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6.0 Management of side-effects

6.1 Nausea and vomiting

Anti-emetics may reduce the incidence of nausea and vomiting but routine administration is not recommended with levonorgestrel regimen. If an antiemetic is prescribed, the client should be informed about the usual side-effects of these medications such as dizziness, and she should be advised to avoid driving, operating machinery and taking alcohol. Vomiting occurring within 2 hours of taking pill necessitates an additional dose or use of an alternative method.

6.2 Bleeding

Any irregular bleeding or spotting after ECP use should not be misunderstood as periods. Next menstrual period may occur one week prior or later than the expected time. Women having excessive or prolonged bleeding should be
evaluated for pregnancy (intra-uterine or ectopic) and its complications.

The amount of bleeding in the following period is usually normal but slightly heavier or lighter flow may be expected.

6.3 Missed period

A delay of 7 days from the expected date of periods was observed in 13% of women in a WHO multicentric trial 6 . But to allay the anxiety of the client and for earlier diagnosis, a urine pregnancy test may be done when delay is more than one week. If negative at this stage, wait for another one week. However, pregnancy test is mandatory if the periods are delayed by more than two weeks from the expected date, and then act according to the report.

6.4 Other side-effects

Side effects like headache, mastalgia, dizziness, giddiness, abdominal cramps etc. are usually minor and self limiting. Simple analgesics can be prescribed if these are disturbing.


Ms P is complaining of nausea after taking ECP 6 hours back and is afraid that she will vomit if she
takes the second dose. How would you handle her complaint?

Explain to her that nausea is expected, encourage her to take the second dose in time with food.
Ms M vomited 8 hours after first dose. What should she do with second dose?
Reassure her that vomiting can occur, and it means that the drug is already in circulation and
acting. If there is any vomiting within 2 hours, she needs to repeat the dose.
Ms R took ECP 28 days back, and has not had her periods yet. How would you manage her?
Do a pregnancy test and manage accordingly.
Ms B started her period following ECP use but is complaining of excessive flow. What can be done?
Reassure her that some women may bleed more. Give her haematinics and haemostats. She
should follow up if bleeding continues beyond one week.
Ms N is complaining of sever headache after second dose of ECP. How can she be helped ?
Remind her that headache is a possible side effect and will not last long. She can take paracetamol
tablet for pain relief.

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