GP - Contraception: Emergency and Post-partum Contraception Flashcards
What are the 2 types of emergency hormonal contraception available in the UK?
- Levonorgestrel
- ullipristal
Emergency contraception: Levonorgestrel
- When should it be taken?
- What dose?
- What is MOA?
- How effective is it?
- Must be taken within 72h of UPSI (unprotected sexual intercourse) - take ASAP as efficiency decreases with time.
- Single dose 1.5mg (progesterone)
- MOA: not fully understood - stops both ovulation and inhibits implantation
- 84% effective if taken within 72h of UPSI
Emergency contraception: Levonorgestrel
- side effects
- what to do if pt vomits
- how often can it be used?
- S/Es: safe and well tolerated, disturbance of the current menstrual cycle is seen in significant minority of women. Vomiting occurs in 1%
- If vomiting occurs within 2h, repeat dose
- Can be used more than 1x in a menstrual cycle if clinically indicated
Emergency contraception: Ulipristal
- MOA
- Dose and recommendations for use
- MOA: progesterone receptor modulator - currently marketed as EllaOne - primary MOA is inhibition of ovulation
- 30mg oral dose taken ASAP, must be within 120h of UPSI
*Concomitant use with levonorgestrel is not recommended
Emergency contraception: Ulipristal
- recommendations within same cycle
- Contra-indications/cautions
- Can be used more than once within same cycle
- May reduce effectiveness of hormonal contraception And should wait 5 days before restarting normal contraception and used barrier methods during this period
- C/I in pts with severe asthma
- C/I in breastfeeding - should be delayed for 1 week after taking ulipristal
What non-hormonal form of emergency contraception is also available in UK?
- Method of use
- MOA
- Intrauterine device
- Must be inserted within 5 days of UPSI and may remain until 5 days after likely ovulation date
- MOA: may inhibit fertilisation/implantation
Emergency contraception: Intrauterine device
- infection prophylaxis
- Effectiveness
- Prophylactic antibiotics may be given if pt considered at high risk of SDI
- 99% effective regardless of where it is used in cycle
Post-partum contraception
- When do women require contraception?
- What options are available to women?
After giving birth, a woman requires contraception after day 21
- Progesterone only pill
- Combined oral contraceptive
- IUD/IUS
Post-partum contraception: POP
- When can pop be started?
- Effect of pop on breastfed child
- Can start POP anytime postpartum
- Started pre day 21: is effective immediately
- After day 21: can start POP and use additional contraception for 2 days
- Small amount of progestogen enters breast milk but not harmful to infant
Post-partum contraception: COC
-What are the rules for breastfeeding and non breastfeeding women?
- May be started from day 21 if not breast-feeding and will provide immediate contraception
- Started after day 21: need additional contraception for 7/7
- Absolutely contraindicated if breastfeeding at <6/52 post partum (UKMEC 4)
- Can be started after if breastfeeding at > 6/52 post partum (UKMEC 2)
Post-partum contraception: IUD/IUS
-When can these be fitted?
-IUS/IUD can be inserted within 48h of childbirth of after 4/52
Post-partum contraception: what is lactational amenorrhea method?
-98% effective providing a woman is fully breast feeding (no supplementary feeds), amenorrhoeic and <6 months post partum
