Contraception protocols
NHS Borders clinical guidelines
Borders Sexual Health recommends the use of the Faculty of Sexual and Reproductive Healthcare’s evidence-based guidance documents.
Please follow the links below to the corresponding faculty guidance
Emergency intra-uterine device
A copper IUD is the most effective form of emergency contraception. It can be fitted up to 5 days after the first episode of unprotected sexual intercourse (UPSI) in a natural cycle, or up to 5 days after the earliest likely date of ovulation (day 19 in a 28 day cycle) – whichever date is later.
Assessment for copper IUD insertion (as the most effective form of emergency contraception) can be carried out at any BSH clinic and arrangements made for insertion by one of our trained IUD fitters during office hours/some evening clinics.
Our Gynaecology colleagues at BGH can be contacted to discuss insertion of PCC IUD.
If referring for an IUD – please provide oral emergency contraception to the woman in case she changes her mind and does not attend for IUD insertion, or in case insertion attempts are unsuccessful. Contact us by email: sexual.health2@borders.scot.nhs.uk
or ring us: 01896 663700. Leave a message and we will get back to you as soon as possible.
Oral emergency contraception (EC)
Oral emergency contraception works by delaying ovulation until sperm within the female reproductive tract are no longer viable. There is unlikely to be any beneficial effect if given after ovulation. However even if presenting after expected date of ovulation, oral EC should still be given if an IUD is not acceptable to the woman – as ovulation can vary even within a regular cycle.
Oral EC can be given even if previous episodes of unprotected sexual intercourse (UPSI) have occurred in the same cycle as evidence suggests that they do not disrupt and existing pregnancy and are not associated with foetal abnormality.
Oral EC can be given more than once in a cycle. If UPA has been used, LNG should not be given for the following 5 days - the effectiveness of UPA may be reduced if a progestogen is taken in the 5 days after taking UPA. UPA can be given again in this time. If LNG has been given, UPA should not be given for 7 days - the effectiveness of UPA could theoretically be reduced if a progestogen has been taken in the preceding 7 days. LNG can be given again in this time.
Ullipristal acetate (UPA) is the most effective oral post coital contraceptive. It can be given up to 120 hours after unprotected sex, at any point in the cycle,
Contraception should not be “quick-started” for 5 days after UPA (the effectiveness of UPA may be reduced if a progestogen is taken in the 5 days after taking UPA).
Levonorgestrel (LNG) is licensed for use up to 72 hours after UPSI. Hormonal contraception can be “quick-started” immediately after LNG.
UPA should be considered first line oral EC. However, if UPSI is likely to have occurred out with a fertile period, contraceptive providers and patients should consider the use of LNG with a “quick-start” method, especially if it is likely that further UPSI will take place in this cycle.
If appropriate, oral post-coital contraception (PCC) is available to women free of charge from community pharmacists.
If appropriate, oral post-coital contraception is also available from all Borders Sexual Health (BSH) clinics.
Contraception
Method specific guidance:
Intrauterine contraceptive methods
Combined Hormonal Contraception
Please contact Borders Sexual Health should you require any additional advice or wish to discuss specific cases.
Email: sexual.health2@borders.scot.nhs.uk
Tel: 01896 663700