EMERGENCY CONTRACEPTION (EC)

DR. J . B. BABBAR

INCHARGE, MEDICAL UNIT

FPAI

Emergency Contraception (EC)(Post coital contraceptive / Morning after pill)

What is EC?

“Administration of a contraceptive after unprotected coitus & before implantation of

pregnancy”

History of Emergency Contraceptive (EC)

Ancient Methods1. Vaginal douches2. Inducing menses by taking oral drugs

Drugs1. Diethyl stillbesterol (DES)2. Yuzpe’s regimen3. Levonorgestrel (LNG)4. Intra-uterine contraceptive device5. Mifepristone (RU-486)

Emergency Contraception (EC)

“Seventy five percent of pregnancies are unwanted”

“Women decide to continue since they just conceived and had no choice”

“If they know about a method which could protect them after unprotected coitus, they would have used

it”

Why there is a need for EC

1. More often than not they get exposed when

they were not expecting it to happen.

2. Woman thinks she cannot conceive.

3. Unfortunate events - sexual assault / rape.

4. Failure of contraceptive : condom breakage

Mechanism of Action of EC

1. Prevent implantation of blastocyst

2. Tubal hurry

3. Changes in endometrium

4. Changes in cervical mucous

Emergency Contraception - Window Period

“Emergency contraceptives (EC) are effective if taken within 120 hours”

Yuzpe’s Regimen

Tab Ovral -G : 2 stat, 2 after 12 hours(Ethinyl estradiol : 50 µgm

+Levonorgestrel : 500 µgm)

Tab Ovral-L/Mala-D/Mala-N

4 stat, 4 after 12 hours

(To be taken within 72 hrs after coitus)

Success rate : 85%

Why Yuzpe’s Regimen is not Popular

1. High incidence of nausea and vomiting

2. Breast tenderness

3. Relatively unsafe in women with CVA/CAD/Ca Breast/Jaundice

Newer - Levonorgestrel (LNG)

Levonorgestrel 750 µgm 1 stat, 1 after 12 hrsORLevonorgestrel 1500 µgm stat

Advantages-

1. Lesser nausea and vomiting2. Relatively safe3. Can be given upto 12 hrs4. Success rate : 95-98%

Preparation of Levonorgestrel (LNG)

1. Pill 72® : Cipla

2. Ecee tablet® : German Remedies

3. Norlevo® : Shreya’s

Cost : Rs. 35-75/2 tabs

OTHER METHODS OF EC

1. Intrauterine Contraceptive Device

Advantage : Can continue to use

Disadvantage : Risk of PID

2. Mifepristone (RU-486)

‘Still under trial’

“Not acceptable to some due to its use for inducing abortion”

EC : Client Counseling and Useful Information

Useful information to be provided to a client :1. Emergency contraceptive is effective if taken within 120

hours after unprotected intercourse

2. Sooner the ECPs are taken after unprotected intercourse more effective they are

3. Repeated unprotected intercourse in the same cycle can not be protected by single use of ECPs

4. ECPs can prevent only 85% of pregnancies after unprotected intercourse.

5. Next period may be delayed upto 7 days after using ECPs. In case she fails to get period within 7 days after expected period she should contact her doctor.

6. Use of ECPs do not protect against STDs. She should be advised tests for STD and treatment accordingly

7. She should be advised against further act of intercourse in current cycle after using EC.

EC : Client Counseling and Useful Information

Client Screening & Assessment for EC use

History1. Date of last menstrual period (LMP)

2. Average length of menstrual cycle

3. Timing of last act of intercourse and previous acts in

the current cycle

4. Time in hours since last act of unprotected intercourse

5. Current or recent use of contraception

6. History of medical disorders, sexually transmitted

disease or major illness

Client Screening and Assessment for EC use

Physical Examination :

Not necessary except when pregnancy is suspected.

Laboratory tests :

1. Urine pregnancy test if pregnancy is suspected.

2. Tests for sexually transmitted diseases.

Side Effects of EC

1. Nausea

2. Vomiting

3. Delay in menses : upto 7 days

4. Failure : 2-5%

When should she return after using EC

1. If periods are delayed > 7 days

2. Wants to use regular contraceptive

3. Any unexplained symptom/sign

Regular Contraceptive Use After EC Use

“More than 75% women prefer to switch to a regular method after using EC once”

Contraindications for EC use

Pregnancy seems to be the only contraindication for the use of Emergency Contraceptive Pill (ECPs).

Levonorgestrel only regimen is devoid of any risks and can be safely used in situations where use of Combination Pills is a concern due to presence of Estrogen dependent conditions.

Use of Copper intrauterine devices, although as effective as ECPs may be avoided in following situations due to risk of PID.

Misconceptions with Use of EC

1. Will promote promscuity

2. Will decrease use of regular contraception

3. Is a kind of abortion

4. Is a method of family planning

Record KeepingExample of Record Keeping for EC use1. Name (optional)

2. Age

3. Marital Status

4. Date of LMP

5. Length of duration of menstrual cycle

6. No. of unprotected acts in current cycle

7. Time since last act of unprotected coitus (in hour)

8. Past use of ECPs

9. Past use of Regular Contraceptive

10. Method prescribed