An emergency contraception algorithm based on risk assessment: changes in clinicians' practice and patients' choices

Area of Science:

• Reproductive Health
• Contraception
• Emergency Contraception

Background:

• A standardized algorithm was implemented in Contraceptive and Sexual Health Services in June 2011.
• The protocol aimed to prioritize copper intrauterine devices (IUDs) as first-line emergency contraception.
• Hormonal methods, including ulipristal acetate (UPA), were intended as second-line options.

Purpose of the Study:

• To evaluate the impact of a new protocol on emergency contraception method selection.
• To assess changes in the uptake of copper IUDs versus hormonal methods after protocol implementation.
• To investigate the effect of ulipristal acetate (UPA) introduction on IUD acceptance rates.

Main Methods:

• The study analyzed method selection for emergency contraception before and after protocol implementation.
• Ulipristal acetate (UPA) was offered as a second-line choice for high-risk episodes up to 120 hours post-intercourse.
• Levonorgestrel 1.5 mg was the second-line choice for very low-risk presentations between 72 and 120 hours.

Main Results:

• The proportion of women offered an IUD increased from 49% to 61.6% after the protocol.
• In high-risk women, IUD offers rose significantly from 59% to 93.3%.
• Following UPA introduction, IUD acceptance decreased from 30% to 14.1%, with 14.5% receiving UPA versus 7.8% receiving an IUD.

Conclusions:

• The standardized protocol successfully increased IUD offers for emergency contraception, particularly in high-risk scenarios.
• The introduction of ulipristal acetate (UPA) has led to a significant reduction in IUD acceptance.
• Further research is needed to understand the reasons for decreased IUD uptake post-UPA introduction.