EHC

Question 1

Define EC

Answer 1

Intervention aimed at preventing unintended pregnancy after unprotected sexual intercourse or potential contraceptive failure

Question 1

List 2 indications for EC

Answer 1

• When the patient has a natural cycle and no contraception has been used
• When there is incorrect use or potential failure of hormonal contraception

Question 2

What day of the cycle is the first day of menstruation?

Answer 2

Day 1 of the cycle

Question 3

What is the menstrual cycle?

Answer 3

The first day of menstruation to the day before the next menstruation

Question 4

How does EC work?

Answer 4

Delays ovulation

Question 5

When does ovulation occur?

Answer 5

14 days before menstruation starts

Question 6

How do we calculate estimated ovulation date?

Answer 6

Determining length of cycle and subtracting 14

Question 7

When is the fertile period?

Answer 7

5 days leading up to and including the estimated ovulation day (6 days) - 30% chance of pregnancy

Question 8

How long are sperm viable in the female genital tract for?

Answer 8

5 days after UPSI

Question 9

How long can an unfertilised egg survive for?

Answer 9

Approx 12-24 hours

Question 10

List reasons for EC

Answer 10

If a woman does not wish to conceive and has had UPSI
- on any day of a natural menstrual cycle (particularly in the fertile window)
- after regular HC used incorrectly
- from day 21 after childbirth unless LAM method met
- from day 5 after miscarriage, abortion, ectopic pregnancy

Question 11

What is the most effective method of EC

Answer 11

Cu-IUD (99% effective)

Question 12

What is the MOA of the copper IUD?

Answer 12

Pre and post ferilisation mechanisms of action
- Causes a local endometrial inflammatory reaction which prevents implantation

Question 13

How long after UPSI can a copper IUD be inserted?

Answer 13

Up to 5 days (120 hours) or up to 5 days after the earliest estimated day of ovulation whichever is LATER

Question 14

What are the rules for a Cu-IUD after missed pill?

Answer 14

• CHC: Earliest observed ovulation occured 8 days after stopping CHC
  Cu-IUD inserted up to 13 days after the start of HFI
• POP: Cu-IUD inserted up to 5 days after the first UPSI following the first missed POP

Question 15

What is the MOA of levonogestrel?

Answer 15

Delays follicular development when administered before the level of LH increases

Question 16

How many hours is levonogestrel licensed for use up to?

Answer 16

72 hours

Question 17

How many hours does it matter if vomited after administration?

Answer 17

3 hours

Question 18

What is EllaOne and its MOA?

Answer 18

• Selective progesterone receptor modulator
  MOA: inhibits follicular rupture even after the level of LH has started to increase

Question 19

How long can EllaOne be used up to?

Answer 19

120 hours
First choice if UPSI during the fertile period

Question 20

How long after EllaOne can you restart HC?

Answer 20

5 days

Question 21

How does the Cu-IUD work?

Answer 21

Prevents implantation

Question 22

What age is a PGD from for EHC?

Answer 22

13 (14 in some areas) provided they are Fraser competent

Question 23

What is the legal age of sexual activity?

Answer 23

16 in UK

Question 24

What to do if children under the age of 13?

Answer 24

Treat cases seriously and report to social services

Question 25

What is Fraser guidance?

Answer 25

Patients under 16 to decide if they consent to contraceptive or sexual health advice and treatment

Question 26

What is the missed pill guidance?

Answer 26

- CHC: 2 or more active pills missed - POP: Traditional (>3hrs late, last pill>27 hrs ago), (Desogestrel POP >12hrs late, last pill> 36 hrs ago) - Depo injection > 14 weeks ago - Transdermal patch off 48 hours - Expired IUC/lost threads - Expired sub dermal implant

Question 27

When taking a COC - is EC needed?

Answer 27

Pills 1-7: EC may be required in pill-free interval/first week of pill Pills 8-14: EC not required if pills in last 7 days have been taken correct Pills 15-21: Finish the pills in current pack and start a new pack the next day provided pill-free interval omitted More than 7 COC pills missed: Restart COC as though never used before

Question 28

How long to discard breastmilk after taking ulipristal?

Answer 28

7 days

Question 29

What weight effects Levonogestrel?

Answer 29

Over 70kg (BMI > 26kg/m2) FSRH advices give double dose if this is the case REFER as this is 'off label'

Question 30

Is ulipristal affected by BMI?

Answer 30

No

Question 31

What medical conditions should levonogestrel and EllaOne not be given to patients with?

Answer 31

Liver dysfunction

Question 32

What drugs affect the efficacy of EC?

Answer 32

Enzyme inducing drugs, guidance advises using Cu-IUD however FSRH advises double dose of levonogestrel if unwilling to use Cu-IUD

Question 33

What to do if progesterone has been taken in 7 days prior?

Answer 33

FSRH advises against use of ulipristal

Question 34

What methods of EC can transgender people use?

Answer 34

All

Question 35

What to advise regarding cycle disruption?

Answer 35

- Advise patient menstrual cycle may be altered, next period early/late - Pregnancy test recommended if menses delayed by more than 7 days after EC