Emergency contraception

• Woman's fertile period:

  • Difficult to pinpoint exactly when ovulation happens
  • If regular 28 day cycle, likely to ovulate around day 14
  • Fertile window is 6 consecutive days ending with (including) day of ovulation
• EC in pregnancy:

  • Contraception is needed from day 21 post partum
  • If UPSI occurs after this time - EC needed
  • Use of copper coil is contraindicated until 28 days post delivery
• 3 methods available:

  • Copper IUD (Cu-IUD)
  • Oral ulipristal acetate 30mg single dose
  • Oral levonorgestrel 1.5mg single dose
• Sperm are viable in the female genital tract for 5 days after UPSI
• Time interval between ovulation and implantation

  • Shortest time is 6 days
  • Majority 8-10 days
• EC either has to prevent fertilization or prevent implantation, it does not disrupt established implantation
• Cu-IUD

  • Inserted up to 120hrs (5 days) post UPSI or up to 5 days post ovulation
  • Pre and post fertilization effects
  • Toxic to sperm and ova
  • Adversely affects the motility and viability of sperm
  • Adversely affects transport of ova
  • If fertilization occurs there is a local inflammatory endometrial reaction that prevents implantation
  • Only method effective following ovulation
• Ulipristal acetate (UPA) - EllaOne

  • 30mg single oral dose
  • Taken up to 120hrs (5 days) after UPSI
  • More effective than levonorgestrel
  • Selective progesterone receptor modulator (anti-progesterone effect)
  • Delays ovulation for at least 5 days
  • Cannot inhibit ovulation at/after LH peak
  • Not effective after ovulation
• Levonorgestrel (LNG)

  • 1.5mg single dose
  • Taken up to 72hrs (3 days) after UPSI
  • Is a type of progestogen
  • Inhibits ovulation, delays or prevents follicular rupture and causes luteal dysfunction
  • Sooner taken the more effective it is
• The most effective EC is the Cu-IUD and should be offered to all women

  Can be used as long term contraception
• Common side effects for oral EC:

  • Headache
  • Nausea
  • Dysmenorrhoea - inform patient that they might miss next period
  • If delayed more than 7 days advise pregnancy test
  • No adverse effect on future fertility or pregnancy
• If vomiting occurs within 3 hours of taking the oral EC - repeat dose
• Long term contraception:

  • Can be started immediately after LNG
  • Have to wait 5 days after UPA
  • Extra contraception (condoms) is required for the 7 seven days of the combined pill or first 2 days of the progestogen only pill
• Patient advice following EC:

  • If she vomits within 3 hours of oral EC, will need to return for further dose
  • Next period may be early or late
  • To do a urine pregnancy test in 3 weeks unless she has a normal menstrual bleed
  • If oral EC fails, it is not thought to be harmful to pregnancy
  • Return if has further UPSI