Objective: To assess the indications for usage of emergency hormonal contraception amongst a population of London genitourinary medicine clinic attenders.
Methods: In a prospective study, 150 consecutive women receiving emergency hormonal contraception (EHC) were enrolled. The attending doctor completed a questionnaire of patient details and prescribed EHC with prophylactic prochlorperazine. Follow-up was arranged three weeks later, at which time outcomes and side-effects of therapy were recorded. For those women who did not reattended as planned case notes were reviewed at three months.
Results: Of 150 women surveyed, 100 (66%) reported contraceptive method failure, 48 (32%) had used no contraception at the time of last sexual intercourse and two requested EHC after sexual assault. Ninety three (62%) reported condom failure, 7 (5%) oral contraceptive pill failure. Seventy five (50%) had used EHC before (range 1-10 times). Seventy one (47%) women reattended within three months. Five (3.3%) of the 150 women were pregnant; none of these cases had experienced nausea or vomiting whilst taking EHC. Side-effects were reported by 22 (31%) of the 71 patients who reattended. Nine (6%) women had been followed-up in the family planning advisory clinic. Of the 71 women who reattended, 39 (55%) reported that their preferred future method of contraception would be condoms. Of the 150 women 19 (13%) underwent tests for sexually transmissible infections within one month of presentation.
Conclusions: EHC usage in this population was associated with a failure rate of at least 3.3% and an overall side effect rate of 31%. Despite requests for emergency contraception because of condom failure many elected to continue using condoms as their preferred method of contraception. The majority of women (53%) did not return for follow-up or family planning advice, and so we believe that future contraceptive plans must be addressed at the time EHC is prescribed.
PIP: In England, health providers conducted a prospective study of 150 consecutive women 14-43 years old who sought emergency hormonal contraception (EHC) (50 mcg ethinyl estradiol + 500 mcg norgestrel) at the genitourinary medicine clinic of The Royal London Hospital in the Whitechapel section of London. 50% had also used EHC in the past. 23% had experienced at least 1 induced abortion. The reasons for EHC use were contraceptive failure for 100 (66%) women, unprotected sexual intercourse for 48 (32%) women, and rape for 2 women. 93% of the women reporting contraceptive failure were using a condom during the index sexual intercourse. The remaining women recognized the possibility of failure of their oral contraceptives (e.g., concurrent use of an antibiotic and forgotten pill). 50 (33%) and 21 (14%) women returned to the clinic for follow-up within 1 month and 1-3 months of initial presentation, respectively. Nine of these women had attended the family planning advisory clinic. 3.3% of the 71 women who returned to the clinic were pregnant. 22 (31%) of the women who returned to the clinic reported side effects (10 nausea and vomiting, 9 nausea, 5 abdominal pain, 1 breast tenderness, and 1 a panic attack). More than 31% of returning women reported an abnormal period after using EHC. 51% of returning women said that their preferred future method of contraception would be condoms. 10% either had not yet decided to use contraception or were planning to become pregnant. Clinic staff screened only 13% of all 150 women for sexually transmitted diseases (STDs) within 1 month of unprotected intercourse. None of them had an STD. Six of the 150 women returned for a second EHC prescription within 3 months. These findings indicate the need for clinicians to address future contraceptive plans at the time of EHC prescription, since most women did not return for follow-up or family planning advice. They should also screen for STDs during this initial contact considering the high rate of unprotected intercourse.