QuestionSBA
QuestionChoice
Ullipristal acetate is a selective progesterone-receptor modulator.
It is liscensed as a form of emergency contraception when taken within 120 hours of UPSI.
It prevents the LH surge preventing ovulation for 5 days.
62393
a
Ullipristal acetate (ellaOne®)
QuestionChoice
The copper IUD is the most effective emergency contraception, it can be utilised 5 days after UPSI. It prevents fertilisation, and also has anti-implantation effects by causing inflammation in the endometrial lining.
Whilst this would be an appropriate option, however, the patient has menorrhagia. The IUD is not a suitable option as it often increases symptoms of menorrhagia.
62397
e
The copper intrauterine device (IUD)
QuestionChoice
Ullipristal acetate should be offered, it is liscenced as emergency contraception for up to 120 hours after UPSI.
62395
c
Advise her to take a pregnancy test in a weeks time as it is too late to take emergency contraception
QuestionChoice
Levonorgestrel it is progesterone-only emergency contraception.
Levonorgestrel can be used as emergency contraception if the UPSI took place within 72 hours.
It delays ovulation by 5 days and thickens the cervical mucus.
For this patient, as it has been over 72 hours since UPSI, Levonorgestrel is not effective emergency contraception.
62394
b
Levonorgestrel (Levonelle)
QuestionChoice
This is called the Yuzpe regimen, it is when a high dose of a combined oral contraceptive pill is used as emergency contraception. Taken within 72 hours of UPSI it has a 75% reduction in the risk of pregnancy. However, this method is no longer used in the UK as it was demonstrated to be far less effective than levonorgestrel.
62396
d
Two doses of the combined oral contraceptive pill
Concept
Chapter
# Overview

Emergency contraception is indicated where unprotected sexual intercourse (UPSI) has occured, or where a contraceptive method has been used incorrectly.

# Copper intrauterine device (Cu-IUD)

- Gold standard emergency contraception
- Can be used 120 hours after the first episode of UPSI in a cycle, or within 120 hours of the earliest expected date of ovulation
- Inhibits fertilization by its toxic effect on sperm and ova.
- If fertilization does occur, the Cu-IUD has an anti-implantation effect.
- Contraindications include uterine fibroids with distortion of uterine cavity, documented/suspected pelvic inflammatory disease (PID) and documented/suspected sexually transmitted infection, especially chlamydia or gonorrhoea


# Ulipristal acetate ("Ella One")

- Selective progesterone receptor modulator
- Binds to human progesterone receptors, suppressing the LH surge and delays ovulation for at least 5 days, until sperm from the UPSI are no longer viable
- It delays ovulation even after the start of the LH surge
- Can be used within 120 hours of UPSI
- Guidance is to wait 5 days before starting ongoing hormonal contraception
- Can only be used once per cycle
- Contraindications:
  - Diseases of malabsorption e.g. Crohn’s
  - Hypersensitivity to Ulipristal Acetate
  - Severe hepatic dysfunction
  - Enzyme inducing drugs e.g. rifampicin
    - Give 3mg levonorgestrel if the patient refuses an IUD, ulipristal acetate is **absolutely** contraindicated here
  - Breast feeding – avoid breastfeeding for 7 days after taking UPA
  - Asthma insufficiently controlled by corticosteroids
  - Drugs increasing gastric pH e.g. omeprazole, ranitidine


# Levonorgestrel ("Levonelle")

- Can be used within 72 hours of UPSI
- Inhibits or delays ovulation for a period of approximately 5 days, until sperm from the UPSI are no longer viable
- Also thickens cervical mucus
- Can quick start hormonal contraception
- Can take more than once in the same cycle if further UPSI
- Ineffective after the LH surge
- Contraindications: no absolute contraindications, however, efficacy may be reduced by: diseases of malabsorption, e.g. Crohn's disease, BMI > 26 or weight >70kg and enzyme inducing drugs e.g. rifampicin
  - If patient refuses IUD, then double dose i.e. 3mg **at once** may be taken



### External links 

- [FPA: Your guide to emergency contraception](https://www.fpa.org.uk/download/your-guide-to-emergency-contraception/)
- [NICE: Clinical Knowledge Summary: Emergency Contraception](https://cks.nice.org.uk/topics/contraception-emergency/)
- [BMJ Best Practice: Contraception](https://bestpractice.bmj.com/topics/en-gb/418)
- [World Health Organization. Family planning - a global handbook for providers](http://apps.who.int/iris/bitstream/handle/10665/260156/9780999203705-eng.pdf?sequence=1)
2050
2642
Emergency Contraception
Topic
60
General Practice
12540
A 21 year old female attends her GP surgery to discuss emergency contraception after having unprotected sexual intercourse (UPSI) 4 days ago. She does not currently use any method of contraception.

Her past medical history is of menorrhagia secondary to dysfunctional uterine bleeding.

Which of the following is the best next step in the management of this patients?
a