Méthodes de contraception d’urgence
Emergency contraceptive pills
| CONDITION | COC | LNG | UPA |
|---|---|---|---|
| Pregnancy | NA | NA | NA |
| Breastfeedinga | 1 | 1 | 2 |
| Post ectopic pregnancy | 1 | 1 | 1 |
| Obesityb (BMI >=30 kg/m2) | 1 | 1 | 1 |
| History of severe cardiovascular disease (ischeamic heart disease, cerebrovascular attack, or other thromoembolic conditions) | 2 | 2 | 2 |
| Migraine | 2 | 2 | 2 |
| Severe liver disease (including jaundice) | 2 | 2 | 2 |
| CYP3A4 inducersC (e.g. rifampicin, phenytoin, phenobarbital, fosphenytoin, nevirapine, oxcarbezipine, primidone, rifabutin, St John's wort/hypericom perforatum) | 1 | 1 | 1 |
| Rape | 1 | 1 | 1 |
- a - Breastfeeding is not recommended for one week after taking UPA since it is excreted in breast milk. Breast milk should be expressed and discarded during that time
- b - ECPs may be less effective among women with BMI ≥ 30 kg/m2 than among women with BMI < 25 kg/m2. Despite this, there are no safety concerns.
- c - Strong CYP3A4 inducers may reduce the effectiveness of emergency contraceptive pills.
- d - Repeated ECP use is an indication that the woman requires further counselling on other contraceptive options. Frequently repeated ECP use may be harmful for women with conditions classified as 2, 3 or 4 for contraceptives containing hormones.
Copper IUD for Emergency Contraception
This method is highly effective for preventing pregnancy. It can be used within 5 days of unprotected intercourse as an emergency contraceptive. However, when the time of ovulation can be estimated, the Cu-IUD can be inserted beyond 5 days after intercourse, if necessary, as long as the insertion does not occur more than 5 days after ovulation.
The eligibility criteria for general Cu-IUD insertion also apply for the insertion of Cu-IUDs as emergency contraception.
| CONDITION | Cu-IUD |
|---|---|
| Pregnancy | 4 |
| Rape | |
| a) High risk of STI | 3 |
| b) Low rick of STI | 1 |
| A | Breastfeeding is not recommended for one week after UPA use. Breast milk should be expressed and discarded. |
|---|---|
| B | Ischaemic heart disease, cerebrovascular attack or other thromboembolic conditions. |
| C | The duration of use of ECPs is less than the daily use of hormone-containing contraceptive pills and thus would be expected to have a lower risk for adverse health outcomes. |
| D | Strong CYP3A4 inducers (e.g., rifampicin, phenytoin, phenobarbital, carbamazepine, efavirenz, fosphenytoin, nevirapine, oxcarbazepine, primidone, rifabutin, St John’s wort/hypericum perforatum) may reduce the effectiveness of ECPs. |
| E | No woman should be refused or discouraged from using EC based on her weight. ECPs may be less effective among women with BMI ≥ 30 kg/m² than among women with BMI < 25 kg/m². They may be offered the most effective EC, the Cu-IUD. |
| F | A woman who needs EC as a consequence of sexual assault may be entitled to free EC and other post-sexual assault services in emergency department or health care centers. She should be offered this information. |
| G | Using LNG and then UPA ECPs (or vice versa) within 120 hours may compromise effectiveness. |
| H | Severe lactose problems refers to galactose intolerance, Lapp lactase deficiency, glucose-galactose malabsorption. |
| I | When the time of ovulation can be estimated, the Cu-IUD can be inserted beyond 5 days following intercourse, if necessary, as long as the insertion does not occur more than 5 days after ovulation. |
| J | Method not effective >5 days after unprotected intercourse. However, it does not cause harm to the woman or the developing embryo if used accidentally during pregnancy. |
Abbreviations:
| Cu-IUD: | Copper intrauterine device |
|---|---|
| CYP3A4: | Cytochrome 450 3A4 enzyme |
| EC: | Emergency contraception (includes Cu-IUD and ECPs) |
| ECPs: | Emergency contraceptive pills (includes LNG and UPA) |
| LNG: | Levonorgestrel. |
| PID: | Pelvic inflammatory disease |
| STI: | Sexually transmitted infection |
| UPA: |
Additional Notes:
1. EC methods do not protect against STIs, including HIV. If there is a risk of STI/HIV, the correct and consistent use of condoms is recommended. · 2. Additional protection after EC: 2A. The Cu-IUD may be left in place to provide highly effective ongoing contraception, and is immediately effective 2B. After UPA ECPs, advise use of a barrier method or abstinence for two weeks. The patient should see her contraception specialist if she wants to resume or start using a regular contraceptive method. Starting hormonal contraception immediately after UPA may compromise the effectiveness of UPA. 2C. After LNG ECPs, advise use of a barrier method or abstinence for one week. Regular contraception may be resumed or initiated at time of LNG administration.
This tool aims to summarize key information for pharmacists and providers helping women make informed postcoital contraceptive choices. It is based on recommendations made by the World Health Organization and the Faculty of Sexual and Reproductive Healthcare.
