There isn't anything new in this emergency contraception guideline, it just brings Ella-One into the guideline. The main things to remember are:
- Levonelle – only licensed up to 72 hrs. It is effective up to 96 hrs, but may not be effective between 96 and 120 hrs. Remember that if the woman is on liver-enzyme inducers, she needs a double dose.
- Ella-One – is at least as effective as Levonelle and remains effective and is licensed until 120hrs.
- Copper Coil – licensed and effective up to 120 hrs.
So why ever use Levonelle?
It can be used more than once in a cycle. Ella-One is probably safe in pregnancy, but isn’t proven to be yet, so can only be used once in a cycle. You also can’t use Ella-One in women who are taking or have been taking liver enzyme inducers in the last 28d, nor if they are on PPI / ranitidine or using antacids.
What do you need to warn women about after using EC?
- If they are on the pill (ie have missed pills / late starting after the PFI) then:
- With Levonelle – extra precautions for 7d with COC (9d with Qlaira) and 2d with POP
- With Ella-One – extra precautions for 14d with COC (19d with Qlaira) and 9d with POP (it blocks progesterone receptors, hence this long impact).
- If they vomit within 2 hrs of Levonelle, or 3 hrs of Ella-One, they need another dose.
- Their period may be delayed up to a week.
- Always do a pregnancy test 3/52 after the USPI.
- STD screening – consider this as up to 10% of young people requesting EC have chlamydia.
- Contraception – consider quick starting contraception (eg COC (except for dianette) / POP / implant. All are safe in pregnancy.
Can you provide EC in advance?
Yes – though it doesn’t reduce pregnancy rates. It may be helpful for women relying on condoms.