Guideline of the month: new rules for emergency contraception
The key guideline for April
The guideline
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.
Practical issues
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.
Expert comment
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.’
The guideline
FSRH. CEU Clinical Guidance: Emergency Contraception. London: FSRH, 2017
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Readers' comments (2)
Hassanali Mamdani | Locum GP12 Apr 2017 7:25pm
Very helpful information.
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Dealing with one problem at a time | Salaried GP23 Apr 2017 10:38pm
How about this for a guideline. No need for GP involvement at all and patients can go direct to pharmacy and get emergency contraception. If entitled to free they get it free and if not they pay up just as you would if you got a parking fine.
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