Emergency Hormonal Contraception

OTC - EHC

• LEVONELLE - Levonorgestrel (LNG) 1.5mg

  • Prevents ovulation and fertilisation and (post-ovulation?) - discourages implantation

  • Licensed OTC for ages 16 and over

• ELLAONE - Ulipristal acetate (UPA) 30mg

  • Delays ovulation

  • Alterations to endometrium

  • Licensed OTC for all women of childbearing age

Efficacy and ADRs

Levonelle

• Licensed up to 72 hours

• Overall efficacy = 84%

  • 95% (<24hrs)

  • 85% (<25-48hrs)

  • 58% (49-72%hrs)

• ADRs

  • Headache, nausea lower abdominal pain, breast tenderness, irregular bleeding, increased risk of ectopic pregnancy

ELLAONE (first line)

• Slightly higher efficacy and lower pregnancy rate in 0-72hrs to LNG

• 48-120hrs - 2% pregnancy rate

• Efficacy of UPA reduced if any progesterone taken in the 7 days post UPA - theoretical risk

• ADRs

  • Headache, nausea, abdominal pain, irregular bleeding, dysmenorrhea

Emergency Contraception

Copper-bearing IUD (GP/GUM clinics)

• Non-hormonal!!!!!!

• Fitting: STI screen and/or prophylactic antibiotics

• Risks/ADRs: cramping, bleeding, heavier/longer/painful periods, bacterial infection, thrush, ectopic pregnancy

Indication for EHC

• After UPSI on any day of menstrual cycle

• UPSI in 28 days following use of enzyme-inducing drugs (anti-seizure)

• UPSI from 21 days postpartum

• UPSI from 5 days post-abortion/miscarriage/ectopic pregnancy

• After ejaculation onto external genitalia

• UPSI before new contraception is effective

• After contraceptive failure

  • Split condom

  • Missed pill

  • DDI with hormonal contraception

  • Delayed contraceptive implant or injection

  • Detached contraceptive patch

  • 7 days prior to IUD/IUS being dislodged/removed

  • Dislodged/early removal diaphragm