Emergency Contraception Flashcards
(38 cards)
What are the three forms of EC in the UK?
- oral progestogen-only EC - levonorgestrel
- oral selective progesterone receptor modulator - ulipristal acetate
- copper IUD
Who should be offered the IUD as EC?
All women with no contraindications as it is the most effective method of EC
What are the contraindications to levonorgestrel EC?
None
In whom may the copper IUD not be suitable for EC?
- More than 2 days but less than 4 weeks post-partum
- Persistently elevated b-hCG levels following gestational trophoblastic or malignant disease
- Uterine cavity distortion
- current PID
- history of copper allergy
- known long QT syndrome
- known symptomatic Chlamydia or Gonorrhoea infection
What types of EC may be affected by enzyme inducing drugs?
Levonorgestral and Ulipristal-acetate
What can you offer in someone wanting LNG EC but on enzyme inducing drugs?
Double dose of LNG can be prescribed off licence but explain that the effectiveness of this approach is not known. NOTE: a double dose of UPA is not recommended
In which women should UPA be avoided?
- Hypersensitive to UPA
- Severe asthmatics treated by oral glucocorticoids
- Galactose intolerant, lactase deficient or have glucose-galactose malabsorption
- Breasting (feeding not recommended for 7 days after UPA use - the milk should be expressed and discarded)
What is the MOA of the copper IUD?
- Inhibition of fertilization
- Anti-implantation effect
What is the MOA of levonorgestrel?
- Delay or prevent ovulation
- Ovulation is delayed for 5 days by which time any sperm in the reproductive tract will be non-viable
- When taken prior to the onset of the LH surge, ovulation is delayed or inhibited
Up to what time period is levonorgestral licensed for as EC?
Up to 72 hours after UPSI. Off licence it may be taken up to 96 hours after UPSI.
What is the MOA of UPA?
- Selective progesterone receptor modulator with antagonistic and partial agonistic effects
- Binds to progesterone receptors in target tissues: the uterus, ovaries and hypothalamus
- Delays ovulation for at least 5 days
- If the LH surge has started but no peaked, ovulation can be inhibited, with up to a 5 day delay in follicular rupture.
Up till when can UPA be given as EC?
Up to 120 hours after UPSI
How long should women wait until resuming their normal contraception after taking UPA?
Wait 5 days. During this time and until effective contraceptive cover from their chosen method of contraception has been achieved, individuals should either abstain or use barrier methods.
What is the efficacy of LNG EC?
0.6-2.6% if UPSI occurred within the previous 72 hours
What is the efficacy of UPA EC?
1-2%
What is the efficacy of IUD EC?
<0.1%
How may weight effect oral EC?
- Women with a BMI >26 or a weight >70kg LNG is less effective
- Women with BMI >30 or a weight >80kg, UPA less effective
What should you offer as EC in women of greater weight?
Copper IUD
- If declines IUD, UPA can be offered
- If UPA not suitable, offer 3mg of LNG (double dose, both tablets taken at the same time) for women with BMI >26
How do you calculate the earliest likely ovulation date?
Start date of the LMP plus 14 days less than the number of days in the shortest cycle
How do you determine the latest date an IUD can be fitted?
The earliest likely ovulation date + 5 days.
What must you consider before giving EC?
- LMP date
- Need for UPT
- Earliest ovulation date
- Timing of ALL episodes of UPSI in current cycle
- Details of potential contraceptive failures, for example, how many missed pills and when in the packet
- Previous EC use in the cycle
- PMHx
- Drug Hx
- Need for ongoing contraception
- Sexual Hx and STI screening
In what circumstance can a Copper IUD not be inserted for EC if a woman has had multiple UPSI event within her current cycle?
If they have had multiple UPSI events >120 hours ago within the current cycle and >5 days since earliest ovulation date.
If a woman has had UPSI within 120 hours and >5 days since her earliest ovulation date, can a Copper IUD still be inserted for EC?
Potentially yes if the following criteria met:
They have been correctly and consistently using a reliable method of contraception throughout the rest of their current cycle. (For the purposes of being reasonably certain that an individual is not currently pregnant, barrier methods of contraception can be considered reliable providing that they have been used consistently and correctly for every episode of intercourse.)
When is EC indicated in a woman using CHC, POP or implant?
UPSI whilst using liver enzyme inducing medication or in the 28 days following their use
