Emergency contraception | Emergency contraception

Emergency postcoital contraception will be effective only in the first few days after sexual intercourse until the egg is released from the ovary and fertilized by sperm. It should be borne in mind that emergency contraceptives cannot be considered as a regular way to prevent unplanned conception.

Emergency contraception is a method of preventing unplanned pregnancy in the event of ineffective use of permanent contraception or unprotected intimacy. Also, postcoital contraceptives can be used in cases of sexual violence or in case of improper use of contraceptives.

The action of postcoital contraception is aimed at delaying or suppressing ovulation, blastocyst implantation, egg transport and disruption of the fertilization process.

Indications for the use of emergency contraception

Medicines and emergency contraception can be used in the following situations:

Failure to use a contraceptive drug or device;
Physical violence (rape);
Incorrect use of contraception, which includes: taking a pill that contains only progestogen later than 3 hours after intimacy;
skipping oral combined contraception three or more times in a row;
an injection of norethisterone enanthate, which contains only a progestogen, given later than 2 weeks;
condom slipping, breaking or misuse;
a monthly injection of combined contraceptives given more than 7 days later;
late insertion, displacement or early removal of a transdermal patch or hormonal ring;
rupture, breakage, displacement or early removal of the cervical cap or diaphragm;
interrupted sexual intercourse - ejaculation on the external genitalia or in the vagina;
incomplete dissolution of spermicidal film or tablet before intimacy;
unsuccessful abstinence, incorrect calculation of the safe period for sexual intercourse when using the periodic abstinence method or using barrier contraceptives on fertile days of the menstrual cycle;
choice of hormonal contraceptive implant or intrauterine contraceptive device.

What emergency methods have been developed

Contraception after sexual intercourse cannot be used later than 72 hours after intimate intercourse. After this, its effect rapidly decreases. Several methods of unscheduled contraception have been developed, but only a few have found widespread use:

Yuzpe method – combined contraceptives are taken in an increased daily dose according to the scheme;
mifepristone tablets;
antigonadotropin Danazol tablets;
postcoital contraceptives with levonorgestrel for oral administration;
intrauterine device with copper wire winding.

Not all tablets for emergency contraception can be purchased at a pharmacy without a prescription; without a doctor’s instructions, a woman can only purchase levonorgestrel-based drugs and some mifepristone tablets. The intrauterine device must also be installed by a doctor under aseptic conditions.

Oral medications

For emergency contraception, you can purchase drugs based on estrogen-progestogen components. This method of emergency birth control is called the Yuzpe method. Combined oral contraceptives are used for it. The regimen includes taking a certain number of tablets twice with an interval of 12 hours. In total, they should provide 100 mcg of ethinyl estraliol and 500 mcg of levonorgestrel. Drugs with high dosages of hormones are often used:

It is advisable to take the first 4-5 tablets as soon as possible after sex, depending on the dose in one. But it is allowed to take them within 72 hours.

Emergency contraceptives, which are used after unprotected sexual intercourse, containing levonorgestrel, are sold without a doctor's prescription, unlike COCs. Such drugs include:

Emergency protection pills against unwanted pregnancy need to be taken only once as soon as possible, you need to do this within 3 days. It takes 3 hours for the pill to be absorbed; if vomiting occurs during this time, the method cannot be considered effective, so a repeat pill is taken.

These are one of the best emergency contraceptives, but they should not be used more than once a month. This scheme is harmful and leads to hormonal imbalance and can cause uterine bleeding.

Mifepristone is a non-hormonal safe drug. It is an antiprogestin, blocks progesterone receptors in the endometrium and prevents implantation. Mifepristone is included in the following drugs:

Express pills for unwanted pregnancy are taken, regardless of the day of the menstrual cycle, for 3 days after unprotected sex. Food affects the absorption of emergency contraception, so they are drunk 2 hours before or 2 hours after meals. During this period, mifepristone prevents fertilization and implantation. But the drug is also used for medical abortion in combination with misoprostol.

