Emergency contraception

Levonelle one step 1500 micrograms

Counselling

Why is emergency contraception being requested?

Back up to a failed FP method.
Not using any other FP method regularly.
First time of sexual intercourse and was it a one off/mistake/non-consensual.

If underage, does not need parental consent, but encourage her to discuss with parents, whilst ensuring confidentiality. Discuss FP options for the future. If over 72 hours since unprotected intercourse (UPSI), GP to consider EC for up to 120 hours or IUD insertion up to 5 days. It is good practice to be positive towards UPSI patients because they have had the courage to seek advice. Discuss sexual health and risk of STIs, may need a follow up for STI screening. Available as OTC from chemists and out-of-hours from Casualty.

Risks and Advantages

Nausea, vomiting, headaches, breast tenderness and altered menstrual cycle.
Around 99.6% effective if used within 24, but failure rate increases by 50% for every 24 hours after UPSI (80% effective at 72 hours).
Unlicensed use up to 120 hours (refer to GP).
Very few contraindications. Not known to be teratogenic. May be given more than once in a menstrual cycle.

Indications

After unprotected intercourse. Up to 72 hours, although may be effective up to 120 hours after intercourse. However consider referral to GP for IUD insertion or late EC prescribing.
Failure/accident with barrier method
If one or more COC pill missed at the beginning or the end of the pack, so that the PFI has been extended by more than 7 days.
If more than 3 pills missed from 30 – 35ug oestrogen strength COC. Or, 2 or more from 20ug strength COC pack. As long as at least 7 pills have been taken prior to this.
If 1 or more POP pills have been missed and intercourse has taken place.
If on enzyme inducing drugs eg anti-epileptic, St John’s Wort etc. will need a 50% higher dose of EC (1500mcg + 750mcg = 2250mcg Levonelle).
Post partum and bottle feeding – earliest ovulation can occur at 28 days.
Virtually no contraindications (pregnancy, active porphyria, active severe liver disease, severe allergy to constituent). If on Warfarin, check INR 3 – 4 days after.

History

BP, smoking – but not a contraindication.
Menstrual history, LMP (exclude risk of ongoing pregnancy).
Time of UPSI (If over 72 hours refer to GP)
FP method used, discuss options for future use and give condoms if necessary and PAL on emergency contraction and FP options if appropriate.

Review

If no period or lighter than usual – should return for pregnancy test.
For further FP advice if appropriate, STI screening, or to follow up a raised BP.

References

Glasier,A Gebbie,A Family Planning and Reproductive Health Churchill Livingstone
Guillbaud,J Contraception Today Taylor and Francis