Mohammad OTC and Emergency Contraception

How long can sperm remain viable in the fallopian tubes?

How long is the egg viable?

Up to 5-6 days.

Approximately 24 hours.

When is the fertility window?

When is conception risk highest after unprotected sex?

The 5 days before ovulation plus the day of egg release. It is variable though, because ovulation does not consistently occur on the same day of each menstrual cycle.

When ovulation occurs during the first 3 days following unprotected sex.

Which vaccines for STI prevention are mentioned?

HPV vaccine and HBV vaccine.

What is the most important barrier contraceptive that helps protect against STIs?

Male condoms.

What factors can increase male condom breakage?

How do synthetic non-latex condoms compare with latex condoms for breakage?

Incorrect placement, oil-based lubricant with latex condoms (instead, use water or silicone-based lube), condom reuse, and poor fit.

Non-latex had higher breakage rates in studies. Latex is the first choice.

Are nonoxynol-9-coated condoms more effective than untreated condoms?

No. They are no more effective at preventing STIs or pregnancy. They can actually cause irritation and increase infection risk.

What should be used immediately if a condom tears or breaks?

What should not be used?

Immediately insert high-concentration spermicidal foam or jelly into the vagina and consider emergency contraception.

Do NOT use suppositories or vaginal film, because delayed dissolution may decrease efficacy. Don't douche either because it may force sperm into the cervical canal.

What is the STI protection efficacy of lamb cecum (natural membrane) condoms?

Not as effective because pores can allow HIV/HBV transmission.

Can female condoms be used with a latex allergy?

Yes, because it is made of nitrile.

What contraceptive methods should NOT be used with a female condom?

Diaphragm, cervical cap, sponge, or hormonal contraceptive rings.

Because of displacement/interference of the female condom.

What are the main structural components of a female condom?

An outer ring, a long sheath, and an inner ring that secures the sheath by fitting like a diaphragm over the cervix.

How do female condom breakage and slippage compare with male latex condoms?

Can a male and female condom be used together?

Breakage rates are lower, but slippage rates are higher.

No. Friction can increase breakage of both.

What is the active ingredient in vaginal spermicides?

What dosage forms are available?

Nonoxynol-9.

Foams, gels/jellies, suppositories, films, and sponges.

How effective are vaginal spermicides when used alone?

What is the efficacy of condoms plus vaginal spermicides?

Relatively low effectiveness, especially among first-year users.

Similar to the efficacy rates of oral contraceptives and IUDs.

What is a concern with frequent use or high-concentration spermicides?

They may irritate or damage the vaginal/cervical epithelium and may be associated with increased STI risk.

How are spermicide gels/jellies, foams, diaphragms, caps, suppository, films, and sponges administered?

Insert near the cervix.

What medical history should the sponge be avoided with?

Women who have had children or toxic shock syndrome.

What is the OTC oral hormonal contraceptive pill and dose?

Norgestrel (Opill), taken as 1 tablet once daily. It is a progestin-only pill (POP).

What are fertility awareness-based (FAB) methods?

Effectiveness?

Methods that do not use a chemical or barrier to prevent conception; they identify the fertile phase so intercourse is avoided or another contraceptive method is used during that time.

Examples include the calendar method, cervical mucus method, symptothermal method (basal body temperature), home ovulation kits, and lactational amenorrhea.

It is lower efficacy than other methods.

What is the progestin-only EC marketed as Plan B One-Step?

Mechanism?

Does it require a pregnancy test?

Levonorgestrel as one single high-dose.

Primarily inhibits or delays ovulation through negative feedback on the hypothalamus (decreases LH surge). It also thickens cervical mucus.

Pregnancy test is not required.

When should levonorgestrel EC be taken?

Can it still be used after this time?

72 hours of unprotected intercourse. The sooner it is taken, the more effective it is.

It can still be used within 120 hours (5 days), but efficacy declines after 72 hours.

What are adverse effects of levonorgestrel EC?

Is it the same as ulipristal?

Nausea and vomiting.

Other: Headache, breast tenderness, menstrual changes, and dizziness.

Same as ulipristal.

What is the mechanism of ulipristal EC (Ella)?

Is it OTC or prescription?

It is a selective progesterone receptor modulator that blocks progesterone receptors.

It disrupts ovulation and has a direct inhibitory effect on follicular rupture. It is one single dose.

Prescription only.

When should ulipristal EC be taken?

How effective is it compared with levonorgestrel (within 72 hours)?

Up to 120 hours (5 days) after unprotected intercourse.

Similar efficacy when used within 72 hours. After 72 hours, ulipristal is more effective than levonorgestrel.

What is the mechanism of the copper IUD as emergency contraception?

It compromises fertilization through toxic effects on sperm and causes histological changes in the endometrium presumed to impair implantation.

When should copper IUD be used for emergency contraception?

It requires a physician visit for access and insertion and must be placed within 120 hours (5 days) of unprotected intercourse.

What are contraindications to copper IUD insertion?

Pregnancy, active pelvic infection, uterine cavity abnormalities, and certain STIs.

What is the Yuzpe regimen?

Is it recommended?

An emergency contraception regimen using higher doses of regular combined estrogen/progestin hormonal contraceptive pills in 2 doses.

Not recommended because of poor efficacy and adverse effects; it is off-label.

What is the mechanism of mifepristone?

What other drugs are taken with it?

Up to how many days after the start of pregnancy is it used?

After ovulation it can prevent/terminate pregnancy by delaying endometrial maturation.

Taken with ibuprofen and misoprostol (stimulates uterine contractions)

Up to 70 days.

What adverse effects of mifepristone are listed?

Intrauterine bleeding, nausea, and vomiting.

Do short-term emergency contraceptive pills affect clotting factors?

The lecture states they do not; increased venous thromboembolism risk is unlikely.

Is repeated use of emergency contraception harmful?

Repeated use is not harmful, but it is not optimal because EC is less effective as a routine contraceptive method.

How does obesity affect levonorgestrel EC effectiveness?

Ulipristal EC?

Copper IUD?

Effectiveness is reduced in women >75 kg or a BMI ≥26.

Effectiveness is reduced in women >85 kg or a BMI ≥30. May become ineffective at BMI 35.

Effectiveness doesn't change.

Repeat the dose if vomiting occurs within _______ of taking levonorgestrel EC and within _______ of taking ulipristal EC.

Repeat the dose if vomiting occurs within 2 hours of taking levonorgestrel EC and within 3 hours of taking ulipristal EC.

What menstrual change is common if EC is taken before ovulation?

After ovulation?

Early onset of menses, by about 3-7 days.

Normal-to-late onset of menses.

After taking an EC, a pregnancy test should be taken if menses does not start within _______ or is more than _______ late beyond the expected date.

After taking an EC, a pregnancy test should be taken if menses does not start within 21 days or is more than 1 week late beyond the expected date.

When should hormonal contraception be restarted after levonorgestrel EC?

Ulipristal?

The day after levonorgestrel use.

Wait until the next menstrual cycle.

When should barrier-method be used when restarting regular contraception?

Start using a barrier method immediately because of potential cycle irregularities.