Emergency contraception with mifepristone is the safest and has fewer side effects. The dosage of the active substance in tablets is only 10 mg, which is significantly lower than in tablets that cause miscarriage. But you should resort to them only in emergency cases.

An alternative method of emergency contraception for girls is Danazol. This is a drug that belongs to the class of antigonadotropins. It should be drunk within 12 hours at a dosage of 400 mg. Then repeat taking the drug 3-4 more times. Research shows that this drug has fewer side effects than COCs. But the technique has not yet received approval.

Emergency contraception - rules of use

When using postcoital contraceptives to prevent unplanned conception, several rules should be taken into account and followed:

Almost all emergency contraceptives should be taken no later than 72 hours after unprotected intimacy. If more than 3 days have passed since sexual contact, the drug will be ineffective;
If 3-5 days have passed after sexual intercourse, the patient can consult a gynecologist who will install an intrauterine contraceptive device (IUD). An intrauterine device is a special device that is inserted into the uterine cavity to prevent pregnancy;
Before taking any contraceptive, you should consult your doctor.

In addition, it should be taken into account that some diseases of the urinary and digestive systems, as well as taking other medications, can not only reduce the effective effect of postcoital contraception, but also provoke the development of adverse complications. A consultation with a gynecologist, as well as a series of laboratory tests and clinical studies will help determine the presence of possible restrictions and select the most optimal option for an emergency contraceptive.

In what cases can emergency contraception be used?

After unprotected intercourse, to prevent unwanted pregnancy. This could be pills or other medications.

The main condition for their use is a strict time frame - no later than 3 days after unprotected sex.

Taking a pregnancy test should be a mandatory step. If the result is positive, doctors strongly recommend that you stop taking emergency contraceptives. They can provoke the development of pathologies of the reproductive system.

Contraindications to the use of emergency contraception

Postcoital contraception is not recommended for use in the presence of the following pathological disorders and abnormalities in the body:

Chronic and acute forms of renal failure;
Diseases of the biliary tract, liver;
Glucose malabsorption, lactase deficiency and lactose intolerance;
Allergic reactions to the components of the drug;
Crohn's disease;
Jaundice;
Porphyria (pigment metabolism disorder);
Anemia (anemia);
Pathologies of hemostasis;
Severe extragenital disease.

Also, the use of emergency contraceptives is contraindicated in pregnant women, adolescents under 16 years of age, patients during lactation, as well as during long-term treatment with glucocorticosteroid drugs and anticoagulants.

Emergency contraception methods

Modern medicine has two most common methods of postcoital contraception: copper-containing intrauterine devices and pills for emergency pregnancy prevention.

Medicines for emergency contraception

According to experts, the most common and effective postcoital contraceptive is considered to be tablets containing levonorgestrel, a synthetic progesterone. It is recommended to take such drugs in a single dose (1.5 mg) for 120 hours (five days) after unprotected intimacy. You can also take levonorgestrel in two doses of 0.75 mg with an interval of 12 hours. The developed scheme is 50-95% effective in preventing unplanned conception. The sooner the drug is taken after sexual intercourse, the higher its effectiveness.

The mechanism of action of progesterone is to delay or prevent ovulation. The drug may also prevent the fertilization of an egg by affecting the cervical mucus or the ability of seminal fluid to bind to the egg. Since levonorgestrel tablets are ineffective once implantation begins, they do not promote abortion.

Hormonal contraceptives containing progesterone are quite safe and do not pose a threat to future fertility (ability to bear children). Side effects after their use occur rarely and are usually minor.

Emergency contraception in the form of levonorgestrel tablets is not recommended for pregnant women. If a pregnant woman accidentally takes such a drug, it will not harm the health of the fetus or the expectant mother. Hormonal pills should be taken in urgent cases. Since the systematic use of progesterone preparations significantly reduces their effectiveness, such tablets are unsuitable for frequent use. In addition, the constant use of postcoital contraceptives can provoke changes in the menstrual cycle (heavy, scanty, frequent, infrequent, painful menstruation).

