EMERGENCY CONTRACEPTIVE COMMS Flashcards
What questions are important to ask before starting contraceptive counselling ?
o When was the UPSI?
o Has there been other UPSI this menstrual cycle?
o Details of the menstrual cycle – including date of last period
o Details of contraceptives being taken and compliance
Structure for the explanation of each contraceptive ?
o What is it?
o How does it work?
o When can you take it?
o How effective is it?
o What are the risks?
o Pros and cons
Dose, mechanism of action and period of time after UPSI that Levonorgesterel (Levonelle) can be taken
o 1500mg of levonorgestrel taken once off
o How it works – works by inhibiting ovulation by around 5 days, sperm present shouldn’t be there anymore when egg is released
o Can be taken within 72 hours of UPSI
How effective is Levonorgestrel ?
o Not as effective as EllaOne or copper IUD, and possibly not effective at all if taken after ovulation
Main side effects of Levonorgestrel?
Nausea & vomiting
Delayed or late period.
heavier or lighter than usual menstrual bleeding.
spotting or bleeding between menstrual periods
Pros of Levonorgestrel ?
few side effects
can be used with ongoing / current contraception
Dose, mechanism of action and period of time after UPSI that Ulipristal acetate (EllaOne) can be taken
o One off dose of 30mg ulipristal acetate
o Works by delaying ovulation for around 5 days
o Can be taken within 120 hours / 5 days of UPSI – but is less effective if patient is taking progestogens
When is Ulipristal acetate (EllaOne) not effective?
After ovulation
Side effects of Ulipristal acetate (EllaOne)?
Nausea and vomiting
Late or early periods (disruption in menstrual cycle)
In which patients is Ulipristal acetate (EllaOne) not suitable?
Patients with severe asthma
(rendered less effective by enzyme-inducing medications…)
description of device, mechanism of action and period of time after UPSI that the Copper Intrauterine Device can be taken
o Small T shaped plastic and copper device which is inserted into the womb in a small procedure.
o Copper is toxic to sperm and eggs, prevents fertilisation and implantation
o Can be inserted 5 days after UPSI, or within 5 days of earliest projected ovulation
If a patient has a regular 29 day cycle and has sex on day 4 of her cycle, when can they be fitted with copper IUD for emergency contraception?
Her earliest expected date of ovulation would be day 15 of her cycle i.e. 14 days before menstruation. If patient A has UPSI on day 4 of her cycle, a copper IUD could be fitted for emergency contraception on any day up to day 20 of that cycle, providing that a pregnancy test was negative
How effective is the copper IUD?
o Most effective form, less than 1% of women who use it get pregnant
Side effects / risks of Copper IUD?
From insertion operation:
Small risk of infection, expulsion and perforation.
May have irregular bleeding for a few days after
Periods may be heavier, longer and more painful for the first few months
Pros of the copper IUD?
Effective
Can provide ongoing contraception
Doesn’t interact with medications
Long window for use (10 yrs)
Can be taken with other emergency contraceptive
