Contraception - Emergency

Question 1

What is the purpose of emergency contraception?

Answer 1

Prevent pregnancy following sexual intercourse

Question 2

How does emergency contraception differ from other forms of contraception?

Answer 2

It is used after sex, whereas other forms are used before or during sex

Question 3

What are the indications for emergency contraception?

Answer 3

• Sexual intercourse without contraception

- Contraceptive method has failed

Question 4

Give an example of how a contraceptive might fail

Answer 4

Condom torn

Question 5

When might women using POP or COCP need emergency contraception?

Answer 5

If they miss pills, depending on how many pills have been missed

Question 6

What are the types of emergency contraception?

Answer 6

• Emergency hormonal contraception (morning after pill)

- Intrauterine device

Question 7

What are the types of morning after pill available in the UK?

Answer 7

• Levonorgestrel

- Ulipristal acetate

Question 8

What is the brand name for Ulipristal acetate?

Answer 8

EllaOne

Question 9

What is levonorgestrel?

Answer 9

Synthetic progesterone

Question 10

How does levonorgestrel work?

Answer 10

It delays ovulation by 5-7 days, after which any sperm will be non-viable

Question 11

What is ulipristal acetate?

Answer 11

A progesterone receptor modulator

Question 12

How does ulipristal acetate work?

Answer 12

It delays ovulation for 5-7 days, after which any sperm will be non-viable

Question 13

How long after unprotected sex can levonorgestrel be used?

Answer 13

Within 72 hours of unprotected sex

Question 14

How long after unprotected sex can ulipristal acetate be used?

Answer 14

Within 120 hours of unprotected sex

Question 15

Do hormonal emergency contraceptives have an effect on implantation?

Answer 15

No

Question 16

What is the copper intrauterine device usually used as?

Answer 16

A method of long-term non-hormonal contraception

Question 17

How long after unprotected sex can the copper coil be inserted to be used as emergency contraception?

Answer 17

Within 5 days

Question 18

How does the copper coil work as emergency contraception?

Answer 18

Toxic to sperm, and may induce a sterile inflammatory response within the uterus that makes implantation impossible

Question 19

How long does the copper coil provide contraception for if used as emergency contraception?

Answer 19

5-10 years (depending on type) as long as it remains in situ

Question 20

How effective is the copper coil as emergency contraception?

Answer 20

99% effective

Question 21

Who should the copper coil be offered to as emergency contraception?

Answer 21

All women presenting

Question 22

What are the absolute contraindications to levonorgestrel as emergency contraception?

Answer 22

None

Question 23

What reduces the efficacy of levonorgestrel as emergency contraception?

Answer 23

• Diseases of malabsorption

- Enzyme inducing drugs

Question 24

Give an example of a disease of malabsorption

Answer 24

Crohn’s

Question 25

Give an example of an enzyme inducing drug

Answer 25

Rifampicin

Question 26

What should be done if a patient requiring emergency contraception who is on an enzyme inducing drug refuses the IUD?

Answer 26

Double dose of levonorgestrel, e.g. 3mg at once, may be taken. Ulipristal acetate is absolutely contraindicated here

Question 27

What are the contraindications to ulipristal acetate?

Answer 27

- Diseases of malabsorption - Hypersensitivity to ulipristal acetate - Severe hepatic dysfunction - Enzyme inducing drugs - Breast feeding - Asthma insufficiently controlled by corticosteroids - Drugs decreasing gastric pH

Question 28

How long after taking ulipristal acetate should breastfeeding be avoided?

Answer 28

7 days

Question 29

Give 2 examples of drugs reducing gastric pH

Answer 29

- Omeprazole | - Ranitidine

Question 30

What are the contraindications to the copper IUD as emergency contraception?

Answer 30

- Uterine fibroids with distortion of uterine cavity - Documented or suspected pelvic inflammatory disease - Documented or suspected STI, especially chlamydia or gonorrhoea

Question 31

What are the adverse effects of emergency hormonal contraception?

Answer 31

- Nausea - Dizziness - Menstrual disturbance - Abdominal pain

Question 32

What are the adverse effects of IUD?

Answer 32

- Pelvic infections - Expulsion of IUD - Bleeding - Pelvic pain

Question 33

In what forms should follow up advice be provided for emergency hormonal contraception?

Answer 33

- Verbal | - Written

Question 34

What follow up advice should be given in a patient taking emergency hormonal contraception?

Answer 34

- Seek help if vomiting occurs within 2 hours of taking levonorgestrel, or 3 hours of taking ulipristal, as the medication may not have been absorbed adequately - Effectiveness of hormonal methods decreases as the time since sexual intercourse increases

Question 35

What follow up advice should be given in a patient using copper coil is emergency contraception?

Answer 35

Increased relative risk of ectopic pregnancy following insertion of IUD

Question 36

What should the patient be alert to as signs fo ectopic pregnancy following IUD insertion for emergency contraception?

Answer 36

Next period is >5 days late with reduced bleeding, especially coupled with severe lower abdominal pain