Introduction

These below methods do not cause abortion. Instead, they prevent ovulation, fertilisation, and/or implantation.
  • Those who believe life begins at fertilisation may argue that abortion can occur with these methods, and may have objections. However, the method does not cause any alteration to an embryo after implantation.
The emergency contraceptive pill is provided free of charge at most health care centres (e.g. GUM clinics, GP’s). You can also buy it at most pharmacies, if you are over 16 (~£25).

Emergency pills

More effective the sooner they are taken

Levonorgestrel

The same progestrogen found in the IUS. It is a progestrogen only pill. Thus it is safe in breastfeeding, and for women in whom oestrogens are CI’d.
1.5mg dose
Side effects

  • Menstrual irregularities
  • For most women the period will be normal, but it can be 2-7 days late.
  • There may be irregular bleeding during the next menstrual cycle

Efficacy

  • Most effective within 12 hours
  • 95% if <24h
  • 85% if 24-48h
  • 58% if 49-72h
  • May be given up to 120h, but is not recommended. Between 72-120h, an IUD is recommended instead

Vomiting

  • If vomiting occurs within 2 hours of administration, another pill can be given. If vomiting continues, consider IUD, or consider another dose, with an antiemetic (domperidone recommended).

Prescribing

Can be taken as many times as necessary, even within the same menstrual cycle however, not recommended, as it is not as reliable as regular contraception.

barrier method of contraception needs to be used until the next period
If there is any lower abdominal pain before the next period, she should consult immediately to rule out ectopic pregnancy
If she has any concerns (e.g. if next period is late, could be pregnant) to seek medical advice

Ulipristel Acetate

  • Not regularly used in the UK
  • CI’d in uncontrolled asthma
  • Reduces efficacy of COC and POP
  • Should not be used more than once in one menstrual cycle
  • Avoid breast-feeding for 36 hours (precautionary, no evidence)
  • 30mg as soon as possible after intercourse. Should not be used >120 hours after intercourse
  • Side effects – GI disturbance, dizziness, fatigue, headaches, menstrual irregularities

IUD as emergency contraception

  • More effective than levonorgestrel
  • If an IUD (copper coil) is fitted within 5 days of intercourse, it can act as an emergency contraceptive, by preventing implantation of a fertilised embryo.
    • Ensure that the patient has only had unprotected sex once since the last period – if not, the IUD is only effective if fitted within 5 days of the earliest date of ovulation.
  • Efficacy – 99% effective
  • RF’s and side effects –same as the IUD in normal circumstances
    • Remember; risk of infection within 20 days of fitting, and increased risk of PID.
  • Fitting –same as IUD in normal circumstances, except:
    • Swabs for STI should be taken in all instances
    • Antibiotic prophylaxis should be given at the time of insertion
  • Next period – should be at the normal time
  • Follow up –same as UD in normal circumstances. Check up at 3-6 weeks. IUD can then be removed if the patient does not wish to use it as a form of long term contraception

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