Emergency Contraception (EC) Flashcards
What is the aim of emergency contraception (EC)?
Intervention aimed at preventing unintended pregnancy after unprotected sexual intercourse (UPSI) or contraceptive failure.
What are the 3 options for EC? And when is each method appropraite?
- Levonorgestrel- a progestogen taken in one dose as a 1.5 mg tablet, licensed to be used within 72 hours (3 days) of UPSI or contraceptive failure.
- Ulipristal acetate- a selective progesterone receptor modulator taken in one dose as a 30 mg tablet, licensed to be used within 120 hours (5 days) of UPSI or contraceptive failure.
- The copper-bearing intrauterine device (Cu-IUD). This can be inserted up to 120 hours (5 days) after the first episode of UPSI, and provides ongoing contraceptive protection.
What is the mechanism of action of Levonorgestrel?
Levonorgestrel is to inhibit ovulation for about 5–7 days
What is the mechanism of action of ulipristal acetate?
Ulipristal acetate is to inhibit or delay ovulation
What is the mechanism of action of Cu-IUDs?
Toxic effects of copper on the ovum and sperm→ preventing fertilization
What are the advantages of Levonorgestrel?
- All methods are available free if obtained through the NHS
- All methods are safe
- Levonorgestrel is readily available from general practices, sexual and reproductive health clinics and pharmacies.
- Levonorgestrel can be used more than once during the same cycle
What are the disadvantages of Levonorgestrel?
- Limited window of opportunity in which emergency contraception is effective
- Risk of sexually transmitted infections
- A repeated dose is required if the woman vomits less than 3 hours after taking the tablet
- May be effective for up to 120 hours but it is not licensed for use beyond 72 hours
- Less suitable for women using drugs or certain herbal preparations that induce liver enzymes
What are the advantages of ulipristal acetate?
- All methods are available free if obtained through the NHS
- All methods are safe
- Readily available from general practices, sexual and reproductive health clinics and pharmacies
What are the disadvantages of ulipristal acetate?
- Limited window of opportunity in which emergency contraception is effective
- Risk of sexually transmitted infections
- A repeated dose is required if the woman vomits less than 3 hours after taking the tablet.
- Is not suitable for women using drugs or certain herbal preparations that induce liver enzymes
- Breastfeeding should be avoided for 1 week after taking ulipristal acetate
What are the advantages of Cu-IUD?
- All methods are available free if obtained through the NHS
- All methods are safe
- Left in place for ongoing contraception after use as emergency contraception
- Easily removed and fertility is immediately restored to normal
What are the disadvantages of Cu-IUD?
- Limited window of opportunity in which emergency contraception is effective
- Risk of sexually transmitted infections
- Less readily available for emergency contraception than levonorgestrel or ulipristal acetate
- Pain during IUD fitting
- IUD perforation into the uterus
- Increased risk of pelvic infection following insertion
- Some women experience heavier, longer, or more painful periods after an IUD has been fitted
- Spontaneous expulsion of IUD
What is the efficacy of levonorgestrel, ulipristal acetate and Cu-IUD?
- Failure rates for Cu-IUD is lower than 1%.
- Failure rates for ulipristal acetate range from 0.9% to 2.1%
- Failure rates for levonorgestrel range from 0.6% to 3.1%
Which method of emergency contraception is the most efficacious?
Cu-IUD
Where can women obtain EC?
- Emergency contraception is available free of charge from a number of sources, including:
- General practices
- Contraception and sexual health clinics
- Young person’s clinics
- Brook Advisory Centres- for people 25 years of age and younger
- Levonorgestrel and ulipristal can also be obtained free from all pharmacies
