Emergency Contraception

Emergency Contraception - The Morning After Plan

• Definition: Methods used to prevent pregnancy after unprotected sexual intercourse (UPSI) or contraceptive failure.
• Indications:
  • UPSI.
  • Condom breakage/slippage.
  • Missed OCPs (≥2-3 pills).
  • Dislodged/delayed patch/ring.
  • IUD expulsion.
  • Sexual assault.
• Key Principle: Use ASAP; efficacy ↓ with time.
• Not for regular contraception; does not prevent STIs.

⭐ Copper IUD is the most effective emergency contraceptive and can be inserted up to 5 days (120 hours) after UPSI or ovulation, whichever is later, provided pregnancy is excluded prior to insertion (off-label extension in some guidelines).

Emergency Contraception - The Pill & The Coil

• Oral EC (Pills):
  • Levonorgestrel (LNG):
    • Dose: 1.5 mg single dose.
    • Window: Up to 72h (3 days); efficacy ↓ with time.
    • MOA: Delays ovulation.
  • Ulipristal Acetate (UPA):
    • Dose: 30 mg single dose.
    • Window: Up to 120h (5 days); more effective than LNG, especially at 72-120h.
    • MOA: SPRM; delays ovulation.
• Intrauterine Device (IUD):
  • Copper IUD (Cu-IUD):
    • Window: Up to 120h (5 days) post-UPSI.
    • Efficacy: >99%; most effective EC.
    • MOA: Prevents fertilization; may inhibit implantation.

⭐ Cu-IUD is the most effective EC method and offers ongoing contraception.

Emergency Contraception - Fertilization Foes

Emergency Contraception (EC) primarily acts before implantation, mainly by preventing fertilization. Methods use distinct "fertilization foe" tactics.

• Hormonal EC (Levonorgestrel - LNG; Ulipristal Acetate - UPA):
  • Primary: Delay or inhibit ovulation (no egg, no fertilization).
  • Also: Thicken cervical mucus (sperm barrier).
• Copper IUD (Cu-IUD):
  • Primary: Spermicidal effect (copper ions toxic to sperm).
  • Inhibits sperm migration and capacitation.

⭐ UPA more effectively inhibits ovulation than LNG, especially near the LH surge, offering a wider efficacy window.

Emergency Contraception - Timing is Everything

• Goal: Prevent pregnancy post-UPSI or contraceptive failure. Act FAST: earlier = better.
• Methods & Max Efficacy Windows:
  • Levonorgestrel (LNG): 1.5 mg. Within 72 hrs (up to 120 hrs with ↓ efficacy).
  • Ulipristal Acetate (UPA): 30 mg. Within 120 hrs.
  • Copper IUD (Cu-IUD): Within 120 hrs.
• Efficacy Hierarchy: Cu-IUD > UPA > LNG.

  ⭐ Cu-IUD is the most effective EC (>99%), usable up to 5 days (120 hrs) post-UPSI. oka

Emergency Contraception - Safe & Sound Advice

• Initiate ASAP; effectiveness ↓ with delay.
• Counsel: Not for regular contraception.
• Side effects: Nausea (most common), vomiting, headache, dizziness, breast tenderness, irregular bleeding.
• If vomiting occurs within 2-3 hours of oral EC, repeat dose.
• Menstrual changes: Next period may be early/late/normal.
• Advise pregnancy test if menses delayed >1 week or abnormal.
• No protection against STIs; counsel on safer sex practices.
• Reassure: No impact on future fertility.

⭐ EC does not interrupt an established pregnancy nor harm a developing embryo if inadvertently taken during early pregnancy_._

High‑Yield Points - ⚡ Biggest Takeaways

• Levonorgestrel (LNG): Effective up to 72 hours post-intercourse, best within 12 hours.
• Ulipristal Acetate (UPA): More effective than LNG, especially 72-120 hours post-intercourse; Rx only.
• Copper IUD (Cu-IUD): Most effective EC, insertable up to 5 days (120 hours) post-coitus.
• Main action: Primarily delays/inhibits ovulation; Cu-IUD also prevents fertilization/implantation.
• EC is not abortifacient; does not interrupt an established pregnancy.
• Counsel on regular contraception and STI prevention options after EC use.