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Quick Starting Contraception

Quick Starting Contraception

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Quick Starting Contraception

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  1. Quick Starting Contraception

  2. Why consider a “ quick start” • Woman at continuing risk pregnancy. • Woman keen to start method as soon as possible. • To overcome barriers preventing patient returning.

  3. Barriers; what are they? • Cost transport • Availability child care • Time off work • Change of heart • Erratic behaviour; teenagers. • Access to GP/nurse.

  4. Which methods suitable for quick start? • If pregnancy can be reasonably excluded ANY contraceptive method may be quick started but note the requirements for additional precautions. (See table.)

  5. Criteria for excluding pregnancy • No sex since last menses • Correctly and consistently using a reliable method of contraception • Up to day 7 of normal period • Up to 4 weeks post partum • Within 7 days abortion/miscarriage • Fully breast feeding, amenorrhoea and <6m post partum

  6. Which methods for quick start? If pregnancy cannot be excluded, eg after emergency contraception, then the following methods may be used; • CHC • POP • Progesterone only implant • ( depo; second line)

  7. If pregnancy cannot be excluded Amenorrhoea cannot be taken to exclude pregnancy Ensure that a pregnancy test is done not sooner that 3 weeks after last UPSI. Timing of next period may be delayed by POEC.

  8. If risk of pregnancy cannot be reasonable excluded, the contraceptive provider must ensure that the woman is; • likely to continue to be at risk of pregnancy • Aware that there is a risk of pregnancy • Aware of theoretical risk foetal exposure to hormones( although most evidence=no harm) • Pregnancy cannot be excluded until PT no sooner than 3 weeks after last UPSI • Advise how to access pregnancy testing • Ensure adequate additional precautions • Offer condoms • Ensure able to return if any concerns.

  9. Copper IUD • Acceptable as EC up to 5 days after earliest calculated day ovulation ( ie day 19 of a 28 day cycle) • At any time of cycle if within 5 days/120 hrs of first UPSI.

  10. IUS • Not suitable for emergency contraception • Must be “ reasonably certain” woman is not pregnant to insert. • Can be removed up to 12 weeks gestation but increased risk miscarriage.

  11. Effectiveness? • Cochrane ; limited evidence that it reduces number of unintended pregnancies but research poor. • Also no evidence that it affects continuation rates. • Acceptable to women • Fewer appointments; saving costs?