Emergency Hormonal Contraception Overview

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Questions and Answers

What patient condition may indicate the need for referral due to treatment failure?

Symptoms that resolve with over-the-counter medication

No improvement within 7 days of treatment (correct)

Patient experiencing only mild discomfort

Symptoms persisting for more than 5 days

Which of the following treatments for vaginal thrush is affected by drug interactions?

Antibiotics

Oral corticosteroids

Systemic fluconazole (correct)

Topical imidazoles

What is a possible side effect of oral fluconazole?

Headaches

Increased energy levels

Weight gain

Gastrointestinal disturbances (correct)

In which scenario might the prescriber consider contacting for alternative therapy?

The patient experiences adverse effects from treatment Signup and view all the answers

What is the dose for oral fluconazole when treating vaginal thrush?

150 mg taken at any time of day Signup and view all the answers

What is the maximum time frame in which ulipristal can be taken after unprotected intercourse for it to be effective?

120 hours Signup and view all the answers

Which medication should be referred for further evaluation if a woman has taken any in the last 4 weeks?

Rifampicin Signup and view all the answers

What is the main method through which levonorgestrel is believed to work before ovulation?

Delay ovulation Signup and view all the answers

What should a pharmacist suggest if a woman suspects she might already be pregnant?

Use a pregnancy test Signup and view all the answers

Which statement regarding the effectiveness of ulipristal and levonorgestrel is true?

Ulipristal is more effective than levonorgestrel. Signup and view all the answers

What should be done if hormonal emergency contraception is deemed unsuitable for the woman?

Fit a copper intrauterine device Signup and view all the answers

Which scenario does NOT indicate the need for emergency hormonal contraception?

Regular use of the contraceptive pill Signup and view all the answers

What is the primary mechanism by which Ulipristal acts?

Delaying ovulation through luteinizing hormone suppression Signup and view all the answers

Which adverse effect is most frequently reported by women taking emergency hormonal contraception?

Headache Signup and view all the answers

What should a woman do if she vomits within 3 hours after taking the emergency hormonal contraception tablet?

Take another tablet immediately Signup and view all the answers

Which condition should prevent a woman from taking Levonorgestrel?

Severe malabsorption due to Crohn's disease Signup and view all the answers

What is defined as heavy menstrual bleeding (HMB)?

Excessive blood loss interfering with quality of life Signup and view all the answers

Which symptom is most indicative of a potential pre-cancerous condition or cervical cancer?

Postcoital bleeding with irregular cycles Signup and view all the answers

Which of the following is not a contraindication for taking emergency hormonal contraception?

Being under age 18 Signup and view all the answers

Which medication is mentioned to alter menstrual bleeding but is not specified as causing heavy menstrual bleeding?

Cimetidine Signup and view all the answers

In postmenopausal women, abnormal vaginal bleeding is particularly significant because it may indicate which condition?

Endometrial or cervical carcinoma Signup and view all the answers

What should be done if a woman presents with any blood staining in her vaginal discharge?

Directly refer her for further evaluation Signup and view all the answers

Which condition is associated with the most prominent vaginal itching?

Vaginal thrush Signup and view all the answers

What is a possible consequence of using products containing local anesthetics for vaginal symptoms?

Development of sensitivity reactions Signup and view all the answers

Which group of women requires referral upon first occurrence of vaginal symptoms?

Women experiencing their first episode Signup and view all the answers

What indication may suggest a urinary tract infection when associated with vaginal thrush?

Dysuria accompanied by lower abdominal pain Signup and view all the answers

What should a pharmacist inquire about to assess the cause of vaginal itching?

Use of new toiletries or products Signup and view all the answers

During pregnancy, what hormonal change is associated with an increased incidence of vaginal candidiasis?

Alterations in the vaginal environment Signup and view all the answers

In what cases should diabetic women with thrush be referred?

If they experience recurrent episodes of thrush Signup and view all the answers

Which scenario suggests a referral due to sexually transmitted diseases (STDs)?

A woman with a prior history of STDs Signup and view all the answers

What is a potential complication if thrush remains untreated in diabetic patients?

It may enhance C.albicans resistance to treatment Signup and view all the answers

Which condition is characterized by a profuse, frothy, greenish-yellow discharge?

Trichomoniasis Signup and view all the answers

What is the most likely cause of vaginal discharge?

Bacterial vaginosis Signup and view all the answers

Which demographic should be referred if presenting symptoms of vaginal thrush?

Women under 16 or over 60 Signup and view all the answers

What type of discharge is typically associated with bacterial vaginosis?

Thin, white, and fishy Signup and view all the answers

Which infection is commonly treated with over-the-counter medications?

Vulvovaginal candidiasis Signup and view all the answers

What is a common symptom of vulvovaginal candidiasis?

