Requesting the morning-after pill — CCE clinical encounter

CCE-style clinical encounter: a 27-year-old woman with BMI 36 presents 4 days after condom failure mid-cycle requesting levonorgestrel. The candidate must recognise her elevated oral EC failure risk, offer copper IUD as first-line, arrange ongoing contraception, and close the STI loop without judgement.

clinical encounter with role-player (CCE format)2 min readVerification in progress

Prompt

A 27-year-old woman attends urgently. Condom broke 4 days ago, around day 13 of her regular cycle. BMI 36. She has read about 'the morning-after pill' online and wants levonorgestrel today. She is not on any regular contraception and says she 'never gets on with the pill'. No allergies. Last cervical screening normal.

Objectives

Elicit the timing relative to cycle and establish that oral EC failure risk is elevated (mid-cycle plus obesity). ^[6]
Offer the copper IUD as the most effective emergency contraception within the 5-day window, with ongoing contraception built in. ^[13]
If oral EC is chosen after informed discussion, prefer ulipristal over levonorgestrel at this interval and explain why. ^[5]
Start effective ongoing contraception immediately — LARC-first counselling grounded in CHOICE effectiveness data. ^[1] ^[2]
Close the dual-protection and follow-up loops: condoms for STIs, pregnancy test at 3 weeks. ^[6]

References16Show

[1]Winner B, Peipert JF, Zhao Q, et al. Effectiveness of long-acting reversible contraception N Engl J Med, 2012.PMID 22621627
[2]Secura GM, Allsworth JE, Madden T, et al. The Contraceptive CHOICE Project: reducing barriers to long-acting reversible contraception Am J Obstet Gynecol, 2010.PMID 20541171
[3]Birgisson NE, Zhao Q, Secura GM, et al. Preventing Unintended Pregnancy: The Contraceptive CHOICE Project in Review J Womens Health (Larchmt), 2015.PMID 25825986
[4]Sundaram A, Vaughan B, Kost K, et al. Contraceptive Failure in the United States: Estimates from the 2006-2010 National Survey of Family Growth Perspect Sex Reprod Health, 2017.PMID 28245088
[5]Glasier AF, Cameron ST, Fine PM, et al. Ulipristal acetate versus levonorgestrel for emergency contraception: a randomised non-inferiority trial and meta-analysis Lancet, 2010.PMID 20116841
[6]Glasier A, Cameron ST, Blithe D, et al. Can we identify women at risk of pregnancy despite using emergency contraception? Data from randomized trials of ulipristal acetate and levonorgestrel Contraception, 2011.PMID 21920190
[7]Banh C, Rautenberg T, Duijkers I, et al. The effects on ovarian activity of delaying versus immediately restarting combined oral contraception after missing three pills and taking ulipristal acetate 30 mg Contraception, 2020.PMID 32474062
[8]Lidegaard Ø, Nielsen LH, Skovlund CW, et al. Risk of venous thromboembolism from use of oral contraceptives containing different progestogens and oestrogen doses: Danish cohort study, 2001-9 BMJ, 2011.PMID 22027398
[9]Lidegaard O, Nielsen LH, Skovlund CW, et al. Venous thrombosis in users of non-oral hormonal contraception: follow-up study, Denmark 2001-10 BMJ, 2012.PMID 22577198
[10]Collaborative Group on Epidemiological Studies of Ovarian Cancer, Beral V, Doll R, et al. Ovarian cancer and oral contraceptives: collaborative reanalysis of data from 45 epidemiological studies including 23,257 women with ovarian cancer and 87,303 controls Lancet, 2008.PMID 18294997
[11]Korver T, Klipping C, Heger-Mahn D, et al. Maintenance of ovulation inhibition with the 75-microg desogestrel-only contraceptive pill (Cerazette) after scheduled 12-h delays in tablet intake Contraception, 2005.PMID 15639065
[12]Rice CF, Killick SR, Dieben T, et al. A comparison of the inhibition of ovulation achieved by desogestrel 75 micrograms and levonorgestrel 30 micrograms daily Hum Reprod, 1999.PMID 10221231
[13]Ramanadhan S, Goldstuck N, Henderson JT, et al. Progestin intrauterine devices versus copper intrauterine devices for emergency contraception Cochrane Database Syst Rev, 2023.PMID 36847591
[14]Kaiser JE, Turok DK, Gero A, et al. One-year pregnancy and continuation rates after placement of levonorgestrel or copper intrauterine devices for emergency contraception: a randomized controlled trial Am J Obstet Gynecol, 2023.PMID 36427600
[15]Kaunitz AM, Arias R, McClung M Bone density recovery after depot medroxyprogesterone acetate injectable contraception use Contraception, 2008.PMID 18226668
[16]Van der Wijden C, Manion C Lactational amenorrhoea method for family planning Cochrane Database Syst Rev, 2015.PMID 26457821

