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postcoital_contraception

post-coital emergency contraception

counselling:

  • do pregnancy test if pregnancy possible although:
    • no evidence that it will adversely effect the fetus if given in early pregnancy or if it fails to prevent pregnancy
    • may not prevent pregnancy ⇒ advise to see a doctor at 4wks
  • special precautions:
    • may increase INR in pts on warfarin
    • risk of STDs
  • ongoing contraception

options:

levonorgestel (progesterone only) regime:

  • in June 2002, levonorgestrel (LNE) became the 1st drug licensed for use as an emergency contraceptive in Australia.
  • 1st dose 0.75mg LNE taken ASAP & repeat dose 12hrs later
  • higher efficacy & lower side effect profile
  • efficacy post coitus: within 24hrs = 95%; 25-48hrs = 85%; 49-72hrs = 58%;
  • for pts presenting > 72hrs and less than 5 days post-coitus, consider emergency insertion of IUCD:
    • prevents > 99% of pregnancies
  • relative C/I:
    • nulliparity
    • pts at high risk of acquiring STDs

traditional post-coital combined contraceptive Yuzpe regime:

  • 2 doses of (100ug estradiol + 500ug levonorgestrel ie. 2 tablets per dose) taken 12hrs apart
  • pack includes:
    • 2 tablets metoclopramide to be taken if feeling nauseous & in which case take one 30min prior to 2nd dose
    • 6 OCP tablets (2 extra in case emesis within 6hrs of 1st dose, premed with metoclopramide)
    • instruction sheet

future possibilities

  • a five day course of oral meloxicam (Mobic) given around the time of ovulation may be effective as an emergency contraceptive by inhibiting production of prostaglandins in the periovulatory follicle that are needed for follicle rupture and oocyte release, an animal study published in Human Reproduction in 2010 suggests.
postcoital_contraception.txt · Last modified: 2011/08/25 21:24 (external edit)