Emergency contraception

Question 1

Emergency contraception

Answer 1

can be used after episodes of unprotected intercourse (UPSI)

• Levonorgestrel should be taken within 72 hours of UPSI (3 days)
• Ulipristal should be taken within 120 hours of UPSI (5 days)
• Copper coil can be inserted within 5 days of UPSI, or within 5 days of the estimated date of ovulation

Question 2

Intrauterine device

• when can you give it?
• MOA?

Answer 2

copper coil can be used up to 5 days after unprotected intercourse or within 5 days after the earliest estimated date of ovulation

copper coil is toxic to ovum and sperm, inhibits implantation. insertion can lead to PID if high risk of STI. keep coil in until next period and can be moved or left as long term contraception.

Question 3

Levonorgestrel

• what is it?
• when can you give it? how much?
• other pills
• side effects and breastfeeding

Answer 3

type of progestogen
prevents / delays ovulation
same hormone found in the intrauterine system

licensed for up to 72 hours post intercourse
1.5mg single dose
3mg single dose in
women above 70kg or BMI above 26

not harmful if pregnancy occurs

COCP and POP can be taken immediately after taking levonorgestrel. extra contraception required for first 7 days of the pill / first 2 days of POP

side effect: nausea and vomiting. if occurs 3 hrs after pill- repeat.

side effects:
Spotting and changes to the next menstrual period
Diarrhoea
Breast tenderness
Dizziness
Depressed mood

avoid breast feeding 8hrs after taking the dose to reduce exposure to infant

Question 4

Ulipristal (EllaOne

• MOA
• what do about the other pills
• how much (mg)
• side effects + breastfeeding + contraindications

Answer 4

selective progesterone receptor modulator (SERM) works by delayign ovulation

more effective than levongestrol

Wait 5 days before starting the combined pill or progestogen-only pill after taking ulipristal. Extra contraception (ie. condoms) is required for the first 7 days of the combined pill or the first 2 days of the progestogen-only pill.

single dose 30mg
licensed up to 120 hours after inttercourse

Nausea and vomiting are common side effects. If vomiting occurs within 3 hours of taking the pill, the dose should be repeated.

Other side effects include:

Spotting and changes to the next menstrual period
Abdominal or pelvic pain
Back pain
Mood changes
Headache
Dizziness
Breast tenderness

• avoid breastfeeding 1 week after (express and discard milk)
• *avoid in patient with severe asthma