EHC Methods and Contraception Study Guide: Types, Dosing, and Counselling
This detailed study guide provides essential information on Emergency Hormonal Contraception (EHC), including the various methods available, dosages, timing, side effects, and when to refer patients. It also covers general contraceptive methods, ensuring safe and effective family planning for healthcare professionals, pharmacy students, and those involved in sexual and reproductive health services.
 
Key Features:
Emergency Contraception (EHC) Methods
Levonorgestrel (Levonel):
Available OTC for women aged 16 or over, and as POM (Prescription Only Medicine) via PGDs for those under 16.
Dosage & Timing: 1.5 mg single dose within 72 hours of unprotected sex (ASAP, ideally within 12 hours).
Consider repeating the dose if vomiting occurs within 3 hours.
Can be taken at any point in the menstrual cycle.
Side Effects: Headache, nausea, and altered bleeding patterns.
Ulipristal Acetate (EllaOne):
A selective progesterone receptor modulator (SPRM) available up to 120 hours (5 days) after unprotected sex.
Dosage & Timing: 30 mg single dose as soon as possible.
Can be taken at any point in the menstrual cycle.
Considerations: Avoid if taking progestogen contraceptives in the last 7 days, as efficacy may be reduced.
Side Effects: Similar to Levonorgestrel (headache, nausea).
When to Refer
Severe Lower Abdominal Pain: Could indicate ectopic pregnancy; urgent referral needed.
Post-EHC Follow-Up: Recommended if periods are unusual, or if a pregnancy test is needed 3 weeks after unprotected sex.
Special Considerations and Contraindications

Drug Interactions:
Levonorgestrel: Reduced efficacy with enzyme inducers (e.g., carbamazepine, rifampicin).
Ulipristal Acetate: May be less effective when used with progestogens or enzyme-inducing drugs.
 
Effectiveness & Contraceptive Advice:
EHC is not a substitute for regular contraception. Barrier methods (e.g., condoms) should be used until the next cycle or until the contraceptive is re-established.
Obesity and BMI Considerations: Reduced effectiveness of Levonorgestrel with BMI >26 kg/m²; consider Ulipristal Acetate or double Levonorgestrel dose in such cases.
 
Other Contraceptive Methods
Desogestrel (Lovima & Hana):
Available OTC for women ≥16 years, effective as a progestogen-only pill (POP).
Starting Dosing: 1 tablet every 24 hours, starting from Day 1 of the menstrual period.
 
Missed Pills: If missed by >12 hours, use barrier contraception for 7 days and consider EHC.
Emergency Contraception & Breastfeeding
Levonorgestrel: Safe to use during breastfeeding, but it’s advised to take after breastfeeding and wait for 8 hours before nursing.
Ulipristal Acetate: Should not be used during breastfeeding; women should express and discard milk for 7 days.
 
Key Counseling Points
Medications and Conditions Impacting EHC Effectiveness:
Avoid using EHC when interacting with enzyme inducers or in women with liver conditions.
Discuss the potential side effects like irregular bleeding and other hormonal disruptions.
 
Emergency Contraception and STI Protection: EHC does not protect against sexually transmitted infections (STIs), and barrier methods (e.g., condoms) should always be used for STI prevention.