Family Planning

Board Questions

Which one of the following would be an indication for emergency contraception after unprotected intercourse?

A)       Being 2 days late for a depot medroxyprogesterone acetate (Depo-Provera) injection, which was given 1 week prior to intercourse

B)        Forgetting to change an etonogestrel/ethinyl estradiol vaginal ring (NuvaRing) when the current ring has been in place for 6 weeks

C)        Missing one dose of a combined oral contraceptive pill in the month prior to a sexual encounter

D)       Failure to use backup protection such as a condom when using a progestin-only mini-pill with no missed doses

E)        When a patient reports a sexual encounter that occurred 2 weeks ago

ANSWER: B

In patients who use the etonogestrel/ethinyl estradiol vaginal ring, emergency contraception is recommended if they have intercourse when the same ring has been in place for 5 weeks. Backup protection is advised until the new ring has been in place for 1 week. Backup protection is generally unnecessary with the depot medroxyprogesterone injection unless the patient is more than 2 weeks late for her injection. Backup protection is then recommended for 7 days after the injection. Emergency contraception is recommended for women who miss two or more doses of their combined contraceptive in 1 month, especially if these doses were missed during the first week and unprotected intercourse occurs during that week. Backup protection should continue until the oral contraceptive pill has been taken for 7 consecutive days. Emergency contraception is generally only recommended up to 5 days after unprotected intercourse. The progestin-only mini-pill is effective alone for contraception when taken as prescribed.

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