- Dr. Kaitlin Dupuis MD CCFP
On your exam, could you list FOUR options for emergency contraception?
“Doctor, I need Plan B -
I’m worried because we didn’t use a condom on Friday night!”
List THREE counselling points for a patient who presents for emergency contraception, other than medication.
The topic of emergency contraception is evolving and now you will be able to confidently counsel patients, like this one, with the most up to date recommendations.
Emergency contraception efficacy depends on dose timing and method used.
Here are the options, listed in descending order of efficacy:
1. Copper IUD - if inserted up to 7 days after post unprotected intercourse, 99.9% effective (requires prescription and skilled provider)
2. Ella (30mg ullipristal x 1 dose) - if taken up to 5 days post unprotected intercourse, 98-99% effective (requires prescription)
3. Plan B (1.5mg levonorgestrel x 1 dose) - if taken up to 3 days (some evidence for up to 5 days) post unprotected intercourse, 59-94% effective (does not require a prescription)
*Yuzpe method (100mcg ethyl estradiol, 500mcg levonorgestrol x 2 doses) has more side effects and less effective, so only use when no other method available*
Don’t forget to:
Weight your patient! There is evidence of decreased effectiveness of Plan B in clients with BMI > 25 (2-4X increased chance of pregnancy). If BMI>30, Ella approx. 2 times increased risk of pregnancy, but no increase in risk in BMI 25-29. A Copper IUD is therefore the most effective method for a patient with a BMI>30.
Remind them of side effects! Plan B and Ella side effects including breast tenderness, nausea/vomiting, fatigue, headache and menstrual cramping. Copper IUDs may increase a patient’s menstrual flow and dysmenorrhea.
Offer patients long term contraception! They may start hormonal contraception after 5 days of Ella and within 24 hours of Plan B.
Have them pee! A urine pregnancy test is only needed if the patient has not had their period within 21 days. You may also offer them urine CT/GC screening at this visit.