Emergency contraception (EC) can avoid as much as over 95percent of pregnancies whenever taken within 5 times after sexual intercourse

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 intercourse, concerns about feasible contraceptive failure, wrong usage of contraceptives, and intimate attack if without contraception protection.
  • Types of crisis contraception would be the copper-bearing intrauterine devices (IUDs) additionally the crisis contraceptive pills (ECPs).
  • A copper-bearing IUD could be the most form that is effective of contraception available.
  • The crisis contraceptive supplement regimens suggested by that are ulipristal acetate, levonorgestrel, or combined contraceptives that are oralCOCs) comprising ethinyl estradiol plus levonorgestrel.

What is crisis contraception?

Crisis contraception relates to ways of contraception which can be used to stop maternity after sexual activity. They are suitable for used in 5 days but are far better the earlier they have been utilized following the work of sex.

Mode of action

Emergency contraceptive pills prevent pregnancy by preventing or ovulation that is delaying they don’t cause an abortion. The copper-bearing IUD stops fertilization by causing a chemical improvement in semen and egg before they meet. Crisis contraception cannot interrupt an existing pregnancy or damage a developing embryo.

Who are able to make use of crisis contraception?

Any woman or woman of reproductive age may require crisis contraception in order to avoid a undesirable maternity. There are not any absolute contraindications that are medical the employment of crisis contraception. You can find no age limits for the utilization of crisis contraception. Eligibility requirements for basic usage of a copper IUD also submit an application for utilization of a copper IUD for emergency purposes.

With what situations can emergency contraception be properly used?

Emergency contraception may be used in several circumstances following sexual activity. These generally include:

  • Whenever no contraceptive has been utilized.
  • Intimate assault as soon as the girl had not been protected by a successful method that is contraceptive.
  • If you have concern of feasible contraceptive failure, from poor or wrong usage, such as for example:
    • Condom breakage, slippage, or incorrect usage;
    • 3 or higher consecutively missed combined dental pills that are contraceptive
    • Significantly more than 3 hours later through the typical time of consumption associated with progestogen-only tablet (minipill), or even more than 27 hours after the pill that is previous
    • Significantly more than 12 hours later through the typical time of consumption associated with the desogestrel-containing tablet (0.75 mg) or maybe more than 36 hours following the pill that is previous
    • More than 2 weeks later when it comes to norethisterone enanthate (NET-EN) progestogen-only injection;
    • A lot more than 4 weeks belated for the depot-medroxyprogesterone acetate (DMPA) progestogen-only injection;
    • Significantly more than seven days later for the combined contraceptive that is injectableCIC);
    • Dislodgment, breakage, tearing, or very very early elimination of a diaphragm or cervical limit;
    • Unsuccessful withdrawal ( e.g. Ejaculation into the vagina or on outside genitalia);
    • Failure of a spermicide film or tablet to melt before sexual intercourse;
    • Miscalculation regarding the abstinence duration, or failure to abstain or make use of a barrier technique regarding the fertile times of the period whenever utilizing fertility understanding based techniques; or
    • Expulsion of an intrauterine contraceptive device (IUD) or hormonal implant that is contraceptive.

An advance availability of ECPs can be fond of a lady to make sure that she’s going to keep these things available whenever needed and may just take as quickly as possible after unprotected sex.

Shifting to contraception that is regular

Following usage of ECPs, females or girls may resume or start a method that is regular of. No additional contraceptive protection is needed if a copper IUD is used for emergency contraception.

After management of ECPs with utile link levonorgestrel (LNG) or combined dental contraceptive pills (COCs), females or girls may resume their contraceptive technique, or begin any method that is contraceptive, including a copper-bearing IUD.

After utilization of ECPs with ulipristal acetate (UPA), females or girls may resume or begin any progestogen method that is containing combined hormone contraception or progestogen only contraceptives) in the 6th time after using UPA. They could have an LNG-IUD placed immediately they are not pregnant if it can be determined. The copper can be had by them IUD inserted straight away.

