- Emergency contraception can prevent pregnancy 95% or more if used within five days of intercourse.
- Emergency contraception can be used in the following situations: unprotected sex, doubts about the effectiveness of the contraceptive used, improper use of contraceptives, sexual violence, if no contraceptive was used.
- Emergency contraceptive methods include the use of a copper-bearing intrauterine contraceptive (IUD) and emergency contraceptive pill (ECP).
- Copper IUDs are the most effective form of emergency contraception available.
- The WHO recommended emergency contraceptive pills are ulipristal acetate, levonorgestrel, and combined oral contraceptives (COCs) containing ethinyl estradiol and levonorgestrel.
What is emergency contraception?
Emergency contraception refers to methods of contraception that can be used to prevent pregnancy after intercourse. Such methods are recommended to be used within five days after intercourse, but their effectiveness is higher the earlier they are used.Mechanism of action
Emergency contraceptive pills prevent pregnancy by preventing or delaying ovulation and do not induce abortion. Copper-containing IUDs prevent fertilization by causing chemical changes in the sperm and egg before they touch. Emergency contraception cannot terminate a pregnancy that has occurred or harm a developing embryo.
Who can use emergency contraception?
Emergency contraception may be required by any woman or girl of reproductive age to avoid unwanted pregnancy. There are no absolute medical contraindications for the use of emergency contraception. There is also no age limit for its use. When using a copper-bearing IUD for emergency purposes, the same eligibility criteria apply as when using it as a permanent remedy.
When can emergency contraception be used?
Emergency contraception can be used in some cases after intercourse. These include:
- cases when no contraceptives were used;
- cases of sexual violence when a woman was not protected by an effective contraceptive method;
- cases when there is reason to believe that the contraceptives used are ineffective due to their unsuccessful or improper use, including for the following reasons:
- condom breakage, slipping, or misuse;
- skipping the combined oral contraceptive pill three or more times in a row
- taking a progestogen-only pill (minipill) more than three hours late after the usual time of taking, or more than 27 hours after the previous pill was taken;
- taking a tablet containing desogestrel (0.75 mg) more than 12 hours late after the usual time of administration, or more than 36 hours after taking the last tablet;
- injection of norethisterone enanthate (NET-EN), containing only a progestogen, more than two weeks late;
- a progestogen-only depot-medroxyprogesterone acetate (DMPA) injection more than four weeks late;
- the introduction of a combined injection contraceptive (CIC) with a delay of more than seven days;
- displacement, breakage, rupture, or premature removal of the diaphragm or cervical cap;
- a failed attempt to interrupt intercourse (for example, ejaculation in the vagina or on the external genitals);
- incomplete dissolution of the spermicidal tablet or film before intercourse;
- when using methods based on tracking fertility: errors in calculating the period of withdrawal, failed withdrawal or unsuccessful use of the barrier method on the fertile days of the cycle;
- expulsion of an intrauterine contraceptive device (IUD) or hormonal contraceptive implant.
A woman may be provided with a supply of ECPs in advance so that she can carry them with her in case of need and can take them as soon as possible after unprotected intercourse.
- A set of practical recommendations for the use of contraception - in English
Switching to permanent contraception
After using ECPs, a woman or girl can return to or start using a permanent method of contraception. If a copper-containing IUD is used for emergency contraception, then additional contraceptive protection is not required.
After taking levonorgestrel-containing ECPs (LNG) or combined oral contraceptive pills (COCs), women or girls may restart their method of contraception or start using a method, including a copper IUD.
After using ECPs with ulipristal acetate (UPA), women or girls can continue or start using any progestogen-containing product (combined hormonal contraception or progestogen-only contraceptives) on the sixth day after taking UPA. They may be given an IUD with LNG immediately if they can be determined not to be pregnant. They can immediately enter a copper-containing IUD.
Emergency contraceptive methods
There are four methods of emergency contraception:
- Fuel and energy complex containing UPA;
- Fuel and energy complex containing LNG;
- combined oral contraceptive pills;
- copper-containing intrauterine devices.
Emergency contraceptive pills (ECPs) and combined oral contraceptive pills (COCs)
- ECP with UPA, taken in a single dose of 30 mg;
- ECPs with LNG are given as a single dose of 1.5 mg or, alternatively, LNG is given in two doses of 0.75 mg each, 12 hours apart.
- COCs are taken in two doses: one dose of 100 mcg ethinylestradiol plus 0.50 mg of LNG, then 12 hours later a second dose of 100 mcg of ethinyl estradiol plus 0.50 mg of LNG (Yuzpe method).
Efficiency
A meta-analysis of two studies showed that among women using ECPs with UPA, the proportion of pregnant women was 1.2 percent. Studies have found that pregnancy rates for ECPs with LNG are between 1.2 and 2.1 percent. (1) (2) .
Ideally, ECP with UPA, ECP with LNG or COC should be taken as soon as possible after unprotected intercourse, no later than 120 hours. ECPs with UPA, unlike other ECPs, are more effective in the range from 72 to 120 hours after unprotected intercourse.
Safety
Side effects of ECPs are similar to those caused by oral contraceptive pills and include nausea and vomiting, minor irregular vaginal bleeding, and fatigue. Side effects are infrequent, mild, and usually go away without any additional drug treatment.
