Emergency contraception should be offered to all women at risk of pregnancy after unprotected intercourse. There are no absolute contraindications to hormonal emergency contraception.
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Hormonal methods
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Levonorgestrel method (Postinor2). Recommended method
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- 0.75mgm levonorgestrel and repeat 12 hours later
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- effective within 72 hours of unprotected intercourse
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- most effective closest to event
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- more effective (88% reduction in pregnancy risk) than the older Yuzpe method (75% reduction)and associated with a lower incidence of vomiting 1% vs 20%).
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- proven effect as a single dose (ie 2 tabs of 0.75mgm given together). Not approved method of prescription in Australia thus recommended as a single dose only if compliance / timing with second dose problematic.
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- efficacy demonstrated up to 120 hours
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Yuzpe method (combined oestrogen and progestagen)
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- 100 ug ethinyl oestradiol & 500 ug levonorgestrel (2 Nordiol) and repeat 12 hours later prescribed with antiemetic, begun within 72 hours of intercourse
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Note: alternative formulations can be used provided repeated dosage is at least 100ug ethinyl oestradiol and 500ug levonorgestrel eg 4 Microgynon 30 tabs repeated after 12 hours (total 8 tabs: 120ug and 600ug twice)
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- 75% reduction in of expected pregnancy rate
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both methods:
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- may / may not bleed after treatment
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- period may be delayed up to 2 weeks (in about 10% women)
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- no evidence of teratogenic effects in failed usage
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- ongoing contraception should be discussed and need for STI screening considered
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- can be used more than once in a cycle
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- follow up is advised after the next period
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- women should return for a pregnancy test if the subsequent period is late or light
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- followup available through Choices Clinic
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IUCD (Cu containing) insertion
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- will protect against pregnancy after multiple exposures provided inserted within 5 days of most probable calculated ovulation date (i.e up to day 19 0f 28 day cycle)
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- estimated >90% reduction in expected pregnancy rate
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- risks related to unknown risk of STI / PID (consider taking genital swabs at time of insertion / antibiotic prophylaxis)
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- provides ongoing contraception
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- alternative if previous hormonal method failure
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- insertion can be arranged via ED consultant, receiving registrar, Choices Clinic (Mon,Tues, Thurs am)
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- follow-up available through Choices Clinic
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Royal Women's Hospital Clinical Practice Guidelines (CPGs) are intended to provide guidance to health care professionals, based on a thorough evaluation of research evidence, on the practical assessment and management of specific clinical issues or situations. The guidelines allow some flexibility on the part of the health care professional based on the needs of the specific patient for whom they are caring.
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