Emergency Contraception Short Cases Dr Lynda Turner June 2015

Emergency contraception. False. Cu IUD is the best method with a liver enzyme inducer. Levonorgestrel (Levonelle) may be used at double dose (2 tabs ie. 3mg) Ulipristal (ellaOne) not recommended.

Emergency contraception. True or False. Considering COC pills Emergency contraception needed if: a) Pills 2 and 3 are missed and UPSI on the last day of PFI b) Pills 9 and 10 are missed and UPSI on D11 c) Pills 19 and 20 are missed and UPSI on D21

Emergency contraception. True or False. Considering COC pills Emergency contraception needed if: a) Pills 2 and 3 are missed and UPSI on the last day of PFI TRUE as 7 pills have not been taken following PFI so ovulation not suppressed. Should have EC – LNG or UPA, continue taking pills and also use condoms for 7 days if used LNG and 14days if used UPA

Emergency contraception. True or False. Considering COC pills Emergency contraception needed if: b) Pills 9 and 10 are missed and UPSI on D11 FALSE – 7 pills have been taken prior to the missed pills so ovulation is suppressed. EC not required. Continue taking pills and use condoms for next 7 days

Emergency contraception. True or False. Considering COC pills Emergency contraception needed if: c) Pills 19 and 20 are missed and UPSI on D21 False – as 7 pills have been taken correctly prior to the missed pills. EC not required. Continue taking pills, omit pill free interval and use condoms for next 7 days

Emergency contraception. True or False. A 23 year old woman is taking Noriday (POP) for contraception and forgot to take 2 pills last weekend. She resumed taking her pills and has now taken 4 pills since her missed pills. She had UPSI last night. This was only time she had sex since missing her pills. EC is advised False With the POP once 2 pills have been taken correctly after the missed pills full contraceptive efficacy is restored.

Emergency contraception. True or False. A 21 years old woman attends for repeat Depo-provera injection. Her last injection was 13 weeks 5 days ago. She had UPSI yesterday. She should be advised to have EC False Can be given up to 14 weeks without need for extra precautions or EC as per current FSRH guideline

Emergency contraception. True or False. A 20 years old woman attends your Pharmacy for EC advice. She is taking Microgynon 30 for contraception. Her GP has prescribed Nitrofurantoin for a UTI. A friend told her it would stop her pill working and she needs emergency contraception. False Nitrofurantoin is a broad spectrum antibiotic and is NOT a liver enzyme inducer, so will not reduce the efficacy of the COC. EC NOT required

Emergency contraception. True or False. EC can be used by a girl who has not reached menarche True. It is possible to conceive before menarche, so if there is any risk, EC should be considered. As the girl is likely to be young, Fraser competence and safeguarding need to be addressed during the consultation.

Emergency contraception. True or False. A 5Oyr old woman who is taking HRT can still use EC if required True If a woman is at risk of pregnancy, HRT will not be contraceptive, so she can use EC. All EC options can be considered

Emergency contraception. True or False. A 28 years old woman who is 18 days post natal had UPSI 4 days ago. She is breast feeding. She should be offered a copper IUD as her best option for EC False She does not require EC. Up until Day 21 post partum EC is not required. This is because earliest predicted ovulation post partum is Day 28. Also the earliest that a Copper IUD should be fitted post partum is 4 weeks. Reassure EC not required. Discuss ongoing contraception choices