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The Oakwood Surgery Clinical Protocols Emergency Contraception Author Created Reviewed Review Date Dr Dean Eggitt / J Woodland June 2014 June 2015 Emergency contraception can also be provided by Out of Hours Doctors, Pharmacist or Family Planning Clinic, at East Laith Gate, Doncaster Telephone 640040. The following protocol reflects guidelines from the Faculty of Sexual and Reproductive Healthcare Clinical Effectiveness Unit January 2012 Emergency Hormonal Contraception History to ensure following criteria are met Time of UPSI was within the last 120 hours ( 5 days) Confirm no other episodes of UPSI have occurred during that cycle, where emergency contraception was not used within the appropriate time frame. Date of LMP - this should have been a normal period occurring at the usual time for the patient, her period must not be late Patient must be Fraser competent if under 16 years No contraindications to ellaOne or Levonelle Contraindications Pregnancy or suspected pregnancy Severe liver disease Acute porphyria Allergy to Levonorgestrel or ellaOne Ensue patient is not taking any enzyme inducing drugs, as this will affect their available choice of Emergency Contraception: Anticonvulsants Antitubercle Antifungal All protein pump inhibitors eg lansoprazole Antacids St johns Wort If the patient is taking any of the above medications, the patient should be advised that the copper coil ( Cu IUD ) is the only method of EC not affected by these drugs ensuring effectiveness. Action 1st line treatment for EC is insertion of the copper coil (Cu IUD ) This can be inserted within the first five days of first UPSI (120 hours) in a cycle or within 5 days from the earliest date of ovulation. It is 99% effective with a low failure rate. ALL women should be offered the copper coil before other EC.and this should be documented accordingly. 2nd line treatment if the copper coil is declined is ellaOne. This is licensed up to 120 hours after UPSI. It is 98% effective and is also more effective than levonelle for women with a BMI over 30. It is not recommended to be given more than once in a cycle, or if there has been another episode of UPSI outside of the treatment window 3rd line treatment is Levonelle one step if the above criteria are met. It is 88% effective and can be given up to 72 hours after UPSI. It can also be used more than once in a cycle even if there has been an earlier episode of UPSI outside the treatment window, because it is not contra indicated in pregnancy. Oral Emergency contraception Patient should take treatment as soon as possible after coitus to ensure maximum efficacy, Advise pregnancy test if next period more than 7 days late Warn patient that Levonelle and ellaOne can cause vomiting, if this occurs with 2 hrs of taking either tablet the patient should repeat the treatment with an anti-emetic Give PIL Discuss any concerns re STD’s and offer swabs/GUM accordingly Discuss future contraceptive needs QOF - CODE – advice about long acting reversible contraceptive Refer to GP If under 16 yrs of age If criteria for issuing ellaOne or Levonelle are not met, or the patient prefers emergency IUCD insertion Assess the risk of STI and screen those at high risk. Refer to Doctor or to Family planning clinic if no Doctor available to fit IUCD.
