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