If vomiting occurs within two hours after taking a dose of the drug, the dose should be repeated. ECPs with LNG or UPA are preferred over COCs because they cause less nausea and vomiting. It is not recommended to deliberately use antiemetics before taking ECPs.
The drugs used for emergency contraception do not harm future fertility. Fertility recovery is not delayed after taking ECPs.
There are no medical contraindications for who can use the ECP.
However, some women, for the above reasons, use ECPs intermittently or use them as their primary method of contraception. In such cases, they need additional counseling on which other more permanent contraceptive options may be more suitable and effective for them.
Frequent and intermittent use of ECPs can harm women with medical conditions classified under categories 2, 3, or 4 of the medical eligibility criteria for the use of combined hormonal contraceptives and progesterone-only contraceptives. Frequent use of emergency contraception can lead to increased side effects such as menstrual irregularities, although occasional use does not pose any health risks.
It has been found that emergency contraceptive pills are less effective for obese women (with a body mass index over 30 kg / m2), although they do not pose any safety concerns. Obese women cannot be denied access to emergency contraception when they need it.
When counseling on the use of emergency contraceptive pills, it is necessary to talk about the options for using permanent contraceptive methods, and in case of their alleged ineffectiveness, explain the correct procedure for emergency actions.
The WHO recommends a copper IUD as an emergency contraceptive that should be given within five days of unprotected intercourse. This method is especially suitable for women wishing to start using a long-term, highly effective and reversible method of contraception.
Efficiency
A copper-bearing IUD, when inserted within 120 hours of unprotected intercourse, is more than 99 percent effective in preventing pregnancy. It is the most effective form of emergency contraception available. After its introduction, the woman can continue to use the copper-containing HPM as a permanent method of contraception or switch to another method of contraception at her discretion.
Safety
Medical eligibility criteria
For the emergency use of a copper-bearing IUD, the same criteria apply as for continuous use. Women with medical eligibility criteria for the use of copper IUDs (such as untreated infectious pelvic inflammatory disease, puerperal sepsis, unexplained vaginal bleeding, cervical cancer, or severe thrombocytopenia) should not use them for emergency purposes. In addition, the copper IUD should not be used for emergency contraception after sexual assault, as women may be at significant risk of sexually transmitted infections such as chlamydia and gonorrhea. The copper IUD should not be used for emergency contraception when the woman is already pregnant.
As noted in Medical eligibility criteria for the use of contraceptive methods IUD insertion may further increase the risk of PID in women at increased risk of sexually transmitted infections (STIs), although limited evidence suggests that this risk is low. Current algorithms for detecting an increased risk of STIs have insufficient predictive value. The risk of STIs differs depending on individual behavior and local prevalence of these infections. Thus, although many women at increased risk of STIs may generally have an IUD inserted, some women who are extremely likely to have an STI should not have an IUD inserted until appropriate tests and treatment.
- Medical eligibility criteria for contraceptive use - in English
WHO recommendations for provision of emergency contraception
All women and girls at risk of unwanted pregnancies have the right to have access to emergency contraception, and these methods should routinely be included in all national family planning programs. In addition, emergency contraception should be integrated into health services for populations most at risk of unprotected sex, including the provision of services and care for women and girls who are survivors of sexual violence and living in humanitarian emergencies.
- Promoting Human Rights in Contraception Programs: An Analysis of Existing Quantitative Indicators from a Human Rights Perspective - in English
WHO reaffirms its commitment to scrutinizing emerging evidence through its Continuous New Evidence Revealing (CIRE) System, and to regularly update its recommendations accordingly.
- (1) Can we identify women at risk of pregnancy despite using emergency contraception? Data from randomized trials of ulipristal acetate and levonorgestrel.
Glasier A, Cameron ST, Blithe D, Scherrer B, Mathe H, Levy D, et al. Contraception. 2011 Oct; 84 (4): 363-7. doi: 10.1016 / j.contraception.2011.02.009. Epub 2011 Apr 2. - (2) Effect of BMI and body weight on pregnancy rates with LNG as emergency contraception: analysis of four WHO HRP studies.
Festin MP, Peregoudov A, Seuc A, Kiarie J, Temmerman M. Contraception. 2017 Jan; 95 (1): 50-54. doi: 10.1016 / j.contraception.2016.08.001. Epub 2016 Aug 12. -
Institute of Public Health named after Johns Hopkins Bloomberg / Center for Information Programs and World Health Organization
Emergency contraception are methods and means of preventing unwanted pregnancy, intended for use after intercourse. They are designed for a one-time appointment and are not a substitute for routine contraceptives. The effectiveness of emergency contraception directly depends on the timing and technique of use: if the recommendations of specialists and manufacturers are followed, conception can be avoided in 95% of cases.
- had unprotected intercourse;
- when using barrier contraceptives, they were damaged or slipped;
- 3 times in a row failed to take hormonal drugs of planned contraception;
- there were doubts about the effectiveness of spermicidal tablets or films due to their incomplete dissolution;
- the technique of interrupted intercourse is violated.
