Emergency Contraception (EC, Morning After Pill)

Last updated 10.05.13

 

Index

 

Definition

-  Contraception used immediately after unprotected sexual intercourse, contraceptive failure or sexual assault to prevent conception & pregnancy

 

Features

-  Does not work if already pregnant

-  Most effective if within 72hrs (3/7), earlier is better

-  Does not protect against STIs

-  Levonogestrel most common form in Australia

-  Effectiveness

-  Copper IUD prevents 98%

-  Levonogesterel prevents 85%

-  Yuzpe Regimen prevents 74%

-  No evidence of harm if become pregnant after either method

-  NOT an effective ongoing contraceptive strategy

 

Indications

-  Rape

-  Unprotected sexual intercourse

-  Contraceptive failure

-  Broken condom

-  Missed pill: COC, POP

 

Associated S/S

-  Vaginal discharge: STI, PID

 

Ix

-  STI Screen

-  First pass urine: Chlamydia & Gonorrhoea PCR

-  +/- HIV, HCV, TPHA as indicated

-  Pregnancy test 3 week after

 

Mx

-  Safe sex counseling

-  Contraceptive advice

-  Methods

-  Levonogestrel

-  1.5mg Levonogestrel oral stat dose (x2 750mcg tablets)

-   Just as effective as divided dose

-  OR 750mcg x2 taken 12hrs apart

-  Taken within 3 days of intercourse

-  Most effective within first 24 hrs

-  May cause nausea & vomiting

-  Follow up until next period to exclude pregnancy

-  Available OTC after D/W pharmacist

-  Not on PBS, $40+/-

-   If cost is prohibitive can use script for Levonogestrel 30mcg PO 25pills = 750mg & repeat in 12hrs

-  OR OCP (Yuzpe Regimen)

-  Oldest method

-  100mcg Ethinyl estridial & 500mcg Levonogestrel (Ovral x2) & repeat in 12hrs

-  More side effects: nausea, vomiting

-   Usually done with antiemetics

-  OR Copper IUD

-  Taken within 5 days of intercourse

-  <1% failure rate

-  Leave in until after next period

-  Barrier method until covered by another form of contraception

-  Follow up in 3 weeks

-  Pregnancy test to exclude pregnancy regardless of menstruation

-  30% women early period, 15% late period, rest on time

-  If abdominal pain to present to exclude possible ectopic

 

 

 

References

 

Bayer Emergency Contraception: www.emergencycontraception.com.au

Better Health Channel: www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Contraception_emergency_contraception

Contraception: Your Questions Answered, John Guillebrand