Emergency Contraception counselling

Question 1

Opening the consultation?

Answer 1

• Introduce yourself to the patient including your name and role
• Confirm the patient’s name and date of birth
• Explore why the patient wants emergency contraception

Question 2

How to explain the history?

Answer 2

“In order to establish whether you might need emergency contraception, and which method might work best for you, I need to first need to ask a few questions. We will talk about the details of the unprotected sex and any contraception you may be using, about your periods, about any recent sexual partners so we can think about screening for infections, and about your health in general. After this, we will see what options are available to you.”

Question 3

Details of the unprotected sex?

Answer 3

• The date of the UPSI - where in their menstrual cycle it was
• Any other UPSI’s in this cycle

Question 4

Details of the patient’s menstrual cycle?

Answer 4

• first day of their last period
• You will need to calculate where they are in their cycle, and when you might expect them to ovulate (14 days before menstruation)

Question 5

Contraception relevance?

Answer 5

Need to detail any current contraception

Question 6

A sexual history?

Answer 6

Vagina:
- SOCRATES
- Key symptoms
- Menstrual history
- Past gynaecological history

Penis:
- SOCRATES
- key symptoms

Last sexual contact
- Sign posting
- Timing
- Consent
- Relationship
- Partner demographics
- Types of sex involved
- Contraception
- other sexual patterns

HIV risk assessment

Question 7

Vagina key symptoms - Sexual history?

Answer 7

• Abdominal and pelvic pain
• Post-coital vaginal bleeding
• Intermenstrual vaginal bleeding
• Post-menopasual bleeding
• Abnormal vaginal discharge
• Dyspareunia
• vulval skin changes and itching
• Systemic symptoms

Question 8

Penis key symptoms - Sexual history?

Answer 8

• Abdominal and pelvic pain
• testicular pain or swelling
• Itching or sore skin
• Skin lesions
• urethral discharge
• Dysuria
• Systemic symptoms

Question 9

Signposting: summary of options

Answer 9

• Emergency contraception helps to reduce the risk of you becoming pregnant after having unprotected sex. It will not stop an existing pregnancy, and it is not the same thing as a termination
• There are three types of emergency contraception available in the UK. Two of these are types of ‘morning-after pill’, which both work in similar ways. There is also the option of inserting a copper IUD, which is more effective than the morning after pill but involves a procedure.

“We will talk through these options together and see which one works best for you.”

Question 10

What is Levonelle®?

Answer 10

Levonelle® is a tablet containing a hormone, which is a synthetic progestogen. It is taken as a one-off dose.

Question 11

How does Levonelle® work?

Answer 11

Levonelle® works by inhibiting ovulation for around 5 days.

In theory, this means that any sperm present in the genital tract should no longer be alive by the time that an egg is released, and so there is no resulting pregnancy.

Question 12

When can Levonelle® be taken?

Answer 12

Levonelle® should be taken within 72 hours of UPSI. The longer the delay, the less effective Levonelle® is. Levonelle® is not affected by other progestogen use i.e. it can be used alongside other hormonal contraception.

Question 13

How effective is Levonelle®?

Answer 13

Of the forms of available emergency contraception, Levonelle® is on average the least effective - not effective when taken after ovulation

Question 14

risks or side effects of Levonelle®?

Answer 14

Levonelle® can commonly cause nausea, vomiting, and delayed or early menses
- if a patient vomits within 3 hours of taking Levonelle®, they will need to repeat the dose
- Double dose needed if BMI >26

Question 15

What is ellaOne®?

Answer 15

EllaOne® is an emergency contraceptive pill with ulipristal acetate (UPA). It is a one-dose tablet.

Question 16

How does ellaOne® work?

Answer 16

EllaOne® works by delaying ovulation. In theory, this means that any sperm present in the genital tract should no longer be alive by the time of the (delayed) ovulation, and so there is no resulting pregnancy.

Question 17

When can ellaOne® be taken?

Answer 17

EllaOne® can be taken within 120 hours, or 5 days, of UPSI.

It is rendered less effective by progestogen hormones, and as such should not be taken in a 7 day period following progestogen use

Question 18

How effective is ellaOne®?

Answer 18

EllaOne® is generally more effective than Levonelle® at preventing pregnancy - If EllaOne® is taken after ovulation, evidence suggests that it is not effective

Question 19

What are the risks or side effects of ellaOne®?

Answer 19

EllaOne® can commonly cause nausea, vomiting, and delayed or early menses - If a patient vomits within 3 hours of taking ellaOne®, they will need to repeat the dose

EllaOne® is rendered less effective by enzyme-inducing medication and is not suitable for use in patients with severe asthma.

Question 20

What is the copper IUD?

Answer 20

a copper IUD is a small T-shaped plastic and copper device which is inserted into the womb during a small procedure. It is also known as a coil

Question 21

How does the copper IUD work?

Answer 21

This copper is toxic to sperm and eggs, and this toxic effect prevents pregnancy”

Question 22

When can the copper IUD be used?

Answer 22

up to 5 days, (120 hours) after unprotected sex; or within 5 days of the earliest expected date of ovulation

In order to be effective, the copper IUD should remain in situ ideally for 21 days. It can be left in place for up to 10 years to provide ongoing contraceptive protection.

Question 23

How effective is the copper IUD?

Answer 23

When inserted at the correct time, the copper IUD is the most effective form of emergency contraception

Question 24

What are the risks or side effects of the copper IUD?

Answer 24

A small procedure is required to insert the IUD. Although this should only last around 5 minutes, some people can find it uncomfortable. There is an associated small risk of infection, expulsion and of perforation. Some people may experience irregular bleeding for a few days after the fitting of the IUD. Periods may be heavier, longer and more painful, especially in the first few months

Question 25

Follow up emergency contraception

Answer 25

All patients should be advised to take a pregnancy test 3 weeks after UPSI, to ensure that they have not become pregnant. This should be done even if they have bleeding as this may not represent a normal period.