Emergency contraception is also required to prevent pregnancy resulting from committed rape.
Before turning to the emergency prevention of conception technique, you should make sure that it is necessary. To do this, you need to determine the day of the menstrual cycle: if intercourse occurred in the first or last week with a cycle of 28-30 days, the probability of the release and fertilization of the egg is minimal.
Contraindications
Several emergency contraceptive techniques and medications are being used as an emergency measure to prevent unplanned pregnancy. All of them have both indications and certain limitations that must be taken into account when choosing a remedy. Contraindications include some pathologies of the genitourinary system, blood clotting disorders, previous liver diseases, the presence of bad habits, etc.
That is why, before using certain medications, techniques and methods of contraception, a doctor's consultation is necessary. Only a specialist will be able to choose an emergency contraception technique, the use of which will be associated with minimal harm to the body.
Operating principle
In gynecology, two main techniques are used for urgent contraception: the introduction of intrauterine copper-containing contraceptives and the administration of hormonal drugs. The principle of operation of these two main groups is somewhat different.
The technique of intrauterine contraception is based on the fact that the means (spirals) injected into the organ are perceived by the body as a foreign body. As a result of the constant presence of an irritating factor in the mucous membrane (endometrium), an increased amount of prostaglandins is formed. They increase the contractility of the muscular layer of the uterus and fallopian tubes. The egg cell moving through the tube, due to more intense contractions, enters the uterine cavity ahead of time and cannot attach to the endometrium. This emergency technique prevents the introduction of a fertilized egg into the mucous membrane, preventing an unplanned pregnancy.
Hormonal contraceptive pills work as follows: the substances they contain slow down ovulation, so that the egg continues to remain in the ovary. In addition, hormones change the maturation of the upper layer of the mucous membrane, causing its premature rejection. It is accompanied by bleeding similar to menstruation. Even if the egg has managed to get into the tube and fertilize before using contraception, it will come out along with the blood and the upper layer of the endometrium.
Methods
Before settling on one of the emergency contraceptive techniques, it is necessary to weigh the pros and cons of each option and establish the feasibility of its application in a specific situation.
Hormonal
If no more than 72 hours have passed since sexual intercourse, the gynecologist may recommend one of the hormone-containing drugs as an emergency contraception. The effectiveness of this emergency method ranges from 60 to 90% and depends on the composition of the tablets and adherence to the technique.
Most hormonal emergency contraception is for a single use, in some cases you may need to take the pill again after 12 hours. Before recommending this technique, the doctor must rule out contraindications: individual intolerance to the components, pregnancy (hormones have a negative effect on the fetus), past uterine bleeding and liver disease.
Because the hormonal emergency contraception technique changes the balance of hormones, a woman may experience some discomfort and a temporary deterioration in well-being. Side effects of this emergency conception prevention technique are headaches, dizziness, bouts of nausea, and soreness in the lower abdomen.
The use of the hormonal emergency pregnancy prevention technique in the vast majority of cases causes a cycle violation. Menstruation may begin earlier or later than the due date, while the discharge is more abundant. The reason for the visit to the doctor should be a delay in menstruation by more than three weeks after using contraception.
Hormonal contraception is not recommended for breastfeeding, as some of the components pass into breast milk. If this technique is the only possible way to urgently prevent conception, the drug is taken as follows: the pill is drunk after feeding the baby, who is then transferred to artificial feeding for at least a day. Some medicines for emergency contraception require a longer period to be removed from the body, so a specialist consultation is necessary. Compliance with these recommendations during lactation will minimize the impact of hormones on the baby.
The list of pills that can be used for emergency contraception is quite large. They differ in composition, exposure technique, and a list of contraindications. Only a specialist can determine which pills are suitable in a given situation, and whether it is possible at all to use this technique for preventing conception, after taking an anamnesis and assessing the patient's condition. Hormone medications for emergency medical abortion cannot be purchased over the counter without a prescription.
Non-hormonal
The installation of intrauterine devices is a non-hormonal technique for preventing pregnancy. Today, several dozen types of such contraceptive devices can be found on sale. They are made from flexible plastic, copper or silver. It is believed that the best spirals are those that contain copper. This metal is able to inhibit the vital activity of sperm, which provides an increased efficiency of the prevention technique.
Spirals are divided into types not only by materials, but also by shape. Traditionally, T-shaped devices are used for emergency contraception, but some women with an irregular shape or abnormal curvature of the uterus are advised to install other coils for more secure fixation.
The recommended terms for using such an emergency contraception technique are up to 5 days from the moment of unprotected sexual intercourse. Before placing the spiral into the uterus, it is necessary to undergo a series of tests and examinations that will establish the possibility of using this emergency pregnancy prevention technique. The list includes smears for microflora and oncocytology, clinical blood test, ultrasound of internal genital organs and other examination methods.
Various types of spirals can be introduced both for a short period to prevent conception after unprotected intercourse, and for a long period of up to 5 years (if a woman intends to use the technique as planned contraception).
The method has several contraindications that must be taken into account before making a final decision. Non-hormonal methods of contraception are not suitable for those girls and women who have not yet given birth or have had an ectopic pregnancy in the past. The absolute contraindications for the use of technology include the presence of inflammatory processes in the uterus and appendages, sexually transmitted infections, various pathologies of the endometrium.
