Additional information on indications, administration and side effects is provided in Contraception: an Australian clinical practice handbook.1
Women who present to PFSHSs are assessed to ascertain time of last unprotected sexual intercourse and current contraceptive method.
Women are assessed for EC and information is provided on contraceptive options.
IndicationsUnprotected intercourse, contraceptive failure or sexual assault in a female of childbearing age.
ExaminationUrine pregnancy test (if there is concern about pre-existing pregnancy).
- Ulipristal is first-line therapy for EC.
- Levonorgestrel should be considered as an alternative regime where the patient has liver disease, is taking liver-enzyme-inducing drugs or has other drug interactions, intends to rely on hormonal contraception in that cycle, or where cost is an issue for the patient or the service.1
- Women should also be made aware of the emergency use of the copper-bearing intrauterine device (IUD) and referred for insertion if appropriate.2
Local supply and administration will vary. EC medication may be supplied through PFSHS imprest, hospital pharmacy or co-located community health pharmacy. Some services refer patients to a community pharmacy for over-the-counter supply.
Offer STI testing.
A pregnancy test in three to four weeks may be important in the following situations:
- when the risk of pregnancy is high at the time when the emergency contraception is given
- if hormonal contraception is started immediately after levonorgestrel (i.e. ‘quick start’ use) or within five days after ulipristal
- if levonorgestrel or ulipristal is used more than once in the current menstrual cycle
- if a copper-bearing IUD was inserted as EC
- if the next menstrual period is more than seven days late (more likely with ulipristal than levonorgestrel; about one woman in five using ulipristal may have a period seven or more days later than usual3)
- if the next menstrual period is light or unusual in any way.
Document the history and assessment in the patient’s medical record.
Document administration of EC in the patient’s medical record.
References and further reading
- Ulipristal acetate for emergency contraception. Australian Prescriber. 2016;39:228–9. Available at: https://www.nps.org.au/australian-prescriber/articles/ulipristal-acetate
- Family Planning New South Wales, Family Planning Victoria, and True Relationships and Reproductive Health. Contraception: an Australian clinical practice handbook. 4th ed. Ashfield (NSW): FPNSW; 2016.
- Fine P, Mathé H, Ginde S, Cullins V, Morfesis J, Gainer E. Ulipristal acetate taken 48–120 hours after intercourse for emergency contraception. Obstetrics & Gynecology 2010;115:257–63.
- Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Emergency contraception. Melbourne: RANZCOG; 2016. Available at: https://www.ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical%20-%20Gynaecology/Emergency-contraception-(C-Gyn-11)-Review-July-2016.pdf?ext=.pdf