Emergency contraception

Question 1

Emergency contraception:

Approach to consult for unplanned pregnancy?

Answer 1

1) Background
- timing of menstruation/cycle
- timing of unprotected intercourse in any time frame from 6 days prior to 2 days post possible ovulation
- medications
- are they breastfeeding

2) examination/investigation
- body weight
- beta hcG
- if indicated STI and BBV screening

3) PROVIDE A SCRIPT

4) Arrange follow up
- pregnancy test if period later than 7 days (21 days post Ulipristal acetate beta hcG is reliably negative if not pregnant)
- any contraception follow up

Question 2

Emergency contraception:

Options?

Answer 2

1) Cu-IUD
2) Levonorgestrel
3) Ulipristal Acetate

Question 3

Emergency contraception:

Decision making to choose an option?

Answer 3

1) ≤5 days post Unprotected intercourse
2) The aim should always be for Ulipristal Acetate ($50) unless contraindicated as it is more effective

Considerations:

• severe asthma
• hepatic impairment
• ≤ 28 days since CYP3A4 inducer

3) weight ≥88kg or BMI ≥30 = unknown efficacy of Ulipristal Acetate beyond these ranges
* *double dose Levonorgesterol (3mg) with antiemetic prior if these parameters are met**

Levonorgestrel 1.5mg ($15 - $60)

• repeat dosed if vomited ≤ 2hrs post dose
• will delay period slightly
• common side effects of headache, vomiting
• need a double dose above 70kg

if Levonorgestrel or Ulipristal Acetate used then progestogen containing contraception cannot be started for 5 days

4) If the above is not suitable or chosen = Cu-IUD ($90 and harder to access inserting practitioner)
- Impairs sperm motility
- prevent egg fertilisation,
- prevent ovum implantation

Contraindications:

• pregnancy
• active pelvic inflammatory disease or sexually transmitted disease
• abnormal uterine shape