Curd-like discharge Signup and view all the answers

Which condition has a strong likelihood of being asymptomatic in up to 50% of patients?

Trichomoniasis Signup and view all the answers

What is the effect of oestrogen on vaginal flora?

It ensures a protective barrier against bacterial infections. Signup and view all the answers

Which of the following infections is the least likely cause of vaginal discharge?

Atrophic vaginitis Signup and view all the answers

What is the key characteristic of discharge indicating a potential referral?

Strong odor and non-white, curd-like discharge Signup and view all the answers

Study Notes

Emergency Hormonal Contraception (EHC)

EHC is available over-the-counter (OTC) for women aged 16 and over in the UK.
For women under 16, the pharmacist should refer them to a doctor.
Common reasons for requesting EHC include contraceptive method failure (e.g., condom breakage), missed pills, and unprotected sexual intercourse (UPSI).

Timing of EHC Use

Ulipristal should be taken within 120 hours (5 days) of unprotected sex.
Levonorgestrel should be taken within 72 hours (3 days) of unprotected sex.
Earlier use increases efficacy.
Copper intrauterine devices (Cu-IUDs) can be used for emergency contraception within 120 hours of unprotected sex, if hormonal methods are unsuitable.

Pregnancy Considerations

If pregnancy is suspected (e.g., irregular or delayed period), a pregnancy test should be suggested.
EHC will not work if the woman is pregnant.
There is no evidence that EHC is harmful to pregnancy.

Interactions with Medications

Women taking certain medications (e.g., carbamazepine, rifampicin, griseofulvin) within the previous four weeks should be referred.

Treatment Timescale

Ulipristal should be started within 120 hours of unprotected intercourse.
Levonorgestrel should be started within 72 hours of unprotected intercourse.

Treatment

Levonorgestrel (1.5 mg tablet) and Ulipristal (30 mg tablet) are taken as a single tablet as soon as possible after unprotected sex.
Ulipristal is more effective than levonorgestrel for emergency contraception.

Mode of Action (EHC)

Levonorgestrel may act by delaying or inhibiting ovulation, affecting the fallopian tubes, or altering the endometrium after ovulation to inhibit implantation.
Ulipristal inhibits or delays ovulation via luteinizing hormone suppression.

Side Effects (EHC)

Common side effects include headache and nausea (affecting around 1 in 5 and 1 in 8 women, respectively.)
If vomiting occurs within 3 hours of taking the tablet, another tablet should be taken..

Contraindications (EHC)

EHC should not be taken if pregnant.
EHC should not be taken by those with severe liver problems.
Levonorgestrel should not be taken by those with severe malabsorption issues.

Heavy Menstrual Bleeding (HMB)

The key symptom is excessive blood loss perceived as greater than normal.
Irregular bleeding outside of menstrual periods (e.g., post-coital bleeding) may indicate a structural problem (e.g., cervical cancer).
Several months of heavy bleeding may indicate iron deficiency anemia.
Medications can alter menstrual bleeding (e.g., anticoagulants, thyroid hormones).

Management and Treatment for HMB

For HMB coexisting with dysmenorrhea, NSAIDs are typically preferred over tranexamic acid.
If no improvement occurs within 3 menstrual cycles, discontinue NSAIDs, or tranexamic acid.
NSAIDs in sufficient doses can reduce ovulatory bleeding by approximately 30-40%.

Vaginal Discharge

Common causes include bacterial vaginosis, vulvovaginal candidiasis (thrush), and trichomoniasis.
Thrush is the only OTC treatable vaginal discharge.
Bacterial vaginosis is characterized by a thin white discharge with a fishy odor.

Vaginal Thrush

Women under 16 or over 60 with suspected thrush should be referred.
Vaginal itching and burning are common; discharge may be thick, white, and clumpy.
Refer pregnant women with vaginal thrush, those with a history of STIs or repeated occurrences, or those who do not respond to treatment.

Treatment of Vaginal Thrush

Topical imidazoles (e.g., clotrimazole, miconazole) and oral fluconazole are available OTC.
Fluconazole is usually given as a single dose (150 mg).
Potential side effects of oral fluconazole include gastrointestinal issues (nausea, vomiting, diarrhea) in up to 10% of cases.
Topical medications provide vaginal relief and treatment.

Prevention of Vaginal Thrush

Practices to maintain dryness are suggested (e.g. Avoiding douching, warm environment, cotton undergarments, good hygiene).

Treatment of Partner

Men with balanitis may benefit from similar topical azole treatment for up to 7 days.
Treating without symptoms is contentious.

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Description

This quiz covers important aspects of Emergency Hormonal Contraception (EHC), including its availability, timing of use, and considerations regarding pregnancy. It also discusses interactions with other medications and common reasons for requesting EHC. Test your knowledge on this vital topic in reproductive health.