EHC

Question 1

Why do we supply EHC via a PGD?

Answer 1

1. No charge if exempt
2. Improves access to EHC health advice
3. Increases knowledge of availability of EHC from pharmacies
4. Inc. knowledge of STI risks + refers those at risk
5. Reduces no. of unwanted pregnancies

Question 2

What is EHC?

Answer 2

Emergency Hormonal Contraception

- the measures taken after an act of UPSI to prevent pregnancy

Question 3

What 3 types of EHC are licensed for use in the UK?

Answer 3

1. Levonelle - progesterone oral contraception (1 OTC, 1 POM)
2. EllaOne - ulipristal acetate oral contraception (POM)
3. IUCD - provides EHC but also used as contraception after

Question 4

What are the stages of the Ovarian Cycle?

Answer 4

1. FSH increases = egg cells develop
2. FSH decreases, Oestrogen increases + thickens endometrium
3. LH and FSH increases dramatically, LH stimulating ovulation
4. Ruptured follicle = corpus luteum (makes lots of progesterone)
5. Thickened lining of uterus maintained + waits for ovum to implant
6. Fertilisation doesn’t occur = corpus luteum degenerates
7. loss of progesterone + decreased oestrogen stimulates new menstrual cycle

Question 5

How long should Levonelle One-Step (1500mcg) be taken within UPSI?

Answer 5

72 hours (3 days)
SOONER THE BETTER

Question 6

How long should EllaOne (30mg) be taken within UPSI?

Answer 6

120 hours (5 days)
SOONER THE BETTER

Question 7

How long should IUCD be fitted within UPSI?

Answer 7

120 hours (5 days after)
OR
5 days after earliest time woman could have ovulated

Question 8

What caution needs to be taken when taking Ulipristal (EllaOne)?

Answer 8

Decreases effectiveness of combined hormonal contraception. Should use extra protection for 7 days.

Question 9

What is the mode of action of Levonelle?

Answer 9

1. If taken before ovulation, delays by 5 to 7 days by stopping development of ovarian follicle.
2. NOT effective once implantation has begun
3. Effect at/just after ovulation unknown

Question 10

What is the mode of action of EllaOne?

Answer 10

1. Progestogen receptor modulator
2. Works later in cycle than Levonelle
3. Rate of pregnancy prevention @ same level for 5 days

Question 11

What is the mode of action of an IUCD?

Answer 11

Prevents egg from implanting into the womb

Question 12

Name some common interactions with both Levonelle and EllaOne.

Answer 12

Antiepileptics, Aprepitant, Bosentanm Efavirenz, Fosaprepitant, Griseofulvin, Lumacaftor, Modafinil, Nevirapine, Rifabutin, Rifampicin

Question 13

What are the 4 inclusion criterias to supply levonelle on a PGD?

Answer 13

1. UPSI in the last 72 hours
2. Women > 16 yrs + <25 yrs (varied depending on PGD)
3. Girls < 16 yrs but Fraser Competent
4. Give consent to providing relevant clinical info.

Question 14

Name the exclusion criteria for the supply of levonelle on a PGD?

Answer 14

• UPSI outside last 72 hours
• <16yrs, not fraser competent
• <12 yrs, MUST INFORM Child Protection Team
• Known hypersensitivity to levonorgestrel or any preparation excipient
• Known hereditary problems with galactose intolerance, Lapp lactase deficiency, or glucose-glucose malabsorption
• Pregnancy
• Had baby in last 3 weeks (EHC not required)
• Known Porphyria
• Taking Ciclosporin
• No valid consent given

Question 15

Why would we not recommend an IUCD?

Answer 15

Uncomfortable + painful experience

Question 16

Which oral EHC is better/more effective?

Answer 16

EllaOne

Question 17

What considerations need to be made for a woman who is breastfeeding?

Answer 17

Levonelle and EllaOne both have traces in breast milk. Advise breast pump to drain after taking and then feed.

Question 18

What are the side effects of EHC?

Answer 18

• Headaches
• Tummy Pain
• Changes to next period
• Feeling Sick/BEING SICK (might need another dose)
• tired/dizzy
• diarrhoea
• back pain

Question 19

What should happen if a patient is sick after taking oral EHC?

Answer 19

Levonelle within 2 hours = another dose/IUCD

EllaOne within 3 hours = another dose/IUCD