The installation of an intrauterine device has undeniable advantages in comparison with the use of hormonal emergency contraception:
- the efficiency of the method reaches 98%;
- during intercourse, the woman and her partner do not experience discomfort;
- this is one of the most financially affordable methods of contraception: the spiral can be installed for several years, during which there is no need to use other types of contraceptives;
- the method of non-hormonal emergency contraception is recommended for nursing mothers due to the absence of harmful effects on the baby.
The use of a spiral also has its drawbacks. First of all, this concerns an increase in the intensity of discharge during menstruation. The technique is also not suitable for those women who do not have one permanent partner due to the increased likelihood of infections entering the uterus.
Folk
Some women, after having intercourse without using contraception, avoid visiting a doctor, preferring to hormonal pills and installing a spiral folk remedies for emergency pregnancy prevention.
The most popular methods and types of traditional contraception include douching with herbal infusions and vinegar solution, taking a hot bath, using decoctions from ginger root, marjoram or shepherd's purse. The effectiveness of such techniques is rather low, but this is not the main drawback of such contraception: most of the methods of contraception that are used at home can lead to damage and burns to the uterine mucosa, cause an exacerbation of concomitant diseases and menstrual irregularities. Doctors strongly advise against using such emergency techniques for preventing and terminating pregnancy, as such contraception can affect health and lead to serious complications.
When using any of the emergency conception prevention techniques, the following important points should be considered:
- No form of emergency postcoital contraception protects against sexually transmitted diseases. If intercourse did not occur with a regular partner and there is a possibility of infection, it is necessary to undergo additional examinations for the presence of genital infections as soon as possible.
- During a visit to a doctor, it is necessary to clarify the time frame for a return from emergency to planned contraception, and which pregnancy prevention technique is most optimal for use in the future. First of all, this applies to cases of using hormonal pills. Depending on what the composition and name of the drug is, the timing of the resumption of taking the pills varies from 1 to 6 days.
- If a woman does not plan to have children, she should think about contraception, which will forever eliminate the risk of an unplanned pregnancy. Feedback from specialists and patients suggests that sterilization is the safest and most effective contraceptive technique at the moment.
Points for and against
Any type of emergency contraception has side effects, ranging from allergies, headaches and discomfort to more serious problems that cause irregular and more intense periods. Before using one of the emergency conception prevention techniques, you should definitely make sure of its necessity and weigh all the pros and cons.
pros
Despite the negative impact of hormonal emergency contraception on the body, it has one significant advantage: it helps to avoid the more dangerous stress for the female body associated with abortion. The technique of artificial termination of pregnancy has not only negative physiological consequences. For many women, abortion is the cause of depression, neurosis and other psychological disorders. Using emergency contraception can help you avoid many problems.
Installing an intrauterine device has the following advantages:
- The technique can be used both as an emergency and as a planned contraception.
- The method has the highest degree of effectiveness among all known types of emergency prevention of conception.
Minuses
The main disadvantages of emergency contraception techniques include the presence of many contraindications and side effects. So, hormonal drugs can provoke menstrual irregularities, the appearance of bloody discharge up to the opening of uterine bleeding. Frequent use of such emergency contraception increases the likelihood of an ectopic pregnancy.
The main disadvantages of the spiral installation technique are the need for a preliminary medical examination, the likelihood of injury to the mucous membrane and the walls of the uterus when performing emergency contraception manipulations, an increase in the likelihood of developing inflammatory processes of infectious etiology.
Safety
Despite the regular emergence of new generations of hormone-containing drugs and intrauterine devices for emergency contraception, pharmacists and doctors have not yet been able to develop methods that prevent conception without side effects.
The correct selection of emergency pregnancy prevention techniques will help ensure maximum safety. This can only be done by a doctor after a preliminary examination and assessment of the condition, carrying out certain tests and examinations.
It should be remembered that emergency contraception is a rather serious category of medications, the self-administration of which can result in serious pathologies. The same applies to the intrauterine device: its installation must be performed in appropriate conditions and in compliance with the technique of inserting the device into the uterus.
Receive frequency
The difference between emergency contraceptive pills and conventional contraceptives lies in the multiply increased dosage of biologically active components: drugs for routine use contain significantly less hormones. In this regard, this technique of preventing conception should be used no more than once every 4-6 months. With regular pills, hormonal balance is disturbed. In some cases, too frequent use of emergency contraception techniques can lead to infertility.
As for the technique of using intrauterine devices, here the frequency of installation and removal of contraceptive devices depends on their model and the patient's wishes. On average, coils can provide effective protection against conception for 5-8 years.
Side effects
The list of possible negative consequences depends on the types and methods of emergency contraception, the correct selection of equipment and the exact adherence to the recommendations of a specialist. The main side effects that various emergency pregnancy prevention techniques can cause are:
- from the organs of the reproductive system: soreness, the appearance of uncharacteristic discharge, a violation of the duration of the cycle and the intensity of bleeding;
- from the nervous system: mood swings, dizziness;
- from the gastrointestinal tract: nausea, vomiting, diarrhea;
- from the circulatory system: bleeding, thrombus formation.
