1. Session I, Slide #11 Levonorgestrel (LNG) Emergency Contraceptive Pills Session I: Characteristics of LNG Emergency Contraceptive Pills

2. Session I, Slide #22 Objectives At the end of this session, participants will be able to: 1.Discuss the consequences of unintended pregnancy. 2. Describe the characteristics of emergency contraceptive pills (ECP) in a manner that clients can understand: a.What ECPs are and how they work (mechanism and onset of action) b.Effectiveness c.Side effects d. Safety e. Who can use emergency contraceptive pills f. ECP regimens g. Key points for providers and clients

3. Session I, Slide 3 Objectives (continued) 3. Describe the indications for use of ECPs 4. Demonstrate how to screen clients for ECP use 5. Demonstrate counseling ECP clients including: a. Characteristics of ECPs b. How to address common concerns, rumors and misconceptions about ECPs c. How to use ECPs d. Possible side effects of ECPs and how to manage them e. The importance of on-going contraception after ECP use

4. Session I, Slide 4 What is an unintended pregnancy? Definition: Unintended pregnancy is “a pregnancy that is mistimed, unplanned, or unwanted.” Unintended pregnancy mainly results from the lack of, inconsistent, or incorrect use of effective contraceptive methods. Unintended pregnancy does not mean unwanted births or unloved children.

5. Session I, Slide 5 What are the consequences of unintended pregnancy? The consequences may include: Health risks to mother. Unsafe abortion. Discontinuation of schooling (for adolescents). Emotional distress. Economic difficulties. Disapproval from the community, especially for young, unmarried women. Possible health risks to infants.

6. Session I, Slide 6 What are ECPs? Emergency contraceptive pills (ECPs) are hormonal methods of contraception that can be used to prevent pregnancy following an unprotected act of sexual intercourse. There are different types of ECPs. In this training, we will be focusing on the levonorgestrel-only ECPs. They provide an important back-up in cases of unprotected intercourse, rape or contraceptive accidents, such as forgotten pills or condoms.

7. Session I, Slide 7 How ECPs work ECPs interfere with the process of ovulation (primary mechanism of action) Other mechanisms have been suggested, but not supported by data. ECPs do not inhibit implantation of a fertilized egg. ECPs do not cause abortion of an existing pregnancy

8. Session I, Slide 8 Effectiveness of ECPs The LNG regimen reduces a woman’s chance of pregnancy after a single sex act by at least half and possibly by as much as 80-90%. Effectiveness for an individual woman depends on where she is in her menstrual cycle, when she had unprotected sex and when she used ECPs. Some types of ECP such as ulipristal acetate (UPA) or mifepristone are more effective than LNG-only ECPs and some (regular contraceptives- the Yuzpe regimen) less effective. Effectiveness may be affected by use of certain medications (rifampicin, griseofulvin, Saint John’s Wort, anticonvulsant drugs or ritonavir).

9. Session I, Slide #99 Timing of LNG ECPs

10. Session I, Slide 10 Side effects of ECPs LNG ECPs are well tolerated and leave the body within a few days. Some women experience mild and short-term side effects. These may include: Altered bleeding patterns Nausea (in up to 20% of women) Vomiting (rare) Headache Abdominal pain Breast tenderness Dizziness Fatigue

11. Session I, Slide 11 Safety of ECPs ECPs have no known medically serious complications. They are safe for use by all women including adolescents. ECPs do not cause abortion There is no evidence that ECPs are harmful if taken by a woman who is already pregnant. ECPs have been widely used in various formulations for over 30 years.

12. Session I, Slide 12 No contraindications to the use of ECPs ECPs have no medical precautions or contraindications. No pregnancy test or physical examination is needed before giving ECP ECPs should not be taken if a woman is pregnant because they will not work. ECP effectiveness may be affected by a woman’s heavy weight and by use of certain medications (rifampicin, griseofulvin, Saint John’s Wort, anticonvulsant drugs or ritonavir).

13. Session I, Slide 13 ECP regimens LNG ECPs appear to be effective for 4 days (96 hours) after sex and potentially up to 5 days (120 hours). It appears to be more effective the sooner it is taken after an act of unprotected sex. Two LNG regimens are packaged and labeled specifically for Emergency Contraception 1 tablet levonorgestrel (LNG), 1.5 mg or 2 tablets of 0.75 mg LNG to be taken 12 hours apart (as labeled by the FDA) yet evidence shows that it is best if both pills are taken at the same time.

14. Session I, Slide 14 Other emergency contraceptive options Other types of emergency contraceptives include: Ulipristal acetate, 30 mg in a single dose Mifepristone, 10-25 mg in a single dose (not widely available) Combined hormonal contraceptive pills (Yuzpe regimen) Copper IUD

15. Session I, Slide 15 Key points for providers and clients ECPs: Are the only currently available contraceptive method that prevents pregnancy after sexual intercourse and before implantation. Are safe and effective. Have no medical precautions or contraindications. Have few side effects. Must be taken within 120 hours (5 days) after unprotected sex. The sooner they are taken, the more effective they appear to be. ECPs do not affect an existing pregnancy if taken when a woman is already pregnant.