Contraception Initiation and Quick Start Methods

Initiating Contraception

• Combined hormonal contraceptives (CHC) and progestogen-only pills (POP) can be initiated on days 1-5 of the menstrual cycle and are immediately effective.
• Progestogen-only injectables and the subdermal implant (SDI) can also be initiated on days 1-5 of the menstrual cycle without requiring extra precautions.
• The intrauterine system (IUS) can be fitted on days 1-7 of the menstrual cycle without requiring extra precautions.

Quick Starting Contraception

• Quick-starting contraception can decrease the risk of unplanned pregnancy.
• All methods can be quick-started if it's reasonably certain the individual is not pregnant.
• CHC, POP, depot medroxyprogesterone acetate (DMPA), and the SDI can be quick-started even with a risk of early pregnancy if a high sensitivity pregnancy test is negative.
• There's no evidence that hormones are harmful to a developing fetus.
• Extra precautions should be used for 7 days when quick-starting combined hormonal methods, the SDI, or the IUS.
• Extra precautions should be used for 2 days for POPs

Emergency Contraception

• Emergency contraception is used after unprotected sexual intercourse (UPSI) to prevent unwanted pregnancy.
• The decision on the appropriate method depends on the contraception being used.
• The Faculty of Sexual and Reproductive Healthcare (FSRH) provides guidelines for emergency contraception.

Emergency Contraception Choices

• Emergency contraceptive methods include:
  • Ulipristal acetate (UPA)
  • Copper-bearing intrauterine device (Cu-IUD)
  • Levonorgestrel (LNG)

Ulipristal acetate (UPA)

• UPA is an oral pill with 30 mg of the selective progesterone receptor modulator.
• UPA delays ovulation for at least 5 days until sperm are no longer viable.
• It's effective up to 120 hours following UPSI.
• Re-starting hormonal contraception should be delayed for 5 days after using UPA, and its use should be avoided within 7 days of using any progestogen.

Copper Intrauterine Device (Cu-IUD)

• The Cu-IUD should be fitted within 120 hours of UPSI or within 5 days of the earliest possible ovulation.
• It works by preventing fertilization and implantation.
• The Cu-IUD is the gold standard option with a negligible risk of pregnancy after fitting.

Levonorgestrel (LNG)

• LNG is an oral pill with 1500 µg of the progestogen levonorgestrel.
• LNG delays ovulation if administered before the luteinizing hormone (LH) surge.
• It's effective up to 72 hours after UPSI.

This quiz explores the recommended practices for initiating various contraceptive methods, including combined hormonal contraceptives and injectables. It covers the timelines for starting these methods and the importance of quick-starting options to reduce the risk of unplanned pregnancies. Test your knowledge on this essential aspect of reproductive health.