post coital contraception Flashcards
what are the 2 key indications for emergency contraception?
sex without contraception
contraception has failed
what are the two types of emergency hormonal contraception and how do they work?
Levonorgestrel - synthetic progesterone. Can delay ovulation for 5-7 days, after which any sperm will have become non viable. Can use within 72hrs of unprotected sex.
Ulipristal acetate - progesterone receptor modulator (marketed as EllaOne). Can delay ovulation for 5-7 days. Licensed for use within 5 days of sex
what is the IUD?
copper intrauterine device (commonly abbreviated to Cu-IUD) is usually used a method of long term non-hormonal contraception, but when it is inserted within 5 days of unprotected sex, it may be used as emergency contraception.
how does the IUD work?
copper within the coil is toxic to sperm, and it may induce a sterile inflammatory response within the uterus that makes implantation impossible.
It remains in situ and provides contraceptive cover for five to ten years, depending on the type. Due to this, it is the only method of emergency contraception that provides protection past the initial administration.
99% effective
what can reduce the efficacy of Levonogestrel?
Diseases of malabsorption e.g. Crohn’s
Enzyme inducing drugs e.g. rifampicin
If patient refuses IUD, then double dose i.e. 3mg at once may be taken
what are the contraindications of the copper IUD?
Uterine fibroids with distortion of the uterine cavity
Documented or suspected pelvic inflammatory disease (PID)
Documented or suspected STI (especially chlamydia or gonorrhoea)
what are the contraindications of Ulipristal acetate?
Diseases of malabsorption e.g. Crohn’s
Hypersensitivity to Ulipristal Acetate
Severe hepatic dysfunction
Enzyme inducing drugs e.g. rifampicin
(Give 3mg levonorgestrel if the patient refuses an IUD, ulipristal acetate is absolutely contraindicated here)
Breast feeding – avoid breastfeeding for 7 days after taking UPA
Asthma insufficiently controlled by corticosteroids
Drugs increasing gastric pH e.g. omeprazole, ranitidine
what follow up advice should be given following use of emergency hormonal contraception?
seek help if vomiting occurs within 2hrs of levonogestrel or 3hrs of ulipristal as it may not have been absorbed properly
advise on ADR e.g nausea, dizziness, menstrual disturbance and abdominal pain
pregnancy test no sooner than 3 weeks
what follow up advice should be given following use of the IUD?
advise risk of ectopic pregnancy following IUD insertion
be alert if next period is >5 days late with reduced bleeding, especially coupled with severe abdominal pain
if pregnancy test is positive, need urgent US to locate pregnancy
warn about pelvic infections, expulsion of the IUD, bleeding and pelvic pain
