Park Leys Medical Practice

EMERGENCY CONTRACEPTION PROTOCOL
There are two methods of emergency contraception: Hormonal and the Copper Intrauterine Device (IUD).
The IUD is the most effective- prevents 99% of pregnancies, prompt presentation by the patient is to be encouraged in all cases.

Hormonal Methods:

Levonelle 1

Should be taken within three days (72hours) of UPSI. Efficacy diminishes with time.

Efficacy- up to 95% if taken within 24hrs, up to 85% if taken between 25-48hrs, up to 58% if taken between 49-72hrs, Efficacy beyond 72-120hrs has not been determined.

Patients should continue with their regular contraception within 12 hours of taking emergency contraception but need to use an additional contraceptive method such as condoms for 7 days with the patch or the combined pill or for 2 days with the POP.

Can be used several times in the same menstrual cycle.

EllaONE

[Ulipristal acetate an orally active synthetic progesterone receptor modulator-is thought to act by inhibition or delay of ovulation]

Can be used within 5days of UPSI or contraceptive failure.

Is more effective than levonelle1 especially when taken between 72and 120hours after UPSI. Over all 97.9% efficacy- and 97.3%, 98% and 98.7%, respectively for time intervals of 48-72, 73-96 and 97-120 hours.

1 EllaOne 30mg tablet should be taken as soon as possible and no later than 5 days
after UPSI.

This is an occasional method only. Repeat treatment within the same menstrual cycle is not advised.

Breast feeding women should avoid breast feeding for 36hours after administration.
Not recommended for use with enzyme inducers including St John’s wort or with PPI’s and H2-receptor antagonists or in women with severe asthma insufficiently controlled by oral glucocorticoids.

Prescribe EllaOne if patient presents between 72 and 120hours after UPSI

Patients should continue with their regular contraception within 12 hours of taking emergency contraception .ALSO need to use additional barrier contraceptive method such as condoms until their next period.
Discuss LARCS with patients when prescribing hormonal emergency contraception

The Copper IUD

Can be fitted up to 5 days after UPSI at anytime in the menstrual cycle provided that this is the only UPSI that has occurred since the LMP.
If UPSI has occurred more than once since the LMP, an IUD can be fitted up to five days after the earliest time of possible ovulation [day 19 in a 28day cycle].

Patients can choose to continue with the IUD as their ongoing method of contraception.
Review all patients 3-4weeks after an IUD fitting to check for pregnancy, discuss any problems, remove the IUD if patient is on a period and the patient wishes removal and to discuss future contraceptive needs.

Advise all patients to do a pregnancy test if a normal period has not occurred within 3 weeks of treatment.


Dr EMY Mwale November 2009