Emergency contraception (EC) can avoid as much as over 95percent of pregnancies whenever taken within 5 times after sexual intercourse
- EC may be used when you look at the following circumstances: unprotected sexual intercourse, issues about feasible contraceptive failure, wrong utilization of contraceptives, and sexual attack if without contraception protection.
- Types of emergency contraception will be the copper-bearing intrauterine devices (IUDs) additionally the crisis contraceptive pills (ECPs).
- A copper-bearing IUD may be the many effective type of crisis contraception available.
- The emergency contraceptive supplement regimens suggested by that are ulipristal acetate, levonorgestrel, or combined dental contraceptives (COCs) comprising ethinyl estradiol plus levonorgestrel.
What exactly is crisis contraception?
Emergency contraception relates to types of contraception which can be used to stop maternity after sexual intercourse. They are suitable for used in 5 times but are more beneficial the earlier they’ve been utilized following the work of sex.
Mode of action
Emergency contraceptive pills prevent maternity by preventing or delaying ovulation and they just do not cause an abortion. The copper-bearing IUD stops fertilization by causing a chemical improvement in egg and sperm before they meet. Crisis contraception cannot interrupt an existing pregnancy or damage an embryo that is developing.
Who are able to utilize crisis contraception?
Any girl or woman of reproductive age might need crisis contraception in order to avoid a undesirable maternity. There aren’t any absolute contraindications that are medical the application of emergency contraception. You will find no age limits for the usage of crisis contraception. Eligibility requirements for basic utilization of a copper IUD also make an application for usage of a copper IUD for crisis purposes.
In what situations can emergency contraception be utilized?
Crisis contraception can be utilized in several circumstances after intercourse that is sexual. These generally include:
- When no contraceptive has been utilized.
- Intimate attack once the woman had not been protected by a highly effective method that is contraceptive.
- If you find concern of feasible failure that is contraceptive from incorrect or incorrect usage, such as for instance:
- Condom breakage, slippage, or wrong use;
- 3 or even more consecutively missed combined dental contraceptive pills;
- A lot more than 3 hours later through the typical time of consumption associated with the progestogen-only capsule (minipill), or even more than 27 hours following the past capsule;
- A lot more than 12 hours later from the typical period of intake for the desogestrel-containing product (0.75 mg) or maybe more than 36 hours following the pill that is previous
- Significantly more than 14 days later when it comes to norethisterone enanthate (NET-EN) progestogen-only injection;
- A lot more than 4 weeks late for the depot-medroxyprogesterone acetate (DMPA) progestogen-only injection;
- Significantly more than seven days later for the combined injectable contraceptive (CIC);
- Dislodgment, breakage, tearing, or very early removal of a diaphragm or cap that is cervical
- Unsuccessful withdrawal ( e.g. Ejaculation into the vagina or on outside genitalia);
- Failure of the spermicide tablet or movie to melt before sexual intercourse;
- Miscalculation regarding the abstinence period, or failure to abstain or work with a barrier technique from the fertile days of the period whenever making use of fertility understanding based techniques; or
- Expulsion of a intrauterine contraceptive device (IUD) or hormonal contraceptive implant.
An advance method of getting ECPs can be directed at a lady to make certain that she’s going to keep these things available whenever required and may simply take as quickly as possible after unprotected sexual intercourse.
Shifting to contraception that is regular
After usage of ECPs, ladies or girls may resume or start a regular way of contraception. In case a copper IUD can be used for crisis contraception, no extra contraceptive protection will become necessary.
After management of ECPs with levonorgestrel (LNG) or combined dental contraceptive pills (COCs), ladies or girls may resume their contraceptive technique, or begin any method that is contraceptive, including a copper-bearing IUD.
After usage of ECPs with ulipristal acetate (UPA), ladies or girls may resume or begin any progestogen containing method (either combined hormone contraception or progestogen only contraceptives) in the 6th time after using UPA. They are able to have an LNG-IUD placed immediately if it may be determined they’re not expecting. They could have the copper IUD inserted straight away.
Ways of emergency contraception
The 4 ways of emergency contraception are:
- ECPs containing UPA
- ECPs containing LNG
- Combined dental contraceptive pills
- Copper-bearing intrauterine products.
