Article Text

Download PDFPDF
Use of ulipristal acetate, levonorgestrel and the copper-intrauterine device for emergency contraception following the introduction of new FSRH guidelines
  1. Aisling Susan Baird
  1. Consultant in Sexual and Reproductive Healthcare, Liverpool Community Health, Central Abacus, Liverpool, UK
  1. Correspondence to Dr Aisling Susan Baird, Liverpool Community Health, Central Abacus, Citrus House, 40–46 Dale Street, Liverpool L2 5SF, UK; aisling.baird{at}liverpoolch.nhs.uk

Abstract

Objectives The UK Faculty of Sexual & Reproductive Healthcare (FSRH) has recommended that for emergency contraception (EC) the health professional should discuss individual needs and inform women of the different methods, efficacy, adverse effects, interactions, eligibility and additional contraception. In our sexual and reproductive health care service (Liverpool and Knowsley, UK), revised guidance was issued in early 2012, reflecting Faculty advice. We studied (1) how our use of EC changed, (2) which methods were offered and how this changed, (3) which method was chosen by women who were offered all three UK licensed methods of EC and (4) the appropriateness of the offer of only levonorgestrel (LNG).

Methods We studied a total of 2989 case records in the 3 months before and 3 months following the adoption by our service of the 2011 FSRH guidance. This was a retrospective review of charts undertaken by interrogating our computerised Excelicare® system of clinical records. All EC episodes in the two 3-month periods were analysed, covering October–December 2011 and March–May 2012. Additionally, three non-probabilistic, purposeful samples of representative practitioners’ charts were examined in groups of women offered all methods [and choosing either ulipristal acetate (UPA) or LNG] or who were offered LNG only.

Results The use of LNG fell from 93.0% of EC issued to 76.0%; UPA use rose from 3.0% to 18.7%. In the second 3-month period, of the women offered all three methods, 54.9% chose LNG and 39.8% UPA. LNG-only offers in our judgement were clinically appropriate in 62.5% cases of such offers.

Conclusions Comparing the second period with the first, more women were offered all three methods, the use of LNG fell (93.0% to 76.0%) and that of UPA increased (3.0% to 18.7%). Women were encouraged to exercise choice. However, increasing choice in our service did not lead to a wholesale change from LNG to UPA.

  • emergency contraception
  • family planning service provision

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles

  • Highlights from this issue
    British Medical Journal Publishing Group