Copper-containing intrauterine contraceptives

Emergency contraception in the form of a copper-containing intrauterine contraceptive can be inserted into the uterine cavity for 3-5 days after unprotected intimacy. The mechanism of action of this method is to change the composition of the environment, which damages the seminal fluid and egg until they can come into contact. If the intrauterine contraceptive is inserted into the uterine cavity in a timely manner, this will prevent unwanted pregnancy by 99%. This method of emergency contraception is the most effective way to prevent unwanted conception. After installation of an intrauterine contraceptive, a woman can use it in the future as permanent contraception. If desired, it can be changed to another contraceptive method in the future.

An intrauterine copper-containing contraceptive is a safe form of postcoital contraceptive. When using it, the likelihood of perforation, expulsion and infection is minimal. The only contraindication to the use of this method is existing pregnancy.

Emergency contraception: how much, when, in what cases and why does an adult woman need it?

Our expert: Anna Igorevna Fedorova , Doctor of Medical Sciences, Professor of the Department of Psychotherapy, Medical Psychology and Sexology of the North-Western State Medical University. I.I. Mechnikov (FSBEI HE Northwestern State Medical University named after I.I. Mechnikov)

The very name “emergency contraception” suggests that such products are intended for emergency situations. But still: how often can you use emergency contraception without harm to your health?

Emergency contraception (EC) is not recommended to be taken more than once per menstrual cycle. If the need for protection arises more often, then you should think about planned contraception.

What happens if a woman uses such products too often?

More frequent use of EC may increase side effects - for example, allergic reactions, vomiting, diarrhea, headaches, discomfort in the mammary glands. The likelihood of irregular menstrual bleeding especially increases. However, it is worth noting that “untimely” earlier bleeding or delays of up to 5-7 days are possible even with its correct use.

It is important to understand that emergency contraception is an alternative to abortion. Therefore, if you choose between abortion and menstrual irregularities due to taking the drug, you should choose cycle irregularities. The use of EC, unlike abortion, is not associated with a high risk of consequences leading to infertility and complications in subsequent pregnancies. However, a woman should treat herself with care and use the drug in accordance with the instructions. An exception may be force majeure situations, but you need to ensure that they do not occur too often. It is considered safe to use EC once every 2 or more months.

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At what age is it legal to use emergency contraception?

According to the instructions, emergency contraception can be used from the age of 16. But in exceptional cases (for example, rape), it can be prescribed at an earlier age - always under the supervision of a doctor.

We know that many women avoid emergency contraception because they believe that this is a terrible blow to the hormonal system, which will take a very long time to recover after this. Is this really true?

Let's talk about how emergency contraception works. One possible option is oral tablets, which a woman can use on her own, without the supervision of a doctor. Now there are 2 groups of drugs for emergency contraception - the synthetic progestogen levonorgestrel (Postinor, Escapelle) and the synthetic antiprogestagen mifepristone (Zhenale, Ginepristone). Their mechanism of action is different, but ultimately they all cause changes in the inner layer of the uterus (endometrium) and prevent the attachment (implantation) of a fertilized egg to it. They can also suppress ovulation if taken before it occurs. Levonorgestrel has been used for about 40 years and is recommended for use by the World Health Organization. In cases where pregnancy does occur, the use of levonorgestrel will not prevent its preservation.

Emergency contraception causes changes in the inner layer of the uterus (endometrium) and prevents the attachment (implantation) of a fertilized egg to it. They can also suppress ovulation if taken before it occurs.

Another possible option for emergency contraception is the introduction of an intrauterine copper-containing contraceptive (“intrauterine device”). This procedure can only be performed by a gynecologist.

