Transcript Emergency Contraception

Emergency Contraception
• Emergency contraceptive pills (ECPs)
provide a short, high dose of combined
estrogen and progestin, or progestin
alone and are 75% effective in
preventing pregnancy within 72 hours
after unprotected intercourse
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Indications include:
unprotected intercourse
failure of a barrier method
sexual assault
potential pill failures
recent use of suspected teratogens
• Emergency contraception works in three
ways. It slows down ovulation, it stops the
fertilization of the egg, and it stops the
attachment of the egg to the wall
• Emergency contraceptive pills do not
affect an established pregnancy and
numerous studies of the teratologic risk
of conception during regular use of oral
contraceptives (including the use of
older, higher-dose preparations) found
no increase in risk.
• Emergency contraception is safe. The
ACOG stated in 1996 that no published
studies have reported evidenced based
criteria contraindicating use of ECPs
• The World Health Organization noted
that because ECPs are given over such
a short time period, experts believe they
have no clinical effect on conditions
such as cardiovascular disease, angina,
acute focal migraine and severe liver
disease.
• Both the World Health Organization,
and the International Planned
Parenthood Federation have stated that
there are no absolute contraindications
to use of emergency contraceptive pills
except pregnancy
• The pregnancy exception relates to the
fact that the regimen is not effective
during pregnancy, not to any teratogenic
effects
• On February 25, 1997, the FDA
announced the use of certain combined
oral contraceptives containing ethinyl
estradiol and levonorgestrel as safe and
effective for the prevention of pregnancy
• The pills are given in two doses. To prevent
pregnancy, the first dose of pills must be
taken by mouth as soon as possible, ideally
within 3 days (72 hours), but no later than 5
days (120 hours) of having unprotected sex.
A second dose is taken 12 hours after the first
dose. The number of pills in the dose
depends on the brand of pill used. For
progestin-only pills, both doses can be taken
at the same time or 12–24 hours apart
• On September 3, 1998, the Food and
Drug Administration (FDA) accepted a
commercially available product
containing ethinyl estradiol and
levonorgestrel designated for use as an
emergency contraceptive
• On July 28, 1999 the FDA approved the
first progestin-only contraceptive. The
new product's efficacy in reducing
pregnancies is 83% with less incidence
of nausea and vomiting compared to the
combined oral contraceptive containing
ethinyl estradiol and levonorgesterel.
• There are two distinct pill types, the brand name
"Preven" and the brand name "Plan B". Preven
contains the same hormones as regular birth
control, estrogen and progestin. It causes more
instances of nausea and vomiting than Plan Bs,
and decreases the chances of pregnancy by 75%.
However, Preven can be used as an ongoing form
of birth control. Plan B only contains the hormone
progestin. It is more effective, decreasing chances
of pregnancy by 89%, and has less of a chance for
side effects. These pills can be taken immediately
after the sex, or up to 72 hours later.
• Dose: Two doses of 100ug ethinyl
estradiol and 500ug levonorgestrel
taken 12 hours apart.
• 4 tablets stat of Nordette or Microgynon
30 (or generic equivalent) and another 4
tablets 12 hours later
• As nausea and vomiting are very
common with the Yuzpe method, an anti
emetic, to be taken 30-60 minutes prior
to the hormonal doses, should be
supplied/prescribed with this regimen
• Less common side effects including
headache, breast tenderness and lower
abdominal pain can occur with this
method.1
• No adverse effects on foetal
development have been reported with
the method in cases where pregnancy
has occurred
• Two methods of birth control can be used for
emergency contraception. The most
commonly used method is pills (also known
as the “morning-after pill”). Birth control pills
contain the hormones estrogen and
progestin or, in some cases, progestin only.
The progestin-only method is more effective
and is less likely to cause nausea. The
intrauterine device (IUD) also can be used
for emergency contraception
• Dose: Two doses of levonorgestrel
750 ug taken 12 hours apart.
• Postinor-2 one tablet and another tablet
12 hours later;
• Microlut or Microval twenty-five (25)
tablets and twenty-five (25) tablets 12
hours later.
• Both levonorgestrel and Yuzpe methods
have been shown to be most effective
when commenced within 12-24 hours of
sexual intercourse, with commencement
of the first dose recommended before
72 hours
• A recent study, using the Yuzpe regimen,
found that emergency contraception
may still be effective (though to a lesser
degree) in preventing pregnancy, when
commenced up to 120 hours after
intercourse
The IUD for Emergency
Contraception
• The IUD can be used as emergency
contraception. It works best if inserted
within 5 days of having unprotected sex.
The presence of the IUD prevents the
fertilized egg from attaching to the wall
of the uterus
• A benefit of the IUD is that it can be left
in for long-term use. The IUD may be a
good choice if you cannot take birth
control pills. The IUD does not prevent
sexually transmitted diseases
• Copper bearing IUCDs provide an
effective method of postcoital
contraception. The failure rate is less
than 1%. Careful assessment and
counselling should take place before
insertion is decided upon. The IUCD is
not suitable for women who have risk
factors for pelvic inflammatory disease
• An emergency IUCD can be inserted at any
time in the cycle provided the earliest episode
of unprotected intercourse occurred no more
than 5 days previously. Where the earliest
episode of unprotected intercourse was more
than 5 days previously, an IUCD can be
considered up to 5 days after the calculated
earliest day of ovulation (ie. up to day 19 of a
28 day shortest cycle by history)
• This limit is well within the period before
implantation. If the woman does not
wish to continue using the IUCD as a
contraceptive method, it may be
removed at the time of the next period.
If hormonal contraception has been
commenced, the IUCD may be removed
after 7 active pills have been taken
Frequency of Use
• Emergency contraceptive pills (ECP)
should not replace the use of regular
contraception, as the cumulative
pregnancy rate for frequent use of ECP
is higher than with regular contraception.
However, if unprotected sex occurs in a
cycle where the ECP has already been
used it can be used again
• Women should understand that the use of the
ECP cannot protect them from the possibility
of pregnancy if unprotected intercourse
occurs later in the cycle.
• In cycles, where unprotected intercourse has
occurred more than once, ECP can be used,
although efficacy will be influenced by the
time interval since the first act of unprotected
intercourse. The woman must understand
that, if a pregnancy has already occurred, the
ECP will not be effective
Drug interactions
Hepatic enzyme inducing drugs
• Hepatic enzyme inducing drugs enhance the
metabolism of levonorgestrel and ethinyl
estradiol. If a woman taking these drugs (e.g.
phenytoin, carbamazepine, rifampicin,
griseofulvin) uses emergency hormonal
contraception the recommendation is to
double each dose. This increases the risk of
side effects
Antibiotics
• Antibiotics taken concurrently with
hormonal emergency contraception are
unlikely to alter its efficacy and no
alteration in dose is advised. The
exceptions are the enzyme inducers
rifampicin and griseofulvin as detailed
above