Requesting the morning-after pill — CCE clinical encounter

clinical encounter with role-player (CCE format)2 min readVerification in progress

Objectives

Elicit the timing relative to cycle and establish that oral EC failure risk is elevated (mid-cycle plus obesity). ^[6]

Offer the copper IUD as the most effective emergency contraception within the 5-day window, with ongoing contraception built in. ^[13]

If oral EC is chosen after informed discussion, prefer ulipristal over levonorgestrel at this interval and explain why. ^[5]

Start effective ongoing contraception immediately — LARC-first counselling grounded in CHOICE effectiveness data. ^[1] ^[2]

Close the dual-protection and follow-up loops: condoms for STIs, pregnancy test at 3 weeks. ^[6]

References16Show

[1]Winner B, Peipert JF, Zhao Q, et al. Effectiveness of long-acting reversible contraception N Engl J Med, 2012.PMID 22621627
[2]Secura GM, Allsworth JE, Madden T, et al. The Contraceptive CHOICE Project: reducing barriers to long-acting reversible contraception Am J Obstet Gynecol, 2010.PMID 20541171
[3]Birgisson NE, Zhao Q, Secura GM, et al. Preventing Unintended Pregnancy: The Contraceptive CHOICE Project in Review J Womens Health (Larchmt), 2015.PMID 25825986
[4]Sundaram A, Vaughan B, Kost K, et al. Contraceptive Failure in the United States: Estimates from the 2006-2010 National Survey of Family Growth Perspect Sex Reprod Health, 2017.PMID 28245088
[5]Glasier AF, Cameron ST, Fine PM, et al. Ulipristal acetate versus levonorgestrel for emergency contraception: a randomised non-inferiority trial and meta-analysis Lancet, 2010.PMID 20116841
[6]Glasier A, Cameron ST, Blithe D, et al. Can we identify women at risk of pregnancy despite using emergency contraception? Data from randomized trials of ulipristal acetate and levonorgestrel Contraception, 2011.PMID 21920190
[7]Banh C, Rautenberg T, Duijkers I, et al. The effects on ovarian activity of delaying versus immediately restarting combined oral contraception after missing three pills and taking ulipristal acetate 30 mg Contraception, 2020.PMID 32474062
[8]Lidegaard Ø, Nielsen LH, Skovlund CW, et al. Risk of venous thromboembolism from use of oral contraceptives containing different progestogens and oestrogen doses: Danish cohort study, 2001-9 BMJ, 2011.PMID 22027398
[9]Lidegaard O, Nielsen LH, Skovlund CW, et al. Venous thrombosis in users of non-oral hormonal contraception: follow-up study, Denmark 2001-10 BMJ, 2012.PMID 22577198
[10]Collaborative Group on Epidemiological Studies of Ovarian Cancer, Beral V, Doll R, et al. Ovarian cancer and oral contraceptives: collaborative reanalysis of data from 45 epidemiological studies including 23,257 women with ovarian cancer and 87,303 controls Lancet, 2008.PMID 18294997
[11]Korver T, Klipping C, Heger-Mahn D, et al. Maintenance of ovulation inhibition with the 75-microg desogestrel-only contraceptive pill (Cerazette) after scheduled 12-h delays in tablet intake Contraception, 2005.PMID 15639065
[12]Rice CF, Killick SR, Dieben T, et al. A comparison of the inhibition of ovulation achieved by desogestrel 75 micrograms and levonorgestrel 30 micrograms daily Hum Reprod, 1999.PMID 10221231
[13]Ramanadhan S, Goldstuck N, Henderson JT, et al. Progestin intrauterine devices versus copper intrauterine devices for emergency contraception Cochrane Database Syst Rev, 2023.PMID 36847591
[14]Kaiser JE, Turok DK, Gero A, et al. One-year pregnancy and continuation rates after placement of levonorgestrel or copper intrauterine devices for emergency contraception: a randomized controlled trial Am J Obstet Gynecol, 2023.PMID 36427600
[15]Kaunitz AM, Arias R, McClung M Bone density recovery after depot medroxyprogesterone acetate injectable contraception use Contraception, 2008.PMID 18226668
[16]Van der Wijden C, Manion C Lactational amenorrhoea method for family planning Cochrane Database Syst Rev, 2015.PMID 26457821