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SRH clinical consult
Sexual and reproductive health clinical consultations: emergency contraception
  1. Jayne Kavanagh1,
  2. Pollyanna Cohen2,3,
  3. Corrina Horan2,4
  1. 1 UCL Medical School, University College London, London, UK
  2. 2 EGA Institute for Women's Health, University College London, London, UK
  3. 3 Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
  4. 4 Community Sexual and Reproductive Health, Homerton University Hospital NHS Foundation Trust, London, UK
  1. Correspondence to Dr Jayne Kavanagh, UCL Medical School, University College London, London WC1E 6BT, UK; j.kavanagh{at}ucl.ac.uk

https://doi.org/10.1136/bmjsrh-2023-201831

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    Clinical case

    Jaz, aged 28 years, works as a marketing manager for a clothing company. It is her day off and she attends the walk-in service at her local sexual health clinic on a Monday morning. She requests emergency contraception (EC). She normally uses condoms with her partner of 6 months but did not use one when she had sex last Wednesday (5 days ago). The app Jaz uses to track her period tells her that her last period started 17 days ago. This was a normal period for her – heavy and painful for 2 days and lasting 7 days. Her app shows her cycles vary between 28 and 31 days. When asked, Jaz remembers she also had sex without a condom the Thursday before last (11 days ago).

    Jaz suffers from migraines with aura and believes she cannot use any hormonal or long-acting contraception.

    Jaz has no (other) past medical or surgical history, no allergies to medication and no significant family history. She had a normal cervical screening test 2 years ago and a sexually transmitted infection screen 1 month ago. Neither Jaz nor her partner have had sex with anyone else since.

    Background

    There are three methods of EC available in the UK: two oral methods – one containing levonorgestrel (LNG-EC) and one containing ulipristal acetate (UPA-EC) – and the copper intrauterine device (Cu-IUD).

    Oral EC works by delaying ovulation by 5 days or more. LNG-EC is licensed for use up to 72 hours after unprotected sexual intercourse (UPSI), while UPA-EC is licensed for use up to 120 hours after UPSI. Evidence …

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    Footnotes

    • Twitter @CorrinaHoran

    • Contributors PC drafted half of the first version of the article, based on JK’s teaching resources on emergency contraception and designed the figure and table. JK completed drafting the first version, structured the article, collated feedback and finalised the article. CH critically reviewed and improved the article.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests JK is an Associate Editor for BMJ Sexual & Reproductive Health.

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    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.