After some methods of hormonal contraception, allergic reactions may occur in the form of rashes, swelling, itching.
Effects
If the emergency pregnancy prevention technique is used only in extreme cases and no more than once every few months, the negative effects of contraception will be temporary. With the uncontrolled independent use of hormone-containing medicines, the consequences can be quite serious: from a persistent violation of the cycle to the development of pathologies of the reproductive system and irreversible infertility. Young girls and women of mature age should be especially careful when choosing a technique, since the risk of developing negative consequences is much higher for them.
Any girl or woman of reproductive age may be faced with the need to take urgent measures to prevent unplanned conception. In such cases, the most optimal way out of the situation will be the use of means or techniques of emergency contraception. Before choosing a method of contraception, you should definitely consult your doctor and follow all his recommendations in the future. Self-use of drugs and non-observance of the attached instructions can not only be ineffective, but also harm health. It should be remembered that the use of any emergency contraceptive technique is stressful for the body and entails numerous negative consequences. It should be used only in emergency cases and only as directed by a qualified specialist.
Postcoital contraception is considered to be the prevention of pregnancy, which is highly undesirable. The need to take these funds arises if a woman has forgotten to take an oral contraceptive on time, or a condom ruptured during intercourse. Often, postcoital contraception is used after violent intercourse.
It should be noted that prevention of pregnancy is possible only if the woman took emergency contraceptive within 3 days from the moment of unprotected intercourse.
Levonorgestrel birth control pills
Emergency contraceptives, which contain levonorgestrel, prevent the fertilization of the egg. After taking the pill, ovulation is delayed due to cervical mucus, which prevents sperm from entering the egg.
Will these birth control pills help after intercourse? depends on the time that has passed since sexual contact:
- up to 24 hours - efficiency 95%;
- 25 - 48 hours - 85% efficiency;
- 49 - 72 hours - efficiency 58%.
Consider which levonorgestrel-based birth control pills are currently the most effective:
| Name | How long to take | Instructions | A photo |
| Within 72 hours | The use of an emergency contraceptive is effective for 3 days. It should be noted that there are 2 tablets in the package, respectively, the emergency contraceptive must be taken twice. The second pill should be drunk 12 hours after the first one. Drink clean water without chewing. | ||
| Within 72 hours | Within 3 days after sex (unprotected), you must take one tablet. If there are side effects in the form of vomiting, the drug must be taken again. |  |
Emergency contraception based on mifepristone
Thanks to the active substance (mifepristone), ovulation becomes impossible if you take the pill within 3 days from the moment of unprotected intercourse. In the event that more than 3 days have passed, mifepristone (increased dosage) is used as an early termination of pregnancy (up to 9 weeks).
| Name | How long does it take to take | Instructions | A photo |
| Ginepristone | Within 72 hours | Take 1 tablet with a little water. |  |
| Zhenale | Within 72 hours | It is preferable to take this drug 2 hours before meals, provided that at least 2 hours have passed since the last meal. |  |
| Agesta | Within 72 hours | Take 1 tablet with a little water. It is preferable to take this drug 2 hours before meals, provided that at least 2 hours have passed since the last meal. |  |
Combined oral contraceptives for emergency contraception (Yuzpe method)
The Yuzpe method is an emergency contraception, which is based on the use of oral contraceptives.
To effectively prevent unwanted pregnancy, it is recommended to take the pill within 24 hours of unprotected intercourse. This method is characterized by taking the following medications:
- Marvelon.
- Microgenon
- Regulon.
- Rigevidon.
- Minisiston.
You can also use low-dose hormonal drugs such as Novinet, Logest or Mersilon. In this case, you must take 5 tablets twice with an interval of 12 hours.
Emergency contraceptives for lactation
Women who are breastfeeding can use two types of emergency contraception:
| Contraceptive | Characteristic |
| Installation of an intrauterine device | To prevent unwanted pregnancy, the installation of an ectopic spiral must be carried out within 5 days from the moment of unprotected intercourse. In this case, you do not need to interrupt breastfeeding. It should be noted that after the installation of the intrauterine device, the contraceptive effect will remain in the future. |
| Taking hormonal pills | If a woman, while breastfeeding, decides to use hormonal drugs to prevent unwanted pregnancy, you must stop breastfeeding for 36 hours. In order not to disrupt milk production in a given period of time, a woman needs to express milk, and replace the baby's nutrition with milk formulas by age. During lactation, a woman can choose any of the above types of medications. However, experts recommend giving preference to levonorgestrel-based pills. The most suitable option would be Escapel tablets, which are taken once. |
Non-hormonal emergency contraceptives
There are two types of emergency contraception:
- hormonal drugs;
- non-hormonal drugs.
Drugs that do not contain hormones include medications based on mifepristone. Let's list their names:
- Zhenale;
- Ginepristone;
- Agesta.
Preparations based on this active substance do not violate the hormonal background. Mifepristone tablets are believed to be more effective than levonorgestrel tablets.
Another advantage of non-hormonal drugs is considered a lower percentage of side effects.
