Emergency contraception Flashcards
(25 cards)
What are the UKMEC categories for contraindications/restrictions to the use of EC?
UKMEC cat 1
- no restriction for use
UKMEC cat 2
- method can generally be used, but more careful follow up may be required
- the advantages of using the method generally outweigh the theoretical or proven risks
UKMEC cat 3
- method can be used, but it may require expert clinical judgement and/or referral to a specialist contraception provider since use is not usually recommended unless other methods are not available or acceptable
- the theoretical or proven risks usually outweigh the advantages of using the method
UKMEC cat 4
- use in that condition poses an unacceptable health risk, so the method should not be used
For the Cu-IUD, what conditions fall under UKMEC 4 concerning its use?
Post-abortion and postpartum sepsis
Unexplained vaginal bleeding (suspicious or serious condition) before evaluation (initiation only)
GTD : persistently elevated hCG levels or malignant disease
Cervical cancer : awaiting Tx (initiation only)
Endometrial cancer (initiation only)
Current purulent cervicitis or gonorrhoea (initiation only)
Pelvic tuberculosis (initiation only)
Current PID (initiation only)
For the Cu-IUD, what conditions fall under UKMEC 3 concerning its use?
48 hr to less than 4 weeks postpartum
Organ transplant : complicated : graft failure (acute or chronic), rejection, cardiac allograft vasculopathy (all initiation only)
Known long QT syndrome (initiation only)
GTD : decreasing hCG levels
Cervical cancer : radical trachelectomy
Uterine fibroid with distortion of the uterine cavity
Distorted uterine cavity
Current asymptomatic chlamydial infection (initiation only)
HIV infected : CD4 count < 200 cells/mm3 (initiation only)
Pelvic tuberculosis (continuation only)
If a woman has known symptomatic Chlamydia trachomatis infection or current Neisseria gonorrhoeae infection, what should be completed prior to insertion of a Cu-IUD?
Antibiotic Tx
If a woman has asymptomatic C. trachomatis infection, after when may you consider insertion of a Cu-IUD for EC?
After discussion with the woman about the risk and benefit
Tx with appropriate Abx should be given at the time of insertion (or sooner if possible)
Does the UKMEC included any contraindications to the use of ulipristal acetate (i.e., EllaOne)?
No
For ulipristal acetate, what conditions fall under UKMEC 1 / 2 concerning its use?
Current DVT and PE (on anticoagulants)
Current or past breast cancer
IBD
Acute intermittent porphyria
In which condition does the manufacturer of ellaOne® advice against use?
In asthma controlled with oral steroids
Due to the antiglucocorticoid effect of ulipristal acetate
What is the mechanism of action of the Cu-IUD?
Inhibits fertilisation by its toxic effect on sperm and offer
Adversely affects the motility and viability of sperm & viability and transport of the ova
If fertilisation does occur, the local endometrial inflammatory reaction resulting from the Cu-IUD prevents implantation
When can Cu-IUD be used as EC?
Within 5 days (120 hr) after the first UPSI in a cycle
OR
Within 5 days of the earliest estimated date of ovulation (e.g., day 19 of a regular 28 day cycle)
Essentially whichever of these is later
What is the mechanism of action of the ulipristal acetate (e.g., EllaOne)?
Inhibits / delays ovulation via suppression of the LH surge
Even when it is taken immediately before ovulation is scheduled to occur (i.e., when LH has started to rise), ulipristal acetate is able to postpone follicular rupture for at least 5 days
It is not effective as EC when given after ovulation
After EC with ulipristal acetate, most women will ovulate later in the cycle and are hence at risk of pregnancy from subsequent UPSI
What is the mechanism of action of the Levonorgestrel (e.g., Levonelle)?
Inhibits ovulation hence delaying or preventing follicular rupture and causing luteal dysfunction
If taken before LH surge, it inhibits ovulation for the next 5 days until the sperm from the UPSE for which it was taken are no longer viable
In the late follicular phase, levonorgestrel becomes ineffective (unlike ulipristal acetate which is still able to delay ovulation)
Levonorgestrel is not effective once the process of implantation has started
After taking levonorgestrel women who ovulate later in the cycle are at risk of pregnancy from further UPSI
When can ulipristal acetate be used as EC?
Within 5 days (120 hr) after UPSI or contraceptive failure
When can Levonorgestrel be used as EC?
Licensed for use within 72 hours after UPSI or contraceptive failure
May also be used between 72-96 hours after UPSI or contraceptive failure (unlicensed use), but efficacy decreases with time
Does the UKMEC included any contraindications to the use of levonorgestrel (i.e., Levonelle)?
No
For levonorgestrel, what conditions fall under UKMEC 1 / 2 concerning its use?
Current DVT and PE
Current or past breast cancer
IBD
Acute intermittent porphyria
In which condition does the manufacturer of Levonelle® advice against use?
Severe hepatic dysfunction
However, the Faculty of Sexual and Reproductive Healthcare (FSRH) states that ‘pregnancy poses a significant risk in women with severe hepatic impairment and expert opinion suggests that use of a single dose of LNG 1.5 mg is therefore acceptable
What does of Levonorgestrel is used as EC?
Oral levonorgestrel 1.5mg tablet
What does of ulipristal acetate is used as EC?
Oral ulipristal acetate 30 mg tablet
Which emergency contraception should you offer if it has been 120 hours or more since unprotected sexual intercourse (or the time is unknown)?
≤ 5 days after the earliest likely date of ovulation = Cu-IUD and suitable quick start intervention. Oral EC is unlikely to be effective
> 5 days after the earliest likely date of ovulation or woman is unsure = suitable quick start contraception. Oral EC is unlikely to be effective
What are the possible risk and adverse effects of the Cu-IUD?
Pain on insertion - causes discomfort for a few hours but can be relieved with analgesics
Pelvic pain
Perforation of the uterine wall
Expulsion - risk = 1/20 and more common in 1st year of use
PID
Ectopic pregnancy
Unscheduled bleeding
Weight gain
Decreased libido
What are the possible risk and adverse effects of ulipristal acetate?
Vomiting
Menstrual irregularities
Ectopic pregnancy
Common adverse effects
- mood disorders
- headaches
- dizziness
- N+V
- fatigue
- back pain
- breast tenderness
- myalgia
What are the uncommon and rare adverse effects of ulipristal acetate?
Uncommon
- anxiety
- appetite disorder
- chills
- impaired concentration
- diarrhoea
- drowsiness
- dry mouth
- fever
- flatulence
- hot flush
- increased risk of infection
- insomnia
- libido disorder
- malaise
- skin reactions
- vision disorders
- vulvovaginal disorders
Rare/very rare
- abnormal sensation in eye
- disorientation
- dry throat
- eye erythema
- genital pruritus
- ovarian cyst rupture
- painful sexual intercourse
- syncope
- altered taste
- thirst
- tremor
- vertigo
What are the possible risk and adverse effects of levonorgestrel?
Vomiting
Menstrual irregularities - if a woman has mild bleeding and spotting it could be caused by Levonorgestrel and she should not consider this a safe time for an UPSI
Ectopic pregnancy
Other adverse effects of levonorgestrel include:
- headache
- lower abdo pain
- fatigue
- dizziness
- diarrhoea
- breast tenderness
