contraception

• Emergency Hormonal Contraception Methods

  Levonorgestrel and ulipristal (a progesterone receptor modulator)
• Levonorgestrel mode of action


  The mode of action is not fully understood; it acts both to stop ovulation and inhibit implantation
• Timing and Efficacy of Levonorgestrel


  It should be taken as soon as possible because its efficacy decreases with time; it must be taken within 72 hours of unprotected sexual intercourse (UPSI)
• Levonorgestrel Dosage


  A single dose of 1.5 mg
• Levonorgestrel Dose Adjustment


  For individuals with a BMI >26 or weight over 70 kg, the dose should be doubled
• Efficacy of Levonorgestrel


  It is 84% effective if used within 72 hours of UPSI
• Side Effects of Levonorgestrel


  • Disturbance of the menstrual cycle and vomiting in around 1% of users
• Vomiting and Levonorgestrel


  The dose should be repeated if vomiting occurs within 3 hours of taking levonorgestrel
• Repeat Use of Levonorgestrel

  Yes, if clinically indicated
• Starting Hormonal Contraception After Levonorgestrel


  Hormonal contraception can be started immediately after using levonorgestrel (Levonelle) for emergency contraception
• Ulipristal Mode of Action


  Inhibition of ovulation
• Ulipristal Dosage and Timing

  A 30 mg oral dose taken as soon as possible, no later than 120 hours after intercourse
• Ulipristal and Levonorgestrel


  Concomitant use is not recommended
• Ulipristal and Hormonal Contraception

  Ulipristal may reduce the effectiveness of hormonal contraception; contraception with the pill, patch, or ring should be started or restarted 5 days after taking ulipristal, using barrier methods during this period
• Ulipristal and Asthma


  Caution should be exercised in patients with severe asthma
• Repeated Dosing of Ulipristal

  Yes, repeated dosing within the same menstrual cycle is now allowed
• Breastfeeding and Ulipristal


  Breastfeeding should be delayed for one week after taking ulipristal
• Copper IUD Effectiveness


  It is the most effective method, being 99% effective
• Timing for Copper IUD Insertion

  Within 5 days of UPSI, or up to 5 days after the likely ovulation date if the woman presents later
• Mechanism of Copper IUD

  It may inhibit fertilization or implantation
• Antibiotics and Copper IUD

  Prophylactic antibiotics may be given if the patient is considered to be at high risk of sexually transmitted infection
• Long-term Use of Copper IUD

  Yes, it can be left in place for long-term contraception, or at least until the next period if the client wishes for its removal
• Choosing Between IUD and Oral Contraception


  If a copper IUD is not acceptable or suitable, oral emergency contraception should be considered