What are the safest contraceptives
The safest emergency contraception is the Yuzpe method. Low-dose medications have fewer side effects. If you follow the conditions for taking pills, the effectiveness of this method is 90%.
These birth control pills are available without a prescription.
It should be noted that vaginal contraceptives are not suitable for emergency contraception due to their low effectiveness.
Table: Comparison of the effectiveness and side effects of birth control pills after unprotected intercourse The cost of emergency contraceptives
How much do pills that prevent unwanted pregnancy cost? Consider a list of pills and their average cost:
Please note that the prices for drugs are average. Depending on the region of residence, the cost may vary.
When is postcoital contraception acceptable?
It is possible to use emergency contraceptives if pregnancy is highly undesirable:
- Less than 2 years have passed since the cesarean section.
- Sexual intercourse was violent.
- Past attempts to get pregnant have ended with fetal freezing or ectopic pregnancy.
Before taking a serious medication, its contraindications should be considered:
- Age under 18.
- Existing pregnancy.
- Menstrual irregularities.
- Malignant tumors.
If, after taking an emergency contraceptive, bloody discharge occurs, immediately consult a gynecologist.
If, 2 weeks after using the contraceptive, your period does not come on time, you should also consult your doctor.
How to choose birth control pills after intercourse (
According to international studies, 19% of Russian women have had an abortion. Almost half of them have been repeatedly. At the same time, according to surveys, only 1% of women in the 16-49 age group admit that they could go to terminate pregnancy in the next three years. 54% think they would never choose this method. Moreover, there are now emergency contraceptives that allow you to safely prevent an unplanned pregnancy when used in the first 72 hours after intercourse. More than half of the women surveyed (57%) would rather take the "next day pill" than go for an abortion.
Modern women use all the measures of reproductive planning. At the same time, many couples (17%) still use outdated methods of contraception - the calendar method and coitus interruptus - which lead to pregnancy in 25% and 27% of cases, respectively.
True, even with the use of various methods of contraception, no one is immune from failure. For example, 35% of women found themselves in a situation where a condom broke or slipped out. But even in emergency situations, it is not necessary to think about abortion as the only way to solve the problem.
Need for emergency contraception
Emergency contraceptive pills (ECPs) are designed to prevent pregnancy after unprotected or insufficiently protected intercourse. Therefore, they are sometimes referred to as "next day pills."
The following are used especially for emergency contraception:
- Levonorgestrel. The dose is 1.5 mg or 0.75 mg (in this case, take twice with an interval of 12 hours).
- Ulipristal acetate. Dose 30 mg.
- Mifepristone. Dose 10-25 mg.
The tablets should be taken within 5 days of intercourse. Taking levonorgestrel reduces the chance of pregnancy by 60-90% (in the case of one unprotected intercourse). Ulipristal and mifepristone are more effective than levonorgestrel.
To accept the fuel and energy complex, you do not need to undergo an examination or take laboratory tests.
Emergency contraceptive pills are indicated for use when:
- no other contraceptive was used;
- the contraceptive was used incorrectly;
- the contraceptive was used correctly, but immediately it became clear that it did not provide the desired effect.
Here are the most common situations in which a woman using standard contraceptive methods may need an ECP.
Oral contraceptives, contraceptive patch, vaginal ring
- They began to apply this method at a later stage of the menstrual cycle than the instructions require.
- This method was not used correctly during the menstrual cycle.
- They took medications that could reduce the effectiveness of the method.
Progestin-only injections
- She began to apply this method at a later stage of the menstrual cycle than required by the instructions.
- The contraceptive protection provided by the injection expired before intercourse.
Implants
- The contraceptive protection provided by the implant expired before intercourse.
Intrauterine device or system
- The tool was unintentionally removed.
- You don't feel the antennae.
- Contraceptive protection expired before intercourse.
Condoms
- The condom has broken, slipped off, or has been misused.
Diaphragm or cap
- The agent was dislodged or removed before or during intercourse.
- The remedy was displaced or removed after intercourse earlier than the instructions required.
Spermicide
- A spermicidal agent was not administered before intercourse, as required by the instructions.
- The spermicidal tablet or film did not have time to dissolve before the start of intercourse.
Contraceptive methods based on self-determination of the fertility period
- Were in the fertile period during intercourse.
- Not sure if you were in the fertile period during intercourse.
Interrupted intercourse
- Ejaculation has occurred in the vagina or on the external genitals.
Contraindications and the effect of ECPs on the body
Women who plan to use ECPs are concerned with a number of issues. Let's look at them in order.
1. Are there any contraindications?
The pills are not dangerous under any known circumstances: even if there are health problems. ECPs are not prescribed for women with the onset of pregnancy - they are no longer effective. However, if it is not clear whether there is a pregnancy or not, ECPs can be used as there are no examples of harm to a developing fetus.
But there are side effects - these are irregular vaginal bleeding, nausea, headache, abdominal pain, breast tenderness, dizziness and fatigue.
2. Impact on pregnancy
Studies of women who become pregnant despite taking levonorgestrel or using it accidentally after becoming pregnant show that the hormone does not harm either the pregnant woman or her fetus. In particular, it does not increase the likelihood of miscarriage, low birth weight, congenital malformations of the fetus, or pregnancy complications. There were only a few reports of pregnancy after taking ulipristal, but no complications were noticed.
