Article Text

other Versions

Download PDFPDF
An emergency contraception algorithm based on risk assessment: changes in clinicians’ practice and patients’ choices
  1. Rebecca Jayne McKay1,
  2. Lynne Gilbert2
  1. 1Subspecialist Registrar in Sexual and Reproductive Healthcare, Department of Reproductive Medicine, Cambridge Universities Hospitals NHS Foundation Trust, Cambridge, UK
  2. 2Associate Specialist in Sexual and Reproductive Healthcare, Cambridgeshire Community Services NHS Trust, The Laurels CASH Clinic, Cambridge, UK
  1. Correspondence to Dr Rebecca Jayne McKay, Department of Reproductive Medicine, Cambridge Universities Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK; rjmckay{at}doctors.org.uk

Abstract

Objectives When ulipristal acetate (UPA) was introduced into the Contraceptive and Sexual Health Services service in June 2011 an algorithm was developed to guide method selection. The aim was to encourage clinicians to assess risk and to offer a copper intrauterine device (IUD) as first-line choice with hormonal methods as second-line choice.

Methods UPA was the second-line choice for presentations up to 120 hours after high-risk episodes (i.e. around the time of ovulation). Women at lower risk were also offered UPA if presentation was between 72 and 120 hours after unprotected intercourse unless the risk was very low, in which case levonorgestrel 1.5 mg was the second-line choice.

Results Prior to the protocol only 49% of women were offered an IUD compared with 61.6% afterwards. This improved further in the subgroup of women at high risk where 93.3% were offered an IUD compared with 59% initially. After the introduction of UPA the percentage of women accepting the IUD fell from 30% to 14.1%. Overall 14.5% of women received UPA compared to 7.8% receiving an IUD.

Conclusions Introduction of a standardised protocol for the provision of emergency contraception has significantly increased the proportion of women offered an IUD as postcoital contraception, particularly in women at high risk of conception. Introduction of UPA has seen a halving of the number of women accepting the IUD. This is cause for concern. Further investigation into the reasons behind this decrease in IUD uptake needs to be undertaken.

  • emergency contraception
  • family planning service provision
  • intrauterine devices
  • service delivery

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