Crisis contraception pills (ECPs) and combined dental contraceptive pills (COCs)
Whom suggests some of the drugs that are following crisis contraception:
- ECPs with UPA, taken being a solitary dosage of 30 mg;
- ECPs with LNG taken as a dose that is single of mg, or alternatively, LNG drawn in 2 doses of 0.75 mg each, 12 hours aside.
- COCs, taken as being a split dosage, one dosage of 100 ?g of ethinyl estradiol plus 0.50 mg of LNG, accompanied by a dose that is second of ?g of ethinyl estradiol plus 0.50 mg of LNG 12 hours later on. (Yuzpe technique)
A meta-analysis of two studies indicated that women that utilized ECPs with UPA had a maternity price of 1.2per cent. Research indicates that ECPs with LNG possessed a maternity rate of 1.2per cent to 2.1per cent (1) (2).
Preferably, ECPs with UPA, ECPs with LNG or COCs should be used as soon as possible after unprotected sexual intercourse, within 120 hours. ECPs with UPA are far more effective between 72–120 hours after unprotected sex than many other ECPs.
Side-effects through the usage of ECPs act like those of dental contraceptive pills, such as for instance sickness and nausea, slight irregular genital bleeding, and tiredness. Negative effects aren’t typical, they have been mild, and certainly will generally resolve without further medicines.
The dose should be repeated if vomiting occurs within 2 hours of taking a dose. ECPs with japanese brides LNG or with UPA are better COCs simply because they cause less vomiting and nausea. Routine utilization of anti-emetics before using ECPs just isn’t suggested.
Medications employed for crisis contraception try not to damage fertility that is future. There isn’t any wait into the go back to fertility after using ECPs.
Health eligibility criteria
There aren’t any limitations for the eligibility that is medical of may use ECPs.
Some ladies, but, utilize ECPs over and over over repeatedly for almost any associated with reasons stated above, or as their primary way of contraception. Such situations, further counselling should be offered on which other and much more regular contraceptive choices might be appropriate and much more effective.
Regular and repeated ECP use might be harmful for females with conditions categorized as medical eligibility criteria (MEC) category 2, 3, or 4 for combined contraception that is hormonal Progestin-only contraceptives (POC). Regular utilization of crisis contraception can lead to increased side-effects, such as for example menstrual problems, although their duplicated use poses no understood health problems.
Emergency contraceptive pills had been discovered become less effective in overweight ladies (whoever human anatomy mass index is a lot more than 30 kg/m2), but there aren’t any security issues. Overweight females really should not be rejected usage of crisis contraception whenever they require it.
Counselling for usage of crisis contraceptive pills will include choices for making use of contraception that is regular advice on just how to utilize techniques precisely in case there is recognized method failure.
Copper-bearing devices that are intrauterine
WHO advises that the copper-bearing IUD, when used as a crisis contraceptive technique, be inserted within 5 times of unprotected sexual intercourse. This process is specially suitable for ladies who want to begin using a powerful, long-acting, and reversible contraceptive technique.
Whenever placed within 120 hours of unprotected sexual intercourse, a copper-bearing IUD is significantly more than 99% effective in preventing maternity. Here is the many effective as a type of crisis contraception available. When placed, ladies can continue using the IUD as a continuing approach to contraception, or may want to switch to another method that is contraceptive.
A copper-bearing IUD is just a form that is safe of contraception. It’s estimated that there could be not as much as 2 situations of Pelvic Inflammatory Disease (PID) per 1000 users (3). (FP Global Handbook). The potential risks of expulsion or perforation are low.
Health eligibility requirements
Eligibility requirements for basic utilization of a copper IUD also submit an application for usage of a copper IUD for crisis purposes. Ladies with a disorder categorized as MEC category three or four (as an example, with present PID, puerperal sepsis, unexplained genital bleeding, cervical cancer tumors, or serious thrombocytopenia) for the copper IUD must not make use of copper IUD for emergency purposes. In addition, a copper-bearing IUD really should not be placed for crisis contraception after sexual attack as the girl could be at high danger of an intimately transmitted illness such as for instance chlamydia and gonorrhoea. A copper-bearing IUD really should not be utilized as crisis contraception when a lady is expecting.
The whom healthcare eligibility requirements for contraceptive usage states that IUD insertion may increase the risk further of PID among females at increased risk of intimately transmitted infections (STIs), although restricted proof shows that this danger if low. Present algorithms for determining increased danger of STIs have actually bad predictive value.