Emergency Contraception

Question 1

What emergency contraceptives are available?

Answer 1

Hormonal- levonorgestrel and ulipristal. S3, prevent/delay ovulation
Non-hormonal- copper IUD. Most effictive, 120 hrs, sperm-motility and ova/sperm viability decreased, prevent fertilisation.

Question 2

Efficacy timelines for levonorgestrel and ulipristal?

Answer 2

Levo- up to 72 hrs, evidence shows up to 96 hrs.
Uli- up to 120 hrs, more effective, prevents ovulation after LH surge.

Question 3

Levonorgestrel EC drug interactions

Answer 3

CYP3A4 inducers taken within past 4 weeks (anti-epileptics, rifampicin, St John’s Wort)
Griseofulvin
Ulipristal (reduced effect)

Question 4

Ulipristal EC drug interactions

Question 5

Other indication for ulipristal

Question 6

Supply of levonorgestrel and ulipristal as EC

Question 7

EC if EC levo not available?

Answer 7

Give 2 doses of 25 levonorgestrel 30mcg tablets 12 hrs apart

Question 8

Question asking for EC

Question 9

Can uli or levo cause abortion of established pregnancy

Question 10

Drug interactions influence on EC choice

Question 11

EC choice for breastfeeding and postpartum mothers

Question 12

EC choice for 2 UPSI in same cycle

Question 13

EC ADRs

Question 14

Levo OC continuation after levo EC

Question 15

POP/COC start after ulipristal EC

Question 16

EC counselling and follow-up advice

Question 17

Recurrent EC use limit

Question 18

EC referral and no supply