Question 12: Emergency contraception Flashcards
What is Emergency Contraception (EC)?
EC prevents pregnancy after unprotected sex, but before pregnancy is established.
When can EC be used?
Within 5 days (120 hours) of unprotected intercourse. The sooner, the better.
What are the two main types of EC?
Emergency Contraceptive Pills (ECPs) – within 120 hours
Copper IUD (Cu IUD) – within 120 hours (most effective)
Why is Cu IUD the most effective EC method?
Efficacy remains constant throughout the 5-day window.
Can provide long-term contraception if desired.
Can be removed later if not wanted as ongoing contraception.
When is Cu IUD particularly indicated?
Late presentation (closer to 120-hour mark).
ECP failure risk (vomiting, drug interactions).
Desire for long-term contraception
How do Emergency Contraceptive Pills (ECPs) work?
Delay/inhibit ovulation (primary action).
May interfere with implantation.
DO NOT cause abortion (no effect on established pregnancy).
What are the effectiveness rates of ECPs?
Within 24 hours: POP regimen = 95% effective
Within 120 hours: POP regimen = 58% effective
COC regimen is less effective (77% - 31%)
What are the common side effects of ECPs?
Nausea & vomiting (more common with combined pills).
Dizziness, headaches, fatigue.
Menstrual cycle irregularities.
Can all women use ECPs?
Yes! No age or parity restrictions.
Safe for most women, even those with contraindications to regular hormonal contraception.
Does EC protect against STIs?
No, EC does NOT protect against STIs.
What if a woman is on enzyme-inducing drugs (e.g., rifampicin, ritonavir)?
Best option = Cu IUD
If not acceptable, increase ECP dose:
Levonorgestrel (LNG) 3mg stat OR
Ovral 3 tablets, then 3 more after 12 hours
How soon does fertility return after EC use?
Immediately. Advise on regular contraception use.
ECP counselling
Clients should be counselled about
* The correct regimen for ECP use
* Possible side effects (particularly nausea and vomiting) and how to manage them (take the pills with food and repeat the dose if vomiting occurs within 2 hours of taking or offer Cu IUD
* When to expect the next menses (a few days earlier or later than normal)
* Use condoms or abstain for the rest of the present menstrual cycle.
* ECPs are intended for emergency contraception only and not for regular contraception because of the higher rate of failure and side effects.
* Quick start: a regular method of contraception may be started at the same visit as ECPs are given. This reduces the possibility of pregnancy while waiting for the next menstruation.
* A pregnancy test should be advised if a normal period does not occur within a week after it was expected.
Repeat use of ECPs
Whilst not ideal, ECPs may be given repeatedly. They should not be refused or rationed if requested within 120 hours. Clients should be counselled that repeat use of ECPs is less effective than regular use of COCs, or other contraceptives and result in more side effects. Investigate reasons for repeated requests.
What are Emergency Contraceptive Pills (ECPs)?
High-dose oral contraceptives (COCs or POPs) taken after unprotected sex to prevent pregnancy.
Which is more effective – EC-POP or EC-COC?
OP regimen (Levonorgestrel) → More effective, fewer side effects
❌ COC regimen → Less effective, more nausea/vomiting
What is the most effective form of emergency contraception (EC)?
Copper IUD (Cu IUD) insertion – failure rate < 0.1%.
How does an emergency Cu IUD work?
Prevents fertilization if inserted before ovulation.
Prevents implantation if inserted after ovulation.
Does the Cu IUD protect against STIs?
No STI protection – consider post-exposure ART & prophylactic antibiotics.
How long does the Cu IUD provide contraception?
As long as the device remains in place.
Can be removed at next menses if not needed long-term.
When can the Cu IUD be inserted as EC?
Within 5 days (120 hours) of unprotected sex OR
✅ Up to 5 days after ovulation (if cycle is regular)
✅ Any time within the first 12 days of the menstrual cycle
