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Contraception - emergency - Management
What advice should I give to a woman taking oral ulipristal acetate emergency contraception?

  • Ulipristal acetate emergency contraception should be taken within 120 hours of unprotected sexual intercourse.
  • Because ulipristal acetate is not 100% effective, the woman should have a pregnancy test if her next menstruation is more than 7 days late, if bleeding in next menstrual period is abnormal or if she has symptoms of pregnancy [ABPI Medicines Compendium, 2009].
    • The Faculty of Sexual and Reproductive Healthcare (FSRH), formerly the Faculty of Family Planning and Reproductive Healthcare (FFPRHC), new product review and the manufacturer of ulipristal acetate recommend 7 days delay in onset of menstruation as the threshold for doing a pregnancy test [FFPRHC, 2006b; ABPI Medicines Compendium, 2009].
    • If the date of last menses is unknown, tests for pregnancy should not be fully relied upon before 21 days have elapsed since unprotected sexual intercourse [FFPRHC, 2006b].
  • If the woman vomits within 3 hours of taking the ulipristal acetate pill, she should take a second dose as soon possible.
    • Pharmacies will require another prescription to provide a second dose of ulipristal acetate.
  • The next menstrual period might be different [ABPI Medicines Compendium, 2009].
    • If the woman has early mild bleeding or spotting, this is probably caused by the ulipristal acetate and may not be the start of the next menstrual cycle. She should not regard this time as safe for unprotected sexual intercourse. In any case, no time is regarded as a completely safe time for unprotected sexual intercourse, including time during menstruation.
    • Most women will have a normal period at the expected time; some women will have their period later or earlier than normal.
  • Ulipristal acetate does not provide contraceptive cover for the remainder of the cycle; the woman should therefore use an effective contraceptive method or avoid sexual intercourse [FSRH Clinical Effectiveness Unit, 2009].
    • She should be advised that repeated administration of ulipristal acetate within the same menstrual cycle is not advisable, as its safety and efficacy after repeated administration within the same cycle has not been investigated [ABPI Medicines Compendium, 2009].
    • The available data on the effects to a fetus if exposure occurs are extremely limited, but there have been no reported problems with the very small number of pregnancies to date [ABPI Medicines Compendium, 2009].
    • Ongoing contraception with an IUD may be started at the same time or soon after ulipristal acetate.
  • Ongoing contraception with the contraceptive pill can be started at the same time or soon after taking ulipristal acetate. However, ulipristal acetate may reduce the contraceptive action of hormonal contraception, so a suitable barrier method should be used till the next period [ABPI Medicines Compendium, 2009].

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