Guideline of the month: new rules for emergency contraception
The key guideline for April
The Faculty of Sexual and Reproductive Healthcare has updated its 2012 guideline on emergency contraception, with changes to the use of ulipristal acetate and levonorgestrel in women who have had unprotected sexual intercourse.
Key points for GPs
- Levonorgestrel (Levonelle) is ineffective if taken more than 96 hours after unprotected sexual intercourse.
- The effectiveness of ulipristal acetate (ellaOne) is reduced if a woman takes progestogen in the five days after, or seven days before, starting it.
- Ulipristal acetate can be offered more than once in a cycle, if there is a further episode of unprotected sexual intercourse.
- Women who are breastfeeding should be told not to do so for a week after they have taken ulipristal acetate.
The updated evidence on progestogen means GPs can no longer start it quickly if a patient has used ellaOne for emergency contraception. Levonelle, considered second line by the guideline, may be used for emergency contraception instead.
Dr Jenny Brotherston, a GPSI in sexual health and gynaecology in Hull, says: ‘Overall, the new rules for ellaOne are not good news for emergency contraception, as it was supposed to be more effective and able to be used slightly later in the cycle. Now the less effective Levonelle will often be the only method offered. The take-home message is the copper IUD should be more widely promoted and available.’
FSRH. CEU Clinical Guidance: Emergency Contraception. London: FSRH, 2017