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Questions

What is the emergency contraception product of choice available in community pharmacies for a 30-year-old woman weighing 160 pounds, who has not been using hormonal contraception but has had unprotected vaginal intercourse within the past 5 days?

A. Ulipristal Acetate (ella ™, UPA)

B. Levonorgestrel (LNG) 1.5mg (Plan B ™, others)

C. Double dose of Levonorgestrel 1.5mg

D. No emergency contraceptive is indicated

A. Ulipristal Acetate(UPA) is more effective than LNG in women weighing more than 154 pounds. If she had been taking hormonal contraception prior to the need for EC, this would not be the most effective choice as there may be circulating progestins that may interact with UPA.

B. is incorrect. LNG 1.5mg has been shown to be less effective than UPA in women weighing more than 154 pounds

C. is incorrect. While double doses of LNG 1.5mg have been studied for effectiveness in women weighing more than 154 pounds, the evidence for this dose is not yet adequate to recommend it over UPA

D. is incorrect. Emergency contraception is indicated in women having unprotected vaginal intercourse. UPA is approved for use for up to 5 days after unprotected intercourse.

A 25-year-old woman comes to you seeking emergency contraception. She recently had an intrauterine device removed due to intolerable side effects and has since been using combined hormonal contraception tablets. She informs you that she had sex yesterday but is worried as she has missed the past 3 days of her hormonal contraception tablets. What is the most appropriate form of emergency contraception that you would recommend for her? She says that she weighs 140 pounds.

A. Ulipristal Acetate (ella ™, UPA)

B. Levonorgestrel (LNG) 1.5mg (Plan B ™, others)

C. Double dose of Levonorgestrel 1.5mg

D. No emergency contraceptive is indicated

B. The most appropriate emergency contraception product is levonorgestrel 1.5mg. The women weighs less than 154 pounds and she has missed the past 3 days of her hormonal contraceptive.

A is incorrect. Ulipristal acetate interacts with circulative progestins making it less effective and so levonorgestrel is a more appropriate EC choice in women who have recently been using hormonal contraception.

C is incorrect. Since this woman weighs less than 154 pounds, there is no evidence that an increased dose is necessary for effectiveness.

D is incorrect. Emergency contraception is indicated when unprotected vaginal intercourse has occurred within the past ...

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