Emergency contraception (FSRH 2020 guideline) Flashcards
Which women should be offered emergency contraception?
- After UPSI that has taken place on any day of a natural menstrual cycle.
- After:
UPSI from Day 21 after childbirth (unless the criteria for lactational amenorrhoea are met).
UPSI from Day 5 after abortion, miscarriage, ectopic pregnancy or uterine evacuation for gestational trophoblastic disease (GTD). - After: UPSI if their regular contraception has been compromised or has been used incorrectly.
Which is the most effective method of EC?
The Cu-IUD
How long after UPSI is Ulipristal acetate effective for?
up to 120 hours after UPSI.
How long after UPSI is Levonorgestrel (PO) effective for?
up to 72 hours after UPSI. It is ineffective if taken more than 96 hours after UPSI.
Which is the more effective PO EC?
Ulipristal acetate
Is oral EC effective after ovulation?
No
What is the effect of weight/body mass index (BMI) on the effectiveness of EC?
Effectiveness of the Cu-IUD is not known to be affected by weight or BMI.
It is possible that higher BMI could reduce the effectiveness of oral EC, particularly LNG-EC.
What drug interactions are relevant to use of EC?
- enzyme-inducing drugs may reduce the effectiveness of UPA-EC and LNG-EC therefore women should be offered a Cu-IUD if appropriate. A 3 mg dose of LNG can be considered but women should be informed that the effectiveness of this regimen is unknown.
- the effectiveness of UPA-EC could be reduced
if a woman takes progestogen in the 5-7 days after taking UPA-EC.
Contraindications to UPA?
severe asthma controlled by oral glucocorticoids
Are there any specific considerations for women who are breastfeeding and require EC?
Breastfeeding women have a higher relative
risk of uterine perforation during insertion of intrauterine contraception than non-breastfeeding women. However, the absolute risk of perforation is low.
Breastfeeding women should be advised not to breastfeed and to express and
discard milk for a week after they have taken UPA-EC.
Women who breastfeed should be informed that available limited evidence indicates that LNG-EC has no adverse effects on breastfeeding or on their infants.
What methods of EC should be offered to a woman who has had UPSI and wishes to avoid
pregnancy?
All women requiring EC should be offered a Cu-IUD if appropriate as it is the most effective method of EC.
Otherwise:
women should be advised that oral EC should be taken as soon as possible if there has been UPSI within the last 5 days.
UPA-EC is the first-line oral EC for a woman who
has had UPSI 96–120 hours ago (even if she has also had UPSI within the last 96 hours).
UPA-EC is the first-line oral EC for a woman who has had UPSI within the last 5 days if the UPSI is likely to have taken place during the 5 days prior to the estimated day of ovulation.
The available evidence suggests that oral EC administered after ovulation is ineffective.
When can a copper IUD be used for EC?
Cu-IUD can be inserted up to 5 days after the
first UPSI in a natural menstrual cycle, or up to 5 days after the earliest likely date of ovulation (whichever is later).
Can oral EC be used more than once in a cycle?
Yes but has to be the same drug - if UPA/LNG mixed it can decrease their effectiveness
When to start hormonal contraception after use of PO EC?
Wait 5 days after taking UPA-EC before starting suitable hormonal contraception.
If a woman and her EC provider estimate that UPSI is unlikely to have occurred during her fertile period, she may consider the option of using LNG-EC with
immediate start of hormonal contraception rather than UPA-EC with delayed start of hormonal contraception.
Dose of levonorgestrel for EC?
1.5mg
