Wk 11: Emergency contraception in practice

Question 1

When does ovulation occur?

Answer 1

14 days before menstruation starts

Question 2

When can a copper IUD be inserted?

Answer 2

• W/in 5 days of 1st UPSI

- Upto 5 days after earliest estimated day of ovulation

Question 3

What are the contraindications of Cu-IUD?

Answer 3

• Pregnancy
• > 48hrs or <4 weeks postpartum
• Undiagnosed vaginal bleeding
• Gynaecological cancers: cervical, endometrial, ovarian
• Acute pelvic infection

Question 4

Levonelle

Answer 4

• Upto 72hrs after UPSI
• Taken prior to LH surge
• Less effective once LH starts to rise

Question 5

Ulipristal

Answer 5

• UPSI upto 120hrs ago
• 1st choice if UPSI during fertile period
• Prevents ovulation after LH surge, delaying follicular rupture upto 5 days

Question 6

What are things to remember when taking ulipristal?

Answer 6

• Can’t start/restart hormonal contraception until 5 days after, wait 12 days
• Less effective if patient had progestogen in last 7 days

Question 7

What are the percentages showing the decline of efficacy of levonorgestrel?

Answer 7

• 12hrs: 95%
• 25-48: 85%
• 49-72: 58%

Question 8

How long does ulipristal remain effective for?

Answer 8

95% effective upto 120 hrs after UPSI

Question 9

Is EC needed when taking COC and they have missed pills (2/more) in the first week (1-7)?

Answer 9

May be required if UPSI occurred in pill free interval/first week

Question 10

Is EC needed when taking COC and they have missed pills (2/more) in the second week (8-14)?

Answer 10

• Not required if pills taken correctly the first week

- Advise: finish pack + usual 7 day break

Question 11

Is EC needed when taking COC and they have missed pills (2/more) in the third week (15-21)?

Answer 11

• Omit pill-free interval by finishing current pack + starting new pack next day
• EC not required if HFI is omitted

Question 12

What to give pregnant or suspected pregnant?

Answer 12

levonorgestrel

Question 13

Breastfeeding

Answer 13

• Levonorgestrel: No adverse effects, take after breastfeeding + avoid nursing 8hrs
• Ulipristal: discard milk 7 days after

Question 14

How is the effectiveness of levonorgestrel affected by BMI?

Answer 14

• Red effectiveness of weight > 70kg (BMI>26kg/m2)

- Double dose (3mg): off-label

Question 15

Which medical conditions is levonorgestrel not recommended for?

Answer 15

• Severe liver dysfunction
• Acute porphyria
• Risk of ectopic
• Suffered inflammation of fallopian tube
• Severe malabsorption syndrome: red efficacy

Question 16

Which medical conditions is ulipristal not recommended for?

Answer 16

• Severe liver impairment

- Severe asthma on oral glucocorticoid treatment

Question 17

Which drugs affect the efficacy of EC + what does the FSRH recommend?

Answer 17

• Enzyme inducing drugs
• If used enzyme inducing drugs in past 4 weeks, use Cu-IUD

or

• Double dose (3000mcg) levo if unwilling to use Cu-IUD

Question 18

What is the recommendation when taking hormonal contraception after ulipristal?

Answer 18

• Don’t start until 5 days after

- COC will take 7 days for contraceptive cover tf 12 days after ulipristal