PB#152: Emergency Contraception

Question 1

Most commonly used PO EC regimen

Answer 1

Progestin-only pill

Question 2

Which EC method can be obtained OTC?

Answer 2

Yes

Question 3

Regimens for taking progestin-only EC (2)

Answer 3

Levonorgestrel 1.5mg x1, levonorgestrel 0.75mg x2

Question 4

Outcomes of two progestin-only options

Answer 4

Equally effective, with one-dose regimen more convenient

Question 5

For how long s/p unprotected intercourse is levonorgestrel EC regimen effective?

Answer 5

Up to 72h (but is best used as soon as poss)

Question 6

PO EC method that requires an rx

Answer 6

Ulipristal acetate 30mg x1

Question 7

Class of med of ulipristal

Answer 7

SPRM (antiprogestin)

Question 8

For how long s/p unprotected intercourse is is ulipristal EC effective?

Answer 8

Up to 120h

Question 9

For how long s/p unprotected intercourse is copper IUD effective as EC?

Answer 9

5 days

Question 10

PO method (other than levonorgestrel and ulipristal) that is available for EC

Answer 10

COCs

Question 11

For how long s/p unprotected intercourse is COC EC regimen effective?

Answer 11

Up to 5 days

Question 12

MoA of ulipristal and levonorgestrel-only EC regimens

Answer 12

Inhibiting/Delaying ovulation

Question 13

Is ulipristal effective after LH increase has begun?

Answer 13

Yes, it will still inhibit follicular rupture

Question 14

Is levonorgestrel effective after LH increase has begun?

Answer 14

No, it delays follicular development if administered before LH increases

Question 15

MoA of copper IUD when used as EC

Answer 15

Prevents fertilization by affecting sperm viability and function, in addition to effects on oocyte and endometrium

Question 16

Does EC prevent implantation of a fertilized egg?

Answer 16

No, it is ineffective after implantation

Question 17

Does hormonal EC confer any risk to an established pregnancy or harm to a developing embryo?

Answer 17

No

Question 18

Most frequently reported adverse effects (and percentages) assocaited w/ ulipristal and levonorgestrel (2)

Answer 18

HA (19%), nausea (12%)

Question 19

When do subsequent menses typically occur s/p EC use?

Answer 19

Within 1 week of expected time (though some pts experience irregular bleeding/spotting in week/month s/p tx)

Question 20

Percentage of pts who report nonmenstrual bleeding in first week after use of levonorgestrel-only EC

Answer 20

16%

Question 21

EC is more likely to cause bleeding before expected menses if taken at what point in the menstrual cycle?

Answer 21

Earlier in cycle

Question 22

Management of irregular bleeding associated with/ EC

Answer 22

Resolves w/o tx

Question 23

Reported short-term adverse effects w/ PO regimens (4)

Answer 23

Breast tenderness, abdominal pain, dizziness, fatigue

Question 24

Risk of uterine perforation associated w/ copper IUD insertion

Answer 24

~1/1,000

Question 25

Adverse effects associated w/ copper IUD (3)

Answer 25

Cramping, increased menstrual bleeding, dysmenorrhea

Question 26

Does levonorgestrel EC increase chance that subsequent pregnancy will be ectopic?

Answer 26

No

Question 27

Personal characteristics more often seen in pts seeking EC (3)

Answer 27

<25 y/o, have never been pregnant, have used some form of contraception in the past

Question 28

Has making EC more available been shown to encourage more risky sexual behavior and/or increase risk of unintended pregnancy?

Answer 28

No

Question 29

Conditions in which risks of EC outweigh benefits

Answer 29

None (including pts w/ prior ectopic pregnancy, CV disease, migraines, liver disease, breastfeeding)

Question 30

Specific situation in which all pts of reproductive age should be offered EC

Answer 30

Pts presenting following sexual assault

Question 31

Indicated workup/procedures prior to providing EC

Answer 31

None (including exam, pregnancy testing, determination of day of menstrual cycle)

Question 32

At what time point s/p unprotected intercourse is efficacy maximized?

Answer 32

As soon as possible

Question 33

Reported pregnancy rates following EC IUD placement

Answer 33

0-2%

Question 34

Subsequent pregnancy rates w/ ulipristal regimen, subsequent pregnancy rates w/ levonorgestrel-only regimen

Answer 34

1.4%, 2.2%

Question 35

Pt characteristic where PO EC may be less effective

Answer 35

Overweight/Obese pts

Question 36

Percentage of pregnancies prevented by COC EC regimen

Answer 36

74%

Question 37

Why is levonorgestrel-only EC regimen preferred to COC EC regimen? (2)

Answer 37

Higher pregnancy prevention rates, lower N/V side effects

Question 38

Can PO EC be used more than once within same menstrual cycle?

Answer 38

Yes

Question 39

Why should EC not be used as long-term form of contraception?

Answer 39

Higher hormone exposure than ongoing use of COCs/POPs, association w/ more adverse effects (including menstrual irregularities)

Question 40

Recommended f/u s/p EC

Answer 40

No routine f/u indicated

Question 41

Situations in which clinical evaluation is indicated s/p EC (2)

Answer 41

Menses delayed by >1 week after expected time, lower abdominal pain/persistent irregular bleeding develops

Question 42

When should pregnancy test be performed following EC use?

Answer 42

If menses delayed >1 week

Question 43

Are pts who have taken PO EC at risk of becoming pregnant later in same cycle?

Answer 43

Yes, because EC may work by delaying ovulation

Question 44

When should pts begin using barrier contraceptives s/p EC use?

Answer 44

Immediately

Question 45

When should pts begin using hormonal contraception s/p ulipristal use?

Answer 45

No sooner than 5 days after

Question 46

When can pts begin using a regular contraceptive method after use of levonorgestrel/COC EC regimen?

Answer 46

Immediately (though should abstain from intercourse or use barrier contraceptive x7 days)

Question 47

Most effective method of EC

Answer 47

Copper IUD

Question 48

Continuation rate of copper IUD s/p insertion for EC for parous pts, continuation rate of copper IUD s/p insertion for EC for nulliparous pts

Answer 48

94.3%, 88.2%

Question 49

Is cumulative pregnancy rate in following year lower in pts s/p EC IUD insertion or in pts who used levonorgestrel-only EC?

Answer 49

Pts s/p EC IUD insertion