EHC

• Ulipristal (Ella one)


  • More effective than Levonorgesterol and should be advised 1st line
  • either one can be given at any point in the menstrual cycle
• Ulipristal (Ella one) for 13-16 year olds consider safeguarding/fraser guidlines


  1. Ensure patient understands advice given

  2. Encourage to involve parents

  3. Effect of physical/mental health if treatment withheld

  4. Is action in the best interest of the patient
• Ulipristal (Ella one) dose counselling


  • 30mg tablet to taken straight away (must be taken within 5 days of the event)
  • Inhibits/ delays ovulation via suppression of the LH surge
• Ulipristal (Ella one)


  Preferred over Levonorgesterol if patients BMI>26, >70kg
• Levonorgesterol (Levonelle One) DOSE Counselling


  • 1500mg tablet to taken straight away (must be taken within 3 days of the event)
  • >16 yrs only
  • Prevents ovulation by inhibiting/ delaying ovulation
  • can take more than one in the same cycle
  • safe in breastfeeding
• Levonorgesterol (Levonelle One)


  Prevents about 85% of pregnancies if used within 72 hours. Effectiveness declines over time
• IUD


  • POM
  • Most effective contraceptive method
  • FRSH guidelines recommend IUD as 1st line - practically EHC above is advised 1st line if appropriate
  • If ovulation has already occurred, neither EHC is effective and an IUD must be considered
• Emergency hormonal contraeption (EHC) causes?

  Unprotected intercourse/ contraception method has failed
• EHC REFERRAL

  > unprotected intercourse/contraception method failed >5 days ago

  > <13yrs for ella one, <16 years for levonorgestrel

  > Changes in the period pattern, (heavier, lighter than noraml, irregular

  >interacting medication: enzyme inducers > carbamazepine, rifampicin, phenytoin, primidone, st john warts etc.

  > IUD used in these cases of interactions, including 4 weeks after stopping these drugs

  > severe liver dsyfunction/severe diarrhoea

  > chron's disease

  >asthma treatment with glucocorticoid therapy/ciclosporin treatment pt
• side effects of ulipristal

  headache, nausea, abdominal pain, dysmenorrhea
• advise patients to continue regular hormonal contraception- Ella one can reduce hormonal contraceptives effectiveness. Therefore, still continue but advise pt to use extra methods of barrier contraception as well (condoms)
• if period is delayed greater than 7 days after taking ella one dose then refer to GP to exclude pregnancy
• breastfeeding with ulipristal

  not safe in breastfeeding- Avoid for 1 week after administration—present in milk.

  pump and discard for ONE week
• side effects for levongestrel

  same as ella one BUT pts can experience bleeding not related to menses and fatigue

  > advice pts to continue regular hormonal contraception- no interaction
• if period is delayed greater than 5 days after taking levonorgestrel dose then refer to GP to exclude pregnancy
• EHC counselling

  if vomit within 3 hours of either EHC method, another tablet should be taken immediately

  use barrier methods (condoms) of contraception until next menstural cycle starts

  any abnormal bleeding, pregnancy suspected refer to GP to exclude pregnancy (ectopic pregnancy can occur)

  overweight patients may require a double dose