Risk of Pregnancy in Menstrual Cycle

2. When is there risk of pregnancy? •Any day in the menstrual cycle. Highest risk of pregnancy in the 6 days leading up to and including ovulation •From Day 21 after childbirth unless all the criteria for lactational amenorrhoea are met •From day 5 after miscarriage, abortion & ectopic pregnancy

3. When is emergency contraception indicated? <number>

4. Combined oral contraceptive pills

5. Advice for women missing combined oral contraceptives If two or more pills have been missed (more than 48 hours late)

6. In addition… If pills are missed in Week 3 (Days 15-21): Omit the pill-free interval by finishing the active pills in her current pack and starting a new pack the next day If pills are missed in Week 2 (Days 8-14): There is no indication for EC if the previous seven pills have been taken consistently and correctly and are taken correctly thereafter If pills are missed in Week 1 (Days 1-7): Because the pill-free interval has been extended, EC should be considered if she had unprotected sex during this period

7. Scenarios

8. Advice for women who miss or are late taking POP TRADITIONAL POPs (Micronor , Noridayetc) More than three hours late (more than 27 hours since the last pill was taken) More than 12 hours late (more than 36 hours since the last pill was taken) Take a pill as soon as possible. If more than one pill has been missed just take one pill. Take the next pill at the usual time. This may mean taking two pills in one day. An additional method of contraception is advised for the next 48 hours after the POP has been taken.

10. Emergency contraception: what are the options ?

11. How does oral EC work? •Works by delaying ovulation •The aim is to delay ovulation for 5 days so that any sperm from the UPSI are dead. •No effect after ovulation

12. Oral EC Ulipristal-EC Ulipristal acetate 30 mg Licenced up to 120 hours (five days) after unprotected intercourse or contraceptive failure.

13. Levonorgestrel- EC Contains high-dose progesterone (levonorgestrel 1500 μgm) One tablet taken as soon as possible after unprotected intercourse (Use between 72 and 120 hours after unprotected intercourse is an off-licence use) Ineffective > 96 hours after UPSI

15. When in the cycle is EC effective?

16. Which EHC to give???

17. Enzyme inducers •Both LNG-EC and UPA-EC could be less effective if a woman is taking an enzyme inducer or has taken in the past 28 days •A double dose (3mg of LNG-EC) can be given •A double dose of UPA-EC is not recommended •It is not known if double dose LNG-EC or single dose UPA-EC is more effective for a women using an enzyme inducer

18. Breast feeding UPA is excreted in the breast milk FSRH do not advocate breastfeeding for seven days following ulipristal acetate (UPA) Express and discard breast milk for 7 days LNG not contraindicated. Advice to take immediately after feeding to reduce the potential exposure to the infant

19. Confidentiality and under 16s

20. Fraser Guidelines

21. CONFIDENTIALITY

22. Case Scenario

23. Case Scenario

24. Case scenario

25. Points of advice

26. Decision making….. FSRH – Emergency Contraception Guideline including Decision-making Algorithms

27. Any Questions???