advice for women taking hormonal emergency contraception

Last reviewed 03/2021

A doctor prescribing emergency hormonal contraception in the form of the Yupze method or levonorgestrel method should explain that:

• the FIRST dose of the medication should be taken before a 72 hour period has elapsed since coitus
• the levonorgestrel method is not suitable for women with active acute porphyria or current severe liver disease
• the levonorgestrel method has fewer side effects than the previously used Yupze method
• women should be warned that if they vomit within 2-3 hours of taking the tablets then replacement treatment can be taken e.g. two levenorgestrel 750 mcg tablets (with an antiemetic e.g. domperidone); an alternative form of emergency contraception could be considered
• a barrier method of contraception is required until her next period
• her next period may be early or late
• if she has heavy bleeding or any lower abdominal pain she should be reviewed. Also if in 3 to 4 weeks her subsequent period is abnormally light, heavy or brief, or if she is concerned, she should be reviewed.

How should ulipristal be used

• one tablet should be taken orally as soon as possible, but no later than 120 hours after unprotected sexual intercourse (UPSI) or contraceptive failure
• can be taken with or without food
  • if vomiting occurs within 3 hours, another tablet should be taken
• ulipristal is not recommended to be used more than once per cycle as the safety and efficacy of repeated exposure has not been assessed
• if hormonal contraception is continued after administering ulipristal, barrier contraception should be used until the next period or withdrawal bleed

Restrictions on use of ulipristal:

• contraindicated in pregnancy or suspected pregnancy, as well as in those with a hypersensitivity to any of the excipients
• In the absence of specific studies to monitor safety, ulipristal is not recommended in those with severe hepatic impairment, nor is it recommended in women with severe asthma insufficiently controlled by oral glucocorticoids as it is not known whether ulipristal is excreted in breast milk, breastfeeding women are advised not to breastfeed for 36 hours after treatment

Notes:

• regarding Yuzpe method
  • emergency contraception with the combined hormonal method (Yuzpe) is not suitable for women with focal migraine at time of presentation, with a history of thrombosis, with current severe liver disease or active acute porphyria
  • side effects of the Yuzpe method include dizziness, nausea, vomiting, headache, and breast discomfort

Reference:

• FSRH (October 2009). Ulipristal Acetate (ellaOne®) - product review