Follow-up

This is traditionally at 3-4 weeks. Clearly the patient needs to be seen sooner if she has heavy bleeding or pelvic pain. The aims of follow-up are:

• ensure not pregnant - may need pregnancy test or pelvic exam
• ensure happy with mode of contraception and discuss this as need be
• if PCC failed, counselling re future of pregnancy - failed PCC per se is not an indication for TOP (no hard evidence teratogenesis of PCC) but in practice most patients will opt for TOP

In women who were prescribed levonorgestrel (LNG) emergency contraception:

• 95% will have their menstruation within 7 days after their expected date
• inform them that it does not provide contraception for the remainder of the cycle and effective contraception (or abstinence) must be used
• if menstruation is delayed for more than 7 days or is lighter than usual they should undergo a pregnancy test (consider the possibility of ectopic pregnancy in these patients) (1)

In women who were inserted an emergency IUD:

• removal of the device can be done anytime after the next menstruation without risk of pregnancy provided that
  • unprotected sexual intercourse hasn’t occurred after menses or
  • hormonal contraception was started within the first 5 days of that cycle
• in women who did not menstruate after emergency IUD, the device can be removed after 3 weeks (as long as it is reasonably certain that she is not pregnant)
• management of failure of emergency IUD should be the same as for a long term IUD (1)

Reference:

• (1) Faculty of Family Planning and Reproductive Health Care Clinical Effectiveness Unit. FFPRHC Guidance (April 2006). Emergency contraception. J Fam Plann Reprod Health Care. 2006;32(2):121-8