Choice of contraceptive + emergency contraception

What groups are oestrogen-containing methods contraindicated in?

History of headaches, very overweight, smoking and aged 35+, taking concomitant medicines that have a risk of interaction/medical conditions

What are some fertility awareness methods of contraception (natural family planning)?

Track ovulation to prevent pregnancy - uses a combination of factors

What is coitus interruptus?

Withdrawal method used by many couples, natural method of contraception but not recommended as it is very ineffective

What is the lactational amenorrhoea method of contraception?

Breastfeeding after childbirth to prevent pregnancy - delays the return of ovulation by disrupting gonadotrophin release

What conditions must be met before lactational amenorrhoea method can be used?

• Baby should be getting 85% or more of feeds as breast milk

• Water, juice or vitamins can be given infrequently

• No other liquids should be given

• No long intervals between day or night feeds

• Less than 6 months postpartum

What is male sterilisation known as?

Vasectomy

What is female sterilisation known as?

Tubal occlusion

What are the 2 types of emergency contraception?

• Emergency contraceptive pill - levonorgestrel and Ulipristal acetate

• Copper-bearing IUD

When can the levonorgestrel (Levonelle) emergency contraceptive pill be taken?

Within 72 hours after UPSI

When can the Ulipristal acetate (EllaOne) emergency contraceptive be taken?

120 hours after UPSI - 5 days after

What is the recommended dose of the levornogestrel?

1.5mg single oral dose

What is the recommended dose of ulipristal acetate?

30mg oral dose - single dose

When can a copper IUD be used as emergency contraception?

Within 5 days of 1st UPSI in cycle or 5 days after earliest ovulation date

What is the MOA of the levonorgestrel EC?

Inhibits ovulation and prevents follicle rupture

What is the MOA of ulipristal acetate?

Delays ovulation, even after LH peak

What is the effect of weight on levonorgestrel?

Less effective in overweight/BMI 26+

What is the effect of weight on ulipristal?

Less effective for BMI 30+

What are the interactions and CI for levonorgestrel?

Metabolism increased for 2+ days after for liver enzyme inducers, not recommended in severe hepatic impairment, HIV

What are the interactions and CI for ulipristal?

Metabolism increased for 2+ days after liver enzyme inducers, use of desogestrel POP is less effective, CI in severe asthma controlled by oral steroids and avoid in hepatic impairment

What is the breastfeeding advice for levonorgestrel?

Avoid nursing for 8 hours after taking

What is the breastfeeding advice for ulipristal?

Don’t breastfeed and discard breastmilk for a week

What are the CI for the copper-IUD?

STI risk, previous ectopic pregnancy, young, no breast-feeding for 48 hours, not to be used for 28 days after birth due to perforation risk

What are the interactions and weight considerations for Cu-IUD?

None!

What are the side effects for levonorgestrel, ulipristal and the copper-IUD?

If vomits repeat the dose of tabs, if menstrual cycle occurs 7 days late = pregnancy test,

What are some useful counselling points for all EHC?

• Taking any other meds?

• Weight?

• If pt vomits within 3 hours - take another tablet ASAP

• Ulipristal - with or without food

What type of service is the contraceptive service?

Advanced service that can monitor and supply repeat oral contraceptives, pharmacists measure patients BP and BMI