Ask Patient’s name and what they like to be called
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?
Reasons: why they want emergency contraception/the impact of pregnancy
Emergency contraceptive options: see 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)
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.