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Emergency contraception

Introduction

  • Wash hands
  • Introduce self
  • AskΒ Patient’s name and what they like to be called
  • Explain
  • Establish patient’s age

History of presenting complaint

  • Details of sexual intercourse: when, with whom (regular partner, how old are they, check it was consensual) 
  • Current contraception: type (none/barrier/pill), reason for failure (e.g. missed pill, split condom etc.)
  • Menstrual history: last menstrual period, cycle length, estimated day of ovulation (2 weeks before next menstrual period is due)
    • NB: the fertile period is on the day of ovulation and the 5 days before it (but it is possible to conceive at any time).
  • Any possibility they could already be pregnant/have they already taken emergency contraception this cycle?

Discussions

  • Reasons: why they want emergency contraception/the impact of pregnancy
  • Emergency contraceptive optionssee table below, all must be given ASAP
  • Future contraception options: hormonal contraception can be started immediately after Levonelle or 5 days after ellaOne – barrier methods should be used until contraception has become effective (after 7 days for COCP; after 2 days for progestogen-only pill)
  • Risk of STIs: advise screening as appropriate (consider taking a more detailed sexual history)

Conclusion

  • Pay attention to their concerns (remember ICE – Ideas, Concerns, Expectations)
  • Give them a leaflet about the emergency contraception they’ve taken
  • Advise them to come back in 3 weeks for follow-up/to take a pregnancy test

Emergency contraception options

Here’s some questions

A patient who is breastfeeding requires emergency contraception. She would like a pill rather than an intrauterine device due to a tear sustained in labour. What would you advise?

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    After administering a patient emergency contraception, she asks about some appropriate long-term contraception options. She was on the combined pill but works nights and regularly forgets to take it.

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