Emergency contraception

Sajid Khan
GPST2
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Methods of emergency contraception
Indications for use of emergency
contraception
Methods of action
Clinical Effectiveness
Consultation
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Emergency contraception- (the morning-after
pill) refers to the use of drugs or a device as
an emergency measure to prevent pregnancy.
Given to
◦ Women who have had recent unprotected sexual
intercourse
◦ Failure in another method of contraception
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Levonorgestrel, LNG (oral pill)
◦ “Levonelle 1500, Levonelle one step”
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Ulipristal/UPA
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“ellaOne” (oral pill)
Copper Intrauterine Device
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Missed cocp
Late POP ( >27 hrs for conventional POP,>36
hours for cerazette)
Late depot
Condom not used/ condom accident
IUD removal, expulsion, lost threads
Enzyme inducing drugs and failure to use
extra precautions
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Levonelle 1500 (pom); Levonelle one step;
A progesterone; single 1.5mg dose
Licensed for use up to 72 hours after UPSI or
contraceptive failure
Mechanism of action: works primarily by
inhibition of ovulation. LNG appears to prevent
follicular rupture or cause luteal dysfunction.
LNG taken prior to the LH surge has been shown
to result in ovulatory dysfunction in the
subsequent 5 days.
Inhibit ovulation for 5–7 days, by which time any
sperm in the reproductive tract will have become
non-viable.
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A selective progesterone receptor modulator;
single dose 30 mg.
Licensed for use up to 120 hours after UPSI or
contraceptive failure.
Cost £16.95
Mechanism of action: ; delays LH surge and
has effect on follicular rupture;
Affects hormonal contraception for a short
while afterwards(extra barrier protection cocp
14 days, pop 9 days)
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Copper IUD; can be used up to 5 days
following first UPSI in cycle or within 5 days
from the earliest estimated day of ovulation.
Mechanism of action: copper toxic to sperm
and ovum; primarily inhibits fertilisation (and
implantation)
Effectiveness >99% at any time of cycle
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IUD >99% effective
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LNG up to 95% within 24 hrs
up to 85% within 25-48 hrs
up to 58% within 49-72 hrs
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UPA at least as effective as LNG up to 120
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hours
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Ulipristal acetate versus levonorgestrel for
emergency contraception: a randomised noninferiority trial and meta-analysis.
Glasier AF et al Lancet. 2010
Two randomised controlled trials
◦ 1696 women received emergency contraception within
72 h of sexual intercourse (ulipristal acetate, n=844;
levonorgestrel, n=852). There were 15 pregnancies in
the ulipristal acetate group (1.8%,) and 22 in the
levonorgestrel group (2.6%).
◦ In 203 women who received emergency contraception
between 72 h and 120 h after sexual intercourse, there
were three pregnancies, all of which were in the
levonorgestrel group.
◦ Pregnancy rate lower in UPA than LNG
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Date of LMP;
Time since UPSI
Previous UPSI this cycle?
EC used this cycle?
Discussed oral method v IUD?
Ongoing contraception discussed?
Health promotion
◦ Need STI screen?
◦ Given leaflets for contraception
◦ Condoms offered if needed?
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Advised PT in 3weeks if no period
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Any Questions