Emergency contraception

Introduction

• Wash hands
• Introduce self
• Ask 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 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)

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

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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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