3. Application by adolescents
Clinical or programmatic considerations should not place restrictions on adolescents' access to ECPs: they are safe regardless of age. Teenagers are able to understand the instructions for using this method of contraception.
4. Use during lactation
If less than six months have passed since the birth, and the woman is breastfeeding only, if there was no menstruation in the postnatal period, then ovulation is unlikely to occur. Then the fuel and energy complex is not needed. However, women who do not meet all three criteria may become pregnant. The use of levonorgestrel during lactation is not contraindicated.
5. Use before intercourse
There is no data on how long the contraceptive effect of ECPs persists after taking the pill. Presumably, ECPs taken immediately before intercourse are as effective as ECPs taken immediately after intercourse. However, if a woman has the opportunity to plan to use a contraceptive method before intercourse, a method other than ECPs is recommended, such as condoms or another barrier method of contraception.
6. Use after several unprotected intercourses
Women should try to take ECPs as soon as possible after each unprotected intercourse; it is not recommended to postpone the appointment until the end of the last intercourse. However, a woman should not refrain from taking funds simply because she has had several unprotected intercourses. However, she should be aware that the effectiveness of ECPs may be limited if the earliest unprotected intercourse occurred more than 4-5 days ago. She should limit herself to one intake of ECPs at a time, regardless of the number of previous unprotected intercourse.
7. Reuse of tablets
ECPs are not intended to be deliberately reused or used as a regular, systematic method of contraception. Women who do not want to become pregnant in the future are advised to start or continue using contraceptives that they have been using for a long time after taking the ECP. There is no specific data on the efficacy or safety of frequent use of current ECPs. However, at least 10 studies have confirmed that multiple doses of 0.75 mg levonorgestrel per cycle do not cause serious adverse side effects. It is not known whether the effectiveness of levonorgestrel is reduced by recent or subsequent use of ulipristal, which is a progesterone receptor modulator. Therefore, if a woman who has recently taken levonorgestrel again needs emergency contraception, then it is better for her to use the same remedy.
8. Use of fuel and energy complex in the non-fertile period
Studies have shown that fertilization as a result of intercourse can only occur within 5-7 days before, after or during ovulation. In theory, ECPs might not be needed if unprotected intercourse occurs at a different time in the cycle, since the likelihood of pregnancy even without ECPs would be zero. In practice, however, it is often impossible to determine whether intercourse occurred on the fertile or non-fertile day of the cycle. Therefore, women should not refrain from using ECPs because of the assumption that a particular sexual intercourse occurred during the non-fertile period.
9. Interaction with other medicines
There are no specific data regarding the interaction of ECPs with other drugs. However, the effectiveness of levonorgestrel may be reduced by the use of medications that can reduce the effectiveness of oral contraceptives.
Women who are using bosentan and medicines to treat stomach acid or stomach ulcers (such as omeprazole) or have taken them in the past month should consider inserting a copper IUD. If they opt for the levonorgestrel ECP, a double dose should be taken. It is better not to use Ulipristal in these cases. Since it is a progesterone receptor modulator, it could theoretically reduce the effectiveness of other hormonal contraceptives containing the hormones progestins.
Contraception after taking ECPs
Switching to (resuming) use of regularly taken contraceptives after using ECPs
ECPs do not provide contraception for subsequent intercourse. Therefore, a woman must choose another method of contraception before resuming sex. When should you do this?
Condoms or other barrier methods of contraception
Start using just before your next intercourse.
Hormonal methods: oral contraceptives, contraceptive patch, vaginal ring, injections, implants, levonorgestrel-containing intrauterine hormonal system.
Start using immediately - that is, on the day you take the ECP or the next day. Use the barrier method within 7 days of taking levonorgestrel or within 14 days of taking ulipristal.
Alternatively, start using after your next menstrual period, but use the barrier method in between.
By the way, before the introduction of implants or the hormonal intrauterine system, it makes sense to conduct a pregnancy test: this way you exclude the presence of an existing pregnancy.
If a woman has asked to have a copper-bearing IUD inserted and more than 5 days have passed since the ECP was applied, then this follows after the next menstruation begins.
Sterilization
This procedure should be undertaken after the onset of menstruation following the use of the ECP. The barrier method should be used until the final sterilization is completed.
Emergency contraception is a necessary measure to prevent unwanted fertilization in the first three days after unprotected intercourse. Usually, hormonal drugs (pills) or intrauterine drugs are used for emergency contraception.
It is important to remember that emergency contraception is a one-day drug and cannot be taken all the time!
When they seek their help
Postcoital contraception is designed for women precisely for cases when conception is very undesirable for them. There may be several such options: an accidental intimate meeting, violence, health status, age, etc. Even prosperous married couples sometimes resort to EC means, with an incorrectly performed PAP or with a torn item No. 2.
If a woman uses methods of emergency contraception, you need to remember about the moments that always happen when taking hormonal drugs:
- Subsequent menstruation may not be on schedule.
- The bleeding can be profuse.
- If "emergency pills" were used during an accidental intimate meeting or violence, it is important to inform the gynecologist and get tested for STDs.
