Types:

Copper-bearing IUD

  • Most effective

  • copper = toxic to ovum and spurm

  • effective immediately after insertion

  • works primarily by inhibiting fertilisation

  • fitted within first 5 days (120hrs) following first UPSI or within 5 days of earliest estimated date of ovulation

  • no evidence for LNG-IUS

  • failure \<1%

  • side effects

    • pain

  • contraindications

    • same as cuIUD

    • NOT

      • risk STI

      • previous ectopic pregnancy

      • age

      • nulliparity

Levonorgestrel

  • unclear MOA

    • inhibition of ovulation

    • prevent follicle rupture or luteal dysfunction

    • can inhibit ovulation for 5-7 days

      • sperm degenerated

    • closer to ovulation LNG given then less effective

    • not effective once fertilisation occured

    • pregnancies not affected by LNG failure

  • 1.5mg single oral dose

  • licensed for use wihtin 72hrs

    • may be effective up to 96hrs

  • failure = \~2%

  • obese women using LNG greater risk of pregnancy

    • ?double dose

  • Concommitant use of liver enzyme can reduce efficacy

    • double dose

  • quickstart contraceptive

    • 7 day rule

    • pregnancy test in ≤3/52

side effects

  • headache

  • nausea

    • \<20%

    • if vomits \<2hrs after taking should take another dose ASAP

  • altered bleeding patterns

    • expect bleeding within 7/7 of expected time
Contraindications

  • nil

    • including breast feeding
Use >1 in cycle

  • repeated doses may be effective

  • further UPSI may be indication

Drug interactions

  • inducers: decrease contraceptive efficacy of LNG

    • up to 28d after use

  • CuIUD

  • single 3mg dose amy be administered (outside product licence)

    • no evidence to support this

Ulipristal acetate

  • Progesterone receptor hormone

  • inhibition or delay of ovulation

  • licensed for use 120hrs

When indicated

  • luteal phase (ovulation -> menstruation) = 14d (fairly constant)

  • follicular phase more variable

COC

  • if pills missed Wk 1 and UPSI or barrier failure in W1 or pill-free interval

  • if pill free interval emergency IUD considered up to 15d after taking 21st pill in last packet

POP

  • late or missed pill

  • UPSI before efficacy re-established (48hours)

  • IUD only up to 5d after UPSI

Depot

  • Late injectio (>14w)

IUD

  • removal without immediate replacement

  • in 5 days prior to removal, perforation, partial or complete expulsion