EHC & Progesterone Pill

Question 1

Which 2 drugs are currently used as emergency contraceptives (give their doses too)?

Answer 1

Levonorgestrel 1.5mg
Ulipristal acetate 30mg

Question 2

How long after unprotected sexual intercourse can levonorgestrel be given?

Answer 2

Within 3 days (72h) after sexual intercourse.

Question 3

What age is levonorgestrel licensed as a P medicine?

Answer 3

> 16 years old

Question 4

How long after unprotected sexual intercourse can ulipristal acetate be given?

Answer 4

Within 5 days (120h) after sexual intercourse

Question 5

What are the brands for levonorgestrel and ulipristal acetate?

Answer 5

Levonelle - levonorgestrel
ellaOne - ulipristal acetate

Question 6

When can an intra-uterine device (IUD) be fitted after unprotected sexual intercourse?

Answer 6

5 days after sexual intercourse

Question 7

What should a patient do if they vomit within 2h of taking levonorgestrel?

Answer 7

Take another tablet immediately.

Question 8

What should a patient do if they vomit within 3h of taking ulipristal acetate?

Answer 8

Take another tablet immediately.

Question 9

What class of drugs reduce the efficacy of emergency contraception?

Answer 9

Enzyme inducers, e.g. rifampicin, phenytoin, carbamazepine, ritonavir

Question 10

Why do EHC’s have a long half life?

Answer 10

Because it gets circulated in the portal vein, which constantly gets reabsorbed & circulated in the body.

Question 11

What should you do if a woman is taking an enzyme inducing drug, and requests emergency contraception?

Answer 11

Give double dose levonorgestrel, or refer to get a C-IUD fitted.

Question 12

Which emergency contraception do you give if a person has a BMI of >26kg/m^2, or is >70kg?

Answer 12

Either ulipristal acetate, or double dose levonorgestrel

Question 13

Which immunosuppressive drug can increase in toxicity when given with levonorgestrel?

Answer 13

Ciclosporin - its metabolism is inhibited.

Question 14

What are the benefits of fitting a copper IUD?

Answer 14

Provides immediate effective contraception
Does not affect BMI/weight, or with other drugs

Question 15

Which EHC should asthmatic women taking glucocorticoids NOT be given?

Answer 15

Ulipristal acetate

Question 16

Which medical conditions should levonorgestrel be avoided in?

Answer 16

Severe liver dysfunction
Crohns disease
Inflammation of fallopian tubes

Question 17

What could lower abdominal pain after taking EHC signify?

Answer 17

It could signify an ectopic pregnancy & she must be referred immediately.

Question 18

What is contained in a combined oral contraceptive pill (COC)?

Answer 18

Progesterone & oestrogen.

Question 19

What classifies as a missed pill if a woman is taking a COC?

Answer 19

If >2 pills are missed in the 1st week
If >7 pills are missed in any week during contraceptive therapy
If her pill free week is extended

Question 20

How many days does it take for COCs to reach maximum efficacy?

Answer 20

7 days, after that the pill is at its max. efficacy

Question 21

Why is the last week of the contraceptive pack considered a placebo week?

Answer 21

Because they are there to help the woman make a habit of taking the pill regularly until she starts a new pack the next month.

This is why some packs contain 21, or 28 tablets.

Question 22

What precautions must be taken if a woman is on COCs, and has taken either levonorgestrel or uripristal (and for how long)?

Answer 22

Use barrier methods/extra precaution/refrain from sex:

Levonorgestrel: 7 days, then restart COC immediately

Ulipristal acetate: 12 days, restart COC 5 days after taking EHC

Question 23

When is EHC not given to a woman who is taking COCs?

Answer 23

If she has missed <2 pills in the first week
If she has missed 2-7 pills in any other week during contraceptive therapy

Question 24

What is considered a late/missed pill if the woman is taking progesterone only pills (POP)?

Answer 24

If she has taken her next dose >12h after her previous one.

This is why POP’s should be taken at the same time everyday

Question 25

How many days do POPs reach max. efficacy?

Answer 25

2 days

Question 26

When is EHC given if the woman uses POP?

Answer 26

If she has missed a pill, or taken it late If she has unprotected sex before the max. efficacy of the POP has been established (2 days)

Question 27

What precautions must be taken if a woman is on POPs, and has taken either levonorgestrel, or uripristal (and for how long)?

Answer 27

Use barrier methods/extra precaution/refrain from sex: Levonorgestrel: 2 days, restart POP immediately Ulipristal acetate: 7 days, restart POP 2 days after taking EHC

Question 28

If a woman is breastfeeding, when should she take levonorgestrel?

Answer 28

After breastfeeding, to avoid the amount of levonorgestrel in breast milk in the next feed.

Question 29

How long after taking ulipristal can a woman not breastfeed for?

Answer 29

1 week because it would be present in the breast milk

Question 30

What are the 2 mini-pills available in pharmacies to buy (including doses)?

Answer 30

Lovima 75mcg tablets Hana 75mcg tablets

Question 31

What type of progesterone is present in the mini pill?

Answer 31

Desogestrel.

Question 32

How does desogestrel prevent pregnancy?

Answer 32

It inhibits ovulation by thinning the lining of the uterus & preventing implantation of the fertilised egg. Cervical mucus also thickens & prevents the sperm from penetrating the egg.

Question 33

How are mini pills usually taken?

Answer 33

At the same time everyday (like POPs)

Question 34

What conditions contraindicate the use of the mini pill?

Answer 34

Active thrombosis Active/history of liver disease/cancer Active/suspected sex-steroid sensitive cancer Undiagnosed vaginal bleeding Hypertension/uncontrolled diabetes

Question 35

What happens if a woman has missed her mini pill for >12h?

Answer 35

She should take her next dose as soon as she remembers She is now also unprotected, so should use barrier methods for 2 days Supply EHC if she had unprotected sex after her missed pill

Question 36

Which specific anti-epileptic drug should not be given with Lovima & why?

Answer 36

Lamotrigine because the mini pill reduces its efficacy

Question 37

What should happen if a woman vomits 3-4h after taking her mini pill?

Answer 37

Follow the missed pill rule. Take the pill, and next dose as normal Protection for 2 days