Emergency Contraception counselling Flashcards
Opening the consultation?
- Introduce yourself to the patient including your name and role
- Confirm the patient’s name and date of birth
- Explore why the patient wants emergency contraception
How to explain the history?
“In order to establish whether you might need emergency contraception, and which method might work best for you, I need to first need to ask a few questions. We will talk about the details of the unprotected sex and any contraception you may be using, about your periods, about any recent sexual partners so we can think about screening for infections, and about your health in general. After this, we will see what options are available to you.”
Details of the unprotected sex?
- The date of the UPSI - where in their menstrual cycle it was
- Any other UPSI’s in this cycle
Details of the patient’s menstrual cycle?
- first day of their last period
- You will need to calculate where they are in their cycle, and when you might expect them to ovulate (14 days before menstruation)
Contraception relevance?
Need to detail any current contraception
A sexual history?
Vagina:
- SOCRATES
- Key symptoms
- Menstrual history
- Past gynaecological history
Penis:
- SOCRATES
- key symptoms
Last sexual contact
- Sign posting
- Timing
- Consent
- Relationship
- Partner demographics
- Types of sex involved
- Contraception
- other sexual patterns
HIV risk assessment
Vagina key symptoms - Sexual history?
- Abdominal and pelvic pain
- Post-coital vaginal bleeding
- Intermenstrual vaginal bleeding
- Post-menopasual bleeding
- Abnormal vaginal discharge
- Dyspareunia
- vulval skin changes and itching
- Systemic symptoms
Penis key symptoms - Sexual history?
- Abdominal and pelvic pain
- testicular pain or swelling
- Itching or sore skin
- Skin lesions
- urethral discharge
- Dysuria
- Systemic symptoms
Signposting: summary of options
- Emergency contraception helps to reduce the risk of you becoming pregnant after having unprotected sex. It will not stop an existing pregnancy, and it is not the same thing as a termination
- There are three types of emergency contraception available in the UK. Two of these are types of ‘morning-after pill’, which both work in similar ways. There is also the option of inserting a copper IUD, which is more effective than the morning after pill but involves a procedure.
“We will talk through these options together and see which one works best for you.”
What is Levonelle®?
Levonelle® is a tablet containing a hormone, which is a synthetic progestogen. It is taken as a one-off dose.
How does Levonelle® work?
Levonelle® works by inhibiting ovulation for around 5 days.
In theory, this means that any sperm present in the genital tract should no longer be alive by the time that an egg is released, and so there is no resulting pregnancy.
When can Levonelle® be taken?
Levonelle® should be taken within 72 hours of UPSI. The longer the delay, the less effective Levonelle® is. Levonelle® is not affected by other progestogen use i.e. it can be used alongside other hormonal contraception.
How effective is Levonelle®?
Of the forms of available emergency contraception, Levonelle® is on average the least effective - not effective when taken after ovulation
risks or side effects of Levonelle®?
Levonelle® can commonly cause nausea, vomiting, and delayed or early menses
- if a patient vomits within 3 hours of taking Levonelle®, they will need to repeat the dose
- Double dose needed if BMI >26
What is ellaOne®?
EllaOne® is an emergency contraceptive pill with ulipristal acetate (UPA). It is a one-dose tablet.
How does ellaOne® work?
EllaOne® works by delaying ovulation. In theory, this means that any sperm present in the genital tract should no longer be alive by the time of the (delayed) ovulation, and so there is no resulting pregnancy.
When can ellaOne® be taken?
EllaOne® can be taken within 120 hours, or 5 days, of UPSI.
It is rendered less effective by progestogen hormones, and as such should not be taken in a 7 day period following progestogen use
How effective is ellaOne®?
EllaOne® is generally more effective than Levonelle® at preventing pregnancy - If EllaOne® is taken after ovulation, evidence suggests that it is not effective
What are the risks or side effects of ellaOne®?
EllaOne® can commonly cause nausea, vomiting, and delayed or early menses - If a patient vomits within 3 hours of taking ellaOne®, they will need to repeat the dose
EllaOne® is rendered less effective by enzyme-inducing medication and is not suitable for use in patients with severe asthma.
What is the copper IUD?
a copper IUD is a small T-shaped plastic and copper device which is inserted into the womb during a small procedure. It is also known as a coil
How does the copper IUD work?
This copper is toxic to sperm and eggs, and this toxic effect prevents pregnancy”
When can the copper IUD be used?
up to 5 days, (120 hours) after unprotected sex; or within 5 days of the earliest expected date of ovulation
In order to be effective, the copper IUD should remain in situ ideally for 21 days. It can be left in place for up to 10 years to provide ongoing contraceptive protection.
How effective is the copper IUD?
When inserted at the correct time, the copper IUD is the most effective form of emergency contraception
What are the risks or side effects of the copper IUD?
A small procedure is required to insert the IUD. Although this should only last around 5 minutes, some people can find it uncomfortable. There is an associated small risk of infection, expulsion and of perforation. Some people may experience irregular bleeding for a few days after the fitting of the IUD. Periods may be heavier, longer and more painful, especially in the first few months
Follow up emergency contraception
All patients should be advised to take a pregnancy test 3 weeks after UPSI, to ensure that they have not become pregnant. This should be done even if they have bleeding as this may not represent a normal period.
