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Contraception - emergency - Management
How should I assess a woman requesting emergency contraception?

  • Assess the woman's current risk for becoming pregnant [FFPRHC, 2006b].
    • If she has not used any method of contraception and semen has been in contact with the external or internal genitalia, the risk of pregnancy is sufficiently high to warrant emergency contraception (provided that she is within the eligibility period for emergency contraception).
    • If she is concerned about potential failure of a contraceptive method, ask for details (e.g. for missed oral contraceptive pills, ask how many were missed, and when in the cycle) and assess the validity of this concern — see When contraception might fail. If in any doubt about the risk of contraceptive failure, consider emergency contraception, as it is safe and the side effects are minimal.
  • Assess her need for future contraception [DH, 2004; FFPRHC, 2006a; FFPRHC, 2006b].
    • For example, ask:
      • 'How often have you used emergency contraception?' — recurrent use of emergency contraception is a signal that a long-acting contraceptive method may be indicated.
      • 'Could having unprotected sexual intercourse happen again?'
      • 'Do you have a regular contraceptive method? Are you satisfied with it?'
  • Assess her risk for sexually transmitted infection [FFPRHC, 2006b; NICE, 2007].
    • Risk assessment should take into consideration local prevalence of sexually transmitted infections, the woman's age, and her sexual activity.
    • Consider her risk for having been exposed to sexually transmitted infection, including HIV. Ask about her current circumstances, and current and recent sexual partners, age of onset of sexual activity, and use of alcohol and other substances.
  • Assess her risk for non-consensual sexual intercourse.
    • For example, ask 'Can you always choose when to have (or to not have) sexual intercourse?'
    • With young people, it is important to be satisfied that sexual intercourse has been consensual and is not occurring in an abusive relationship [DH, 2004; HM Government, 2006].
  • Assess if she is vulnerable [NICE, 2007].
    • Under the age of 18 years, and
      • From disadvantaged background; or
      • In, or leaving, care; or
      • Low educational attainment.

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