Emergency Contraception

03 Jan, 2023

Emergency Contraception

What is Emergency Contraception (EC)?

Most sexually active women have had a scare of an unprotected sexual Intercourse (UPSI) at some time or the other during their lives.

Emergency contraception is that ‘second chance’ to prevent an unwanted pregnancy. It offers a solution to such women by ensuring that they do not become pregnant from the UPSI episode.

When does the need for EC arise?

Changing norms and habits in the modern society and women empowerment have contributed greatly to the need for emergency contraception.

  • 1. Method failure: Failure or non-usage of regular contraception. Some women might have forgotten to take their regular dose of oral contraceptive pills, condom slippage/tear, or incorrect use of any other precaution.
  • 2. A chance/surprise/accidental encounter resulting in UPSI
  • 3. For women who have irregular cycles and those who have occasional sex.
  • 4. Women in the perimenopausal period (nearing menopause) who might be having irregular cycles and hence unpredictable ovulation.
  • 5. Victim of sexual assault

What are the dangers of UPSI?

  • 1. Pregnancy, of course
  • 2. Sexually transmitted diseases (STDs) especially with a new partner and without barrier contraceptives.

However, ECs offer protection only against pregnancy and not against STDs.

What is the scientific basis of Emergency contraception?

After its release from the ovary, the unfertilized egg can live in the woman’s body (in the Fallopian tube) for 24-36 hours. The human sperm which enters the female body after UPSI, has the capacity to stay alive for 2-3 days. This means that having an UPSI 2-3 days before or after ovulation (release of egg) can potentially cause fertilization.

Even after fertilization, it takes another 2-3 days for the fertilized product (zygote) to attach itself to the uterus and begin to grow. (implantation)

Emergency contraceptives aims to prevent pregnancy by interfering with the entry of sperms into the body and the latest ones even inhibit ovulation.Some of them also interfere with implantation of the zygote and hence prevent pregnancy.

What are the available emergency contraceptives?

Currently, oral pills (LNG or Ulipristal containing medicines) and Intra Uterine Contraceptive Devices (IUCD) are the methods being offered for EC.

What are the LNG oral pills? And how should they be used?

Often referred to as the ‘morning-after pills’

All of them contain the ingredient Levo Norgestrel (LNG).LNG causes alteration in the secretions of the cervix (Entry point to the uterus), impairs sperm transport and hence prevents fertilization.

The total dose needed for emergency contraception is 1.5 milligrams. The medication must be taken immediately after the act and within 72 hours to be effective at all. If the formulation contains two tablets of 0.75 milligrams, then the woman may take one tablet immediately followed by another 12 hours later. However taking the entire dose (two tablets of 0.75 milligrams=1.5 mgms) at one go is slightly more effective than splitting the dose.

What is an Ulipristal containing EC pill?

At the time of writing (December 2012) Ulipristal containing medications are not available in India.

Ulipristal not only makes the environment hostile for sperm entry but also inhibits ovulation.

These EC pills contain 30 milligrams of Ulipristal and one tablet offers protection if taken within 120 hours (5 days!) of the UPSI, and irrespective of the number of exposure.

What is IUCD? How are they useful as emergency contraceptives?

The IUCD is more popularly known as Copper-T today. (The olden day Lippes’ Loupe and the current LNG-containing IUCD is not being referred to in this section)

Actually the Copper-T is classified as a LARC (Long acting Reversible contraceptive) It may be used for a fairly long time contraception (3 or 5 or even 8-10 years). The copper it contains is capable of killing the sperms (spermicidal) and the fertilized zygote (blastocidal) function. Its physical presence inside the uterus may also prevent the implantation of the zygote.

Copper-T inserted within 5 days after UPSI acts as an effective emergency contraceptive.

Are there any other methods than LNG/Ulipristal or Copper-T?

Yes. In case of a REAL emergency when LNG/Ulipristal pills are not available or Copper-t is unwanted, you could take the usual contraceptive pill that contain LNG (Total dose consumed must be 1.5 milligrams), but after consulting a doctor. (Yuzpe’s regime) LNG dose used in daily contraceptive pills is very less and many tablets must be takes for the desired effect. (up to 4 tablets at 12 hourly interval for one day or 2 tablets at twelve hourly interval for 2 days, depending on the pill formulations) However the combined oral pills also contain estrogen derivatives which could cause side effects like nausea, vomiting and even stroke! So it is not advisable to use the conventional combined oral pills for emergency contraception without medical supervision.

How successful are the emergency contraceptive methods?

LNG containing pills prevent 95% of pregnancies if taken within24 hours of UPSI (84% if within35-48 hours and 58% if within 48-72 hours)

Randomized control trials have shown that Ulipristal is as effective,

Copper-T has the lowest failure rates, less than 1% and also the advantage that it can be continued as a LARC.

What are the side-effects, contraindications and precautions?

  • • Though the ECs are relatively safe and are promoted as over the counter drugs (OTCs) it is always safe and sane to consult medical care givers before you use them, at least for the first time.
  • • Nausea and vomiting can occur. If vomiting occurs within 2-3 hours then you may need to repeat the dose for efficacy. As Yuzpe’s regime has high doses of estrogen, it is more likely there.
  • • Menstrual irregularity-Most women may have a normal period around the expected date. Some may experience prior spotting (LNG pills) and some may have an early period (Yuzpe’s)
  • • Ectopic pregnancy rates because of method failure may be slightly more than observed in the general population.
  • • If pregnancy occurs, then there are no documented fetal effects.
  • • There are conflicting reports of Ulipristal usage for more than once during a menstrual cycle.
  • • There are claims that no drug overdose or dependency (in the sense of drug dependency!) has been reported with LNG pills. The World Health Organization (WHO) says that the “repeated use [of EC] poses no known health risks,”
  • • The contraindications for EC are; pregnancy, geriatric age group (over 65 years).
  • • It must not be used as a routine contraceptive! Women are advised to adopt more comprehensive methods after the first EC itself!

Follow up after using the emergency contraception.

  • 1. Remember that one dose of emergency contraception does not provide protection for the complete cycle.
  • 2. For victims of sexual assaults or UPSI with an unknown partner, it is important to undergo tests for sexually transmitted diseases (STDs) like HIV, Syphilis and hepatitis etc.
  • 3. Report to the doctor if you do not get your expected period eve by the end of a week.
  • 4. Report to the doctor in case of pain abdomen, spotting and giddiness-It could be symptoms of ectopic pregnancy.
  • 5. Do not forget to consult your doctor for detailed information about future contraception as emergency contraceptives are meant for emergencies only and not for routine use….!

For more info, Follow : medlineacademics.com

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