​Contraceptive emergencies and emergency contraception - Dr. Simonis

ASK, INFORM, and OFFER

• Ask – reproductive aged females about unprotected intercourse and desire for pregnancy
• Inform – about risk of pregnancy w/o contraception, and that emergency contraception is effective w/in 3-5 days after unprotected intercourse
• Offer – discharge resources on contraception and family planning follow up 

 
Emergency Contraception

• 2 FDA approved medications  + Copper IUD insertion: Progesterone receptor modulator (Ulipristal acetate “Ella”), progestin only (Levonorgestrel “Plan B”)
  
• Plan B is available OTC, Ulipristal acetate requires Rx
  
• Plan B effective up to 72 hours, Ulipristal up to 5 days
  
• Some studies suggest Ella is more effective than planB
  
• Recent survey shows ED infrequently prescribes ella
  
• Copper IUD insertion, up to 5 days after unprotected intercourse
  
• Side effects = nausea/vomiting, worse with ulipristal, irregular bleeding. No reported deaths or serious adverse effects. 
  
• Very few (if any) contraindications to planB or Ella administration
  
• EC has many barriers to use: insufficient knowledge, providers reluctant to discuss w/patients – especially teens. 
  
• ED providers are good at offering EC to sexual assault victims, but not to patients who reports consensual, unprotected sex. 
  

 
Contraceptive emergencies
IUD related:

• if expulsion suspected but not noted by user, need X-ray to eval for perforation
  
• tx perforation with antimicrobials for PID, and consultation for laparoscopic removal 
  
• IUD + STI (BV, trich, GC/CL) – do not need to remove IUD
  
• IUD + PID: no immediate indication for IUD removal if improving on antimicrobial treatment, needs close f/u
  
• Pelvic actinomyces: IUD users can be colonized, can cause PID/abscess requiring prolonged antimicrobials (w/ID involved) and IUD removal. Future IUD contraindicated. 
  
• TSS: rare, but reported 

IUD  + ectopic:

• IUD + first trimester gestation = IUD removal indicated
  
• IUD + miscarriage = IUD removal and antibiotics

OCPs:

• contraindications to combined OCPs (WHO/CDC) 

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