Emergency contraception (Complete) Flashcards
What are the two main types of emergency contraception?
Hormonal emergency contraception (‘emergency pill; ‘morning after pill’)
Intrauterine device (IUD)
What are the two main types of emergency hormonal contraception?
Levonorgestrel (e.g. levonelle)
Ulipristal acetate (e.g. ellaOne)
What is the mechanism of action of levonorgestrel?
Prevents ovulation and implantation
Name an example of medication which uses levonorgestrel
Levonelle
Levonorgestrel should be given within which timeframe from unprotected sexual intercourse?
Within 72 hours
Should be given ASAP as effectiveness decreases with time
Levonorgestrel is less effective in which scenarios?
UPSI occured >72 hours
Patient BMI> 26 (or >70kg)
Taking enzyme-inducing drugs (e.g. antiepileptics such as carbamazepine)
What is the typical dosage of levonorgestrel for emergency contraception?
Single dose 1.5mg
How is the dosage altered for levonorgestrel if the patient has a high BMI (>26/70kg) or is taking enzyme inducing medication?
Double the dosage (3mg)
How should patients who have vomitted after taking the levonorgestrel pill be managed?
Vomitting occured within 2-3 hours since taking the pill: Take a second pill
Vomitting occured >2-3 hours since taking pill: No need to take a second pill
Geeky medics say 2 hours versus passmed which say 3
True or false: Levonorgestrel can be used more than once within a menstrual cycle if required
True
True or false: Hormonal contraception can be used immediately after taking Levonorgestrel for emergency contraception
True
What is the mechanism of action of ulipristal acetate
Prevents ovulation
Name an example of medication which uses ulipristal acetate
ellaOne
Ulipristal acetate should be given within which timeframe from unprotected sexual intercourse?
120 hours (5 days)
Can be more effective than Levonorgestrel, especially later within the 5-day period
What is the typical dosage of ulipristal acetate
30mg
Ulipristal acetate is a contraindiction in which individuals?
Asthmatic patients
Blocks gluccocorticoid receptors, impairing smooth muscle relaxation
True or false: Hormonal contraception can be taken immediately after taking ulipristal acetate
False
Ulipristal reduces the effectiveness of hormonal contraception
What should be advised for woman on hormonal contraception if taking ulipristal acetate?
Start/restart hormonal contraception (pill, patch or ring) after five days of taking ulipristal acetate.
Barrier protection should be used in the meantime
Which form of hormonal emergency contraception is okay to use if breastfeeding?
Levonorgestrel
Ulipristal acetate should not be given
What is the most effective method of contraception?
Copper intrauterine device
What is the mechanism of action of copper IUD?
Releases copper ions, which are toxic to sperm, preventing fertilisation.
Prevent implantation if fertilisation has occurred.
Name an example of a type of copper IUD
ParaGard
Copper IUD should be inserted within which timeframe from UPSI
Within 120 hours (5 days)
If a woman has missed the 120 hour timefram from copper IUD, what is the next best option?
Insert copper IUD within 120 hours of likely ovulation date
Which form of emergency contraception can be used as both long term and short term contraception?
Copper IUD
If a woman chooses not to use copper IUD as long-term contraception, when should it be removed?
Should be kept at least until next period
Copper IUD is contraindicted in which cases?
In patients with STI or abnormal uterus
N.B. Can also worsen bleeding in patients with menorrhagia so hormonal emergency contraception preferred
What can be given if patient does not have STI but is at high-risk and plans to have copper IUD inserted?
Consider prophylactic ABs
