Emergency Contraception

What is EC?

EC Emergency Contraception=

Sexual intercourse

Prevent pregnancy

Prevent pregnancy

Emergencycontraception

Regularcontraception

How do you prevent pregnancy after sexual intercourse?

Orally taking pills Intrauterine device

Emergency contraception

Progestin only

Estrogen+Progestin

What are differences between two types of orally taking EC?

Progestin only Estrogen+Progestin

Levonorgestrel 1.5mg EE 0.2mg + Levonorgestrel 1.0mg

Prevent pregnancy - 85% Prevent pregnancy - 75%

Side effectsNausea – 20%Vomiting – 5%

Side effectsNausea – 50%Vomiting - 20%

Yuzpe regimen

Comparing Progestin only Vs Yuzpe Regimen

Progestin only Yuzpe85% effectiveness 75% effectiveness

2 tablets single dose 8 tablets in two divided doses

Nausea: 20%Vomiting: 5%

Nausea: 50%Vomiting: 20%

Which one do you prefer?

What is OK EC?What are its contents?

Mechanism of action

Levonorgestrel

1. Inhibit ovulation

2. Cervical mucous thickening

4. Inhibit implantation

3. Delay ovum/sperm transport

NOT abortifacient

Mechanism of action

Inhibit ovulation is effective if before ovulation

Delay ovum/sperm transport if after ovulation

Cervical mucous thickening if after ovulation

Enodmetrium is unfavorable for implantation if after ovulation?

More effective, if taking earlier

NOT effective if taking after 5 days

Effectiveness of OK EC• Within 24 hours (1 day) 95 %

• Within 48 hours (2 days) 85 %

• Within 72 hours (3 days) 58 %

95%

85%

58%

0%

20%

40%

60%

80%

100%

24 Hours 48 Hours 72 Hours

Effectiveness

When should a client take OK EC to effectively prevent pregnancy?

When should you prescribe OK EC to a client?

Unprotected sex

Regularcontraception

Sex within 5 days before contraception

Failure to take it regularlyand Sex within 5 days

Within 5 daysEffectiveness???

Who can use OK EC?Use Not use

Women with history of stroke

Women with heart disease

Women with liver disease

Women with breast feeding

Any women within reproductive age

Women with pregnancy

There is no known medical conditions in which OK EC should not be used.

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What are the common side effects of OK EC?

Nausea23%

Fatigue17%

Dizziness11%

Vomiting5%

Breast tenderness5%

These symptoms generally resolve within 24 hours

How to manage an OK EC client with vomiting?

Nausea23%

Fatigue17%

Dizziness11%

Vomiting5%

Breast tenderness5%

Before taking OK EC

Taking anti-emetic one hour ahead

After taking OK EC

Repeating the dose if vomiting occurs within 2 hours

When does next menstruation occur?

Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat

1 2 3 4 5 6 7 8 9 10 11 12

13 14 15 16 17 18 19 20 21 22 23 24 25 26

27 28 29 30

Expected time60%

30% 10%

If delay >7 days, important to rule out pregnancy

SummaryOK EC is NOT

AAbortifacient

Regular birth spacing methodR

Safe for sex until start of next menstruationS

OK EC is more

Effective than Yuzpe

Effective if taking as as possible after unprotected sex

CCausing amenorrhea

method

early

Toxic in any medical conditions and breast feeding motherT