Title: Some counselling issues of ECPs
Course: Adolescent and Youth Reproductive Health - Ethiopia (Full)

Some counselling issues of ECPs

Figure 8.15 A Health Extension Practitioner counselling a girl on ECP.

You should consider the following important points when you counsel young people on ECPs. (Figure 8.15)

- Show her the pills and explain how to use them.
  - She should swallow the first dose as soon as convenient, but no later than 120 hours after having unprotected sex.
  - She should swallow the second dose 12 hours after the first dose. Important: if more than 120 hours have passed since she had unprotected sex, she should not use ECPs.
  - If she vomits within two hours of taking a dose, she should take two tablets as soon as possible. If the vomiting occurs after the first dose, she will still need to take a second dose 12 hours later (you can give her extra pills). To reduce nausea she should take the tablets after eating or before bed.
  - Instruct her not to take any extra ECPs unless vomiting occurs. More pills will not decrease the risk of pregnancy further.

Important: if more than 120 hours have passed since she had unprotected sex, she should not use ECPs. ECPs do not interrupt or abort an established pregnancy.

- ECPs should not be used as a regular contraceptive method. After use of the ECPs a regular method should be started or resumed if pregnancy is not desired.
- ECPs do not protect from STIs/HIV/AIDS.
- ECPs can be used at any time during the menstrual cycle and more than once during a cycle if necessary.
- Review what to expect after using ECPs. Women will not see any immediate signs showing whether the ECPs have worked. The menstrual period should come on time (or a few days early or late). Tell her that if her period is more than a week later than expected, or if she has any cause for concern, she should return to you.
- Instruct her to return to you when she has her period if she wishes to use a contraceptive method to prevent future pregnancies.

In Box 8.3 we have presented the EC regimen for your review. This will help you provide ECPs for young girls who are in need of ECPs when you have no pre-packed ECPs.

Box 8.3 Emergency contraceptive pills (ECPs) regimen:

There are two types of ECP regimen in use:

1. Combined oral contraceptive pills: contain ethinyl estradiol and levonorgestrel or comparable formulations.
  - When high-dose pills containing 50 µg (micrograms) of ethinyl estradiol and 0.25 mg of levonorgestrel are available, two pills should be taken as the first dose as soon as convenient, but not later than five days (120 hours) after unprotected intercourse. The second two pills should follow 12 hours later.
  - When low-dose pills containing 30 µg ethinyl estradiol and 0.15 mg of levonorgestrel are available, four pills should be taken as the first dose as soon as convenient but not later than five days (120 hours) after unprotected intercourse, to be followed by another four pills 12 hours later.
2. Progesterone-only pills:
  - When pills containing 0.75 mg of levonorgestrel are available, one pill should be taken as the first dose as soon as convenient, but not later than five days (120 hours) after unprotected intercourse, to be followed by another one pill 12 hours later.
  - When pills containing 0.03 mg of levonorgestrel are available, 20 pills should be taken as the first dose as soon as convenient but not later than five days (120 hours) after unprotected intercourse, to be followed by another 20 pills 12 hours later.