- Use item 2 before starting the next cycle.
- For any discomfort, a doctor's consultation is imperative. Hormonal drugs are no joke!
If, after 21 days from the moment when the emergency contraceptives were used, menstruation has not begun, a visit to the doctor should be mandatory.
It is important to remember that EC pills, with frequent and regular use, can cause serious pathology in the body, therefore, emergency contraception (as contraceptive) is not constantly used. Otherwise, emergency contraception is much preferable to subsequent abortion.
Action of emergency means
These two funds are considered analogs.What is the effect of the "pill on the second day" based on? These drugs contain a loading dose of hormones or dietary supplements, which are designed to block pregnancy.
Emergency contraceptive pills are divided into two groups:
- Tablets with the active substance levonorgestrel (Escapel, Postinor). Sold in pharmacies without a prescription, indicated for women over 18 years of age.
- Tablets with the active ingredient mifepristone (Ginepristone) are a non-hormonal agent.
Both in the first and in the second case, the mechanism of action is the same: the drugs block ovulation, making pregnancy impossible or preventing the attachment of a fertilized egg. Hormonal (emergency) tablets, provided they are used correctly and the concentration is observed, are quite effective.
Ginepristone is the best in the line of emergency contraception drugs.Benefits of Ginepristone:
- Better tolerated, non-hormonal.
- Has a higher reliability of contraception compared to Postinor and Escapel.
- The effect after taking one tablet.
- The contraceptive is effective even after 120 hours of unprotected intercourse.
Emergency contraception also comes with two popular options: intrauterine devices and birth control pills. They are taken from 1 to 7 days, in the future they will not be effective:
- Antigestagenic drugs.
Agest is practically harmless to the female body, effective in the first 72 hours.
- Progestational drugs.
Many women use grandfather's methods, one of which is douching. Absolutely useless, the sperm rate is much higher, they penetrate the uterus within 60–70 seconds after ejaculation.
What are the contraindications and popular misconceptions?
The fact is that the harm from emergency contraception is much lower than from any type of abortion. Hormonal disruptions after taking the pills are predictable and quite fixable with the correct assistance of a gynecologist.
Contraindications:
- Bleeding of unknown origin.
- Thromboembolism.
- Migraines, smoking.
- Severe liver disease.
- Age over 35.
Unfortunately, emergency contraception is not widespread, especially in remote areas of the country. Many women and men do not know anything about her, some believe all kinds of rumors or use "emergency" drugs incorrectly. In the territory of the former USSR, delusions are even more widespread than in Western countries. The reason is that many women still find it shameful to discuss intimate issues with a gynecologist.
It is important to remember that taking emergency contraceptive drugs is a last resort, as it has a number of serious contraindications.Even if everyday methods of contraception are very effective, it is important to have a Plan B on hand as circumstances vary.
What are the most common misconceptions?
- "Emergency contraception is like abortion."
This is fundamentally wrong, since most drugs prevent pregnancy. Not to be confused with medical abortion, when the embryo is expelled under the influence of drugs.
- "An excellent alternative to traditional contraceptives that are taken all the time."
Another misconception. Many women go to extremes, either avoiding emergency contraception or using it too often. However, any gynecologist will tell you that emergency remedies should be the exception rather than the rule. But under unfavorable circumstances, of course, EC should be used.
How to eliminate the need for EC
Unfortunately, the majority of women prefer postcoital means to the constant use of contraceptives of various types, although in practice it should be the other way around. EC is undoubtedly better than abortion, but still worse than daily contraception. What do gynecologists advise women who, due to certain circumstances, have to take EC? The most important thing is to clearly form an idea of \u200b\u200bthe situation with a possible pregnancy and have the most suitable individual contraceptives.
EC is undoubtedly better than abortion, but still worse than daily contraception.There are certain opinions about situations where intercourse can be safe, but they are a myth, and this is what any woman and man must learn:
- "It is impossible to get pregnant the first time." A myth confirmed by hundreds of sad situations when a woman is left alone with pregnancy.
- "Penetration into the vagina is safe if there has been no ejaculation." Another misconception is inherent in men. The pre-ejaculate contains a sufficient number of sperm capable of fertilization.
Despite the fact that it is the 21st century, many couples use fairly Old Testament ways to avoid pregnancy. Gynecologists can recall in their practice a lot of examples when they had to listen to absolutely ridiculous from the point of view of medicine, "innovative" methods of contraception:
- Urination immediately after intercourse.
- Flushing the external and internal parts of the genitals (douching).
- Sharp jumps, exercises, dances, any movements that (in the opinion of women) are capable of "shaking out" the sperm from the vagina.
- Using hot baths.
Entering into an intimate relationship and neglecting elementary means of protection, both men and women should remember that the speed of movement of sperm cells along the female genitals is a large and irreversible value, already 1.5 minutes after ejaculation they end up in the uterine cavity, and "shake them out" from there it is impossible. It is also important to remember that emergency ("fire") contraception can be compared to calling an ambulance, it cannot be used constantly, but better in the most exceptional cases. At other times, on the advice of a gynecologist, you can choose the best option for protection and enjoy intimacy without fear of unwanted pregnancy.