Thus, the mechanism of action of all these methods is not associated with an abortifacient effect. An abortion is the removal of an egg that has already been implanted (attached to the inner layer of the uterus - the endometrium) by surgery or medication. That is, a pregnancy that has already arisen and has begun to develop is terminated. And the methods of emergency contraception used prevent the very occurrence of pregnancy, which is actually reflected in the very name “contraceptives”. This is a more natural process, since under normal conditions there are always situations when ovulation does not occur in the female body, or the endometrium is not ready to receive an egg. The same is true on the ethical side of the issue - pregnancy is not removed, it simply does not happen.

What are the indications for emergency contraception?

This is any sexual intercourse when contraception was not used and pregnancy is not desired.

As a rule, these are spontaneous sexual contacts (“passion”, irresponsibility, lack of contraception, first sexual intercourse, intoxication), cases of rape or forced sexual contact.
Cases where there has been a failure when using a contraceptive method (condom rupture, slippage or improper use, failed interrupted sexual intercourse (for example, ejaculation in the vagina or on the external genitalia).
In case of violation of the rules for the use of planned contraception: missing two or more tablets of a combined oral contraceptive (COC) or one tablet of a progestin oral contraceptive, sexual intercourse on “dangerous” days when using the calendar method. Let me make a reservation right away that the calendar method is not one of the highly effective methods of contraception, even when used correctly.
When you doubt that your usual contraception is effective.

If, for example, the condom breaks but there is no ejaculation, should I take the pill?

No no need.

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Yes

As a rule, the instructions indicate the period during which you need to take the pill. Usually this is 72 hours. If for some reason a woman did not have time and took it later, there will be no effect? Is there any point in taking a pill if you realize that more time has passed?

The use of EC within 72 hours after sexual intercourse guarantees the high effectiveness of the drug. As this time period increases, efficiency will progressively decrease. This should be taken into account by a woman before taking the drug at a later date.

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What other precautions are needed after unprotected intercourse besides emergency contraception?

If you have contact with a casual partner, you must consult a doctor (gynecologist or venereologist) as quickly as possible. The doctor will help assess the current situation, the risks of infection, and if the risk is high, he may consider it advisable to prescribe a preventive course of therapy to avoid the development of infection. You need to understand that in the first days after unprotected sexual intercourse, infectious agents, even in the event of infection, most likely will not be identified. Screening for the presence of gonorrhea and sexually transmitted infections such as chlamydia, mycoplasma, ureaplasma, and trichomonas is recommended.

Testing for syphilis is recommended after a month, and for infections such as hepatitis B and C, HIV - 3 and 6 months after contact.

Side effects after using postcoital contraceptives

It should be borne in mind that taking a loading dose of hormonal drugs in almost all cases leads to various side effects and disorders. In most patients, taking emergency contraceptives causes nausea or vomiting. To prevent such complications, the tablets should be taken with meals. If vomiting occurs two hours after taking the drug, then the medicine has time to enter the blood and will act accordingly. If the stomach contents erupt earlier than after 2 hours, then the patient should take the pills again. Headaches, dizziness, allergic reactions and diarrhea may also occur. The next menstruation after taking emergency contraception may be more abundant and occur earlier than expected. If you experience severe bleeding, sharp, nagging pain and discomfort in the lower abdomen, you should consult a doctor to find out the causes of pathological abnormalities.

Every woman should consider the following point: emergency contraception is a one-time (one-time) method of contraception. This method of birth control cannot be used regularly. Repeated use of postcoital contraceptives reduces the effectiveness of preventing unwanted conception. The maximum frequency of using this method is no more than 2-3 times a year.

Our clinic employs professional and qualified doctors who will conduct a comprehensive diagnosis of the body and, based on the results of the study, select the most optimal option for post-coital contraception. Also, if necessary, experienced doctors will carry out high-quality and prompt installation of the intrauterine device.

Video: Emergency contraception

Attention!

This article is posted for informational purposes only and under no circumstances constitutes scientific material or medical advice and should not serve as a substitute for an in-person consultation with a professional physician.
For diagnostics, diagnosis and treatment, contact qualified doctors! Number of reads: 1611 Date of publication: 09.20.2017
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