question 15

Should breastfeeding be delayed after taking ulipristal?

Answer 15

Yes for 1 week (not needed for levonorgestrel)

Question 16

The side effects are the same for both levonorgestrel and ulipristal. True or false?

Answer 16

True

Question 17

When must the IUD be inserted for emergency contraception?

Answer 17

Within 5 days of unprotected sex

Or if more than 5 days previously then it can still be inserted up to 5 days after the earliest likely ovulation date

Question 18

How effective is the IUD?

Answer 18

99% = most effective method

Question 19

What are the contraindications for the IUD?

Answer 19

Pregnancy 
Pelvic infection/ PID less than 3 months ago
Gynae cancers
Small uterine cavity 
Copper allergy

Question 20

Can the IUD be used as long term contraception afterwards?

Answer 20

Yes

Or removed after 4 weeks