emergency hormonal contraception Flashcards
(36 cards)
define emergency contraception
Intervention aimed at preventing unintended
pregnancy after unprotected sexual intercourse
or potential contraceptive failure
what are the two main indications for EC?
When the patient has a natural cycle and no contraception has been used
When there is Incorrect use or potential failure of hormonal contraception
how does oral EC work?
- Oral EC works by delaying ovulation
- EC administered after ovulation is ineffective.
- Ovulation occurs about 14 days before menstruation starts
how do you calculate a patients estimated ovulation date?
• We work out the patients predicted ovulation by determining
the length of their cycle and subtracting 14.
• If irregular cycle, calculate earliest likely ovulation date
using the shortest cycle in past 12 months
when is the fertile period?
• Theoretically, there’s only a short time when women can get
pregnant.
• This is the time around ovulation.
• Oral EC works by delaying ovulation
• Oral EC administered after ovulation is ineffective and wont
prevent pregnancy.
• The woman is said to be most fertile the 5 days leading up to and
including the estimated ovulation day (6 days)
what drugs can you use before ovulation?
levonoregestrel
ulipristal acetate
intrauterine device - before and after
how long can sperm survive in the female genital tract?
about 5
days after unprotected sexual intercourse (UPSI)
when should EC be considered?
• On any day of a natural menstrual cycle.
• Particularly in the fertile window
• After regular hormonal contraception has been
compromised or used incorrectly.
• From day 21 after childbirth, unless all the lactational
amenorrhea method (LAM) criteria are met.
• From day 5 after miscarriage, abortion, ectopic pregnancy, or
uterine evacuation for gestational trophoblastic disease
how can you obtain ulipristal- ellaone?
Pharmacy • Purchased OTC (charge) • Supplied via a PGD (Free) Other • GP, SRH or GUM clinic (free)
how can you obtain lebonogestrel-levonelle?
Pharmacy • Purchased OTC (charge) • Supplied via a PGD (Free) Other • GP, SRH or GUM clinic (free)
how can you obtain copper IUD?
GP or GUM clinic • Can only Inserted by a specially trained practitioner at a GP practice, SRH GUM clinic
what is the most effective method of EC and how does it work?
copper IUD
Spermicidal/toxic to ovum – prevents fertilisation
• Can be fitted up to 120hrs (5 days) after UPSI or within 5 days of the earliest predicted date of ovulation
effective before and after ovulation
what is c/i for cu-iud?
• Pregnancy • >48 hours or <4 weeks post-partum • Undiagnosed vaginal bleeding • Gynaecological cancers – Cervical, Endometrial, Ovarian • Acute Pelvic infection
when is levonelle licensed for? what are its indications?
Licensed for use for up to 72hrs after UPSI
• Had UPSI or sex with compromised contraception within the
previous 72 hrs, or
• Have had levonorgestrel but vomited within THREE hours of
administration and are still within 72 hrs of UPSI.
what happens if you take Levonelle prior to the lh surge?
If taken prior to the LH surge can result in ovulatory dysfunction
in the subsequent 5 days
when do you use ulipristal?
UPSI up to 120 hours ago.
• First choice if UPSI during the fertile period
• Can prevent ovulation after the LH surge has started,
delaying follicular rupture for up to 5 days
what influences your choice of oral EC?
- The age of the patient
- The time has elapsed since unprotected intercourse.
- Note what contraception was used at the time of intercourse, if any
- If no contraception has been used conduct a menstrual history.
- If there has been any other UPSI in this cycle = pregnancy risk
- Establish whether there has been any previous use of EC.
- Whether the woman is breast-feeding.
- Any medications
- Medical conditions- eg, liver disease, porphyria.
- Weight of the patient
- Need for ongoing contraception
- Whether they have recently used a progestogen
how much does otc lebonelle cost?
25 pound- must be over 16
how much does ulipristal cost otc?
35
what should you consider when supplying patients u16?
non-consensual intercourse, child protection, vulnerable
adults, consent and confidentiality
what do the fraser guidelines say relating to contraception?
- The young person understands the advice being given.
- The young person cannot be convinced to involve parents/carers or
allow the medical practitioner to do so on their behalf. - It is likely that the young person will begin or continue having
intercourse with or without treatment/contraception. - Unless he or she receives treatment/contraception their physical or
mental health (or both) is likely to suffer. - The young person’s best interests require contraceptive advice,
treatment or supplies to be given without parental consent
how does the effectiveness of oral EH vary with time?
The efficacy of Levonogestrel declines with time.
– Up to 12 hours: 95%, 25-48 hours 85% effectiveness and 49-72
hours 58% effectiveness
Ulipristal remains 95% effective up to 120 hours after UPSI
what is the natrual menstrual cycle?
• This is where the person is not using contraception and no
contraception has been used in the cycle
what is the missed pill rule for COC?
first week pill-EC may be required if UPSI occurred in the pillfree interval or in the first week of pill-taking
second week-EC is not required if the pills in the preceding
7 days have been taken correctly. Advise the
woman to finish the pack and have the usual
7–day break.
3rd week-Omit the pill-free interval by finishing the pills
in the current pack and starting a new pack
the next day.
Emergency contraception is not required if
the pill-free interval is omitted.
