Emergency (Post-coital) Contraception

—Levonelle – 1500ug levonorgestrel (progestogen)x1 dose up to 72 hours after unprotected SI
—EllaOne – 30mg ulipristal acetate (anti-progestogen)x1 dose up to 120 hours after unprotected SI
—Copper IUCD – Can be fitted up to 5 days after unprotected SI and up to 5 days after the expected date of ovulation (day 19 of 28 day cycle)
Counselling a patient about emergency contraception

NB Good communication and rapport with the patient is key to this consultation.

  • Introduce self and check name and DOB (wash hands too)
  • Ask about
    • When the unprotected sex occurred?
    • Does anybody know you are here or is anyone with you? (specifically the other involved, but also partners, parents, friends etc)
    • Ideas, concerns and expectations
    • Do they know about the contraception available?
  • Inform them of
    • Success rates
      • Both pills are up to 95% successful (this decreases substantially with time)
      • The IUCD is closer to 99% effective
    • How they work and what should happen
      • In laymans’ terms: Work by either overloading (Levonelle) or blocking (Ellaone) the action of progesterone, a hormone in the body that is involved in the menstrual cycle.  Most women experience a vaginal bleed (similar but unrelated to the period) after taking the pill, basically the body is losing the lining of the womb and there is no chance of getting pregnant.
      • No one fully knows how the IUCD works, but it is thought to interfere with the womb and the joining of sperm and egg, preventing pregnancy.
    • Side effects
      • Headache, nausea, vaginal bleed, abdominal pain and fatigue are quite common
      • NB If the patient vomits within 2 hours of taking the pill, she should take another and seek advice from a doctor.
      • Hypersensitivity reactions do occur
      • They may also interfere with the menstrual cycle and there may be side effects associated with that e.g. breast tenderness, delayed start of period etc
  • Problems with consent
    • In patients under 16 years old, consent from the individual is enough (legally) if the patient and the situation meets Fraser’s Criteria
      1. the young person will understand the professional’s advice
      2. the young person cannot be persuaded to inform their parents
      3. the young person is likely to begin, or to continue having, sexual intercourse with or without contraceptive treatment
      4. unless the young person receives contraceptive treatment, their physical or mental health, or both, are likely to suffer
      5. the young person’s best interests require them to receive contraceptive advice or treatment with or without parental consent.
  • Further points to discuss in the interview
    • STI check
    • Use of regular contraception
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