Ways of crisis contraception

The 4 types 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)

WHO advises some of the after medications for crisis contraception:

  • ECPs with UPA, taken being a solitary dosage of 30 mg;
  • ECPs with LNG taken being a solitary dosage of 1.5 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 2nd dosage of 100 ?g of ethinyl estradiol plus 0.50 mg of LNG 12 hours later on. (Yuzpe method)

Effectiveness

A meta-analysis of two studies revealed that ladies who used ECPs with UPA had a pregnancy price of 1.2per cent. Research reports have shown that ECPs with LNG had a maternity price of 1.2per cent to 2.1per cent (1) (2).

Preferably, ECPs with UPA, ECPs with LNG or COCs should be studied as soon as feasible after unprotected sexual intercourse, within 120 hours. ECPs with UPA are far more effective between 72–120 hours after unprotected sexual intercourse than many other ECPs.

Unwanted effects from the usage of ECPs act like those of dental contraceptive pills, such as for example nausea and nausea, slight irregular bleeding that is vaginal and exhaustion. Unwanted effects aren’t typical, they’ve been moderate, 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 LNG or with UPA are better than COCs simply because they cause less vomiting and nausea. Routine utilization of anti-emetics prior to taking ECPs just isn’t suggested.

Drugs useful for emergency contraception usually do not damage future fertility. There isn’t any delay when you look at the go back to fertility after using ECPs.

Health eligibility requirements

There are not any limitations when it comes to medical eligibility of who may use ECPs.

Some ladies, but, utilize ECPs over over repeatedly for just about any for the reasons stated above, or as their primary approach to contraception. Such situations, further counselling has to be provided on which other and much more regular contraceptive choices could be right 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 hormone contraception or Progestin-only contraceptives (POC). Regular utilization of crisis contraception can lead to increased side-effects, such as for instance menstrual problems, although their duplicated use poses no understood health problems.

Emergency contraceptive pills had been discovered to be less effective in obese ladies (whoever human anatomy mass index is much significantly more than 30 kg/m2), but there aren’t any security issues. Overweight ladies really should not be rejected usage of crisis contraception whenever it is needed by them.

Counselling for usage of crisis contraceptive pills will include alternatives for making use of contraception that is regular suggestions about simple tips to utilize techniques properly in case there is sensed technique failure.

Copper-bearing devices that are intrauterine

Whom advises that the copper-bearing IUD, when used as an urgent situation contraceptive technique, be placed within 5 times of unprotected sex. This process is very right for women that want to begin to use a powerful, long-acting, and reversible method that is contraceptive.

Effectiveness

Whenever placed within 120 hours of unprotected sexual intercourse, a copper-bearing IUD is significantly more than 99% effective in preventing maternity. This is actually the many form that is effective of contraception available. As soon as placed, females can continue steadily to make use of the IUD as a continuing way of contraception, or might want to switch to another method that is contraceptive.

A copper-bearing IUD is really a safe type of crisis contraception. It’s estimated that there might be significantly less than 2 situations of Pelvic Inflammatory Disease (PID) per 1000 users (3). (FP Global Handbook). The potential risks of perforation or expulsion are low.

Health eligibility requirements

Eligibility requirements for general utilization of a copper IUD also submit an application for usage of a copper IUD for crisis purposes. Females with an ailment categorized as MEC category three or four (for instance, with present PID, puerperal sepsis, unexplained vaginal bleeding, cervical cancer, or serious thrombocytopenia) when it comes to copper IUD must not make use of copper IUD for crisis purposes. In addition, a copper-bearing IUD shouldn’t be placed for crisis contraception after assault that is sexual the lady can be at high threat of an intimately transmitted illness such as for instance chlamydia and gonorrhoea. A copper-bearing IUD shouldn’t be utilized as crisis contraception when a female is expecting.

The whom health eligibility criteria for contraceptive usage states that IUD insertion may increase the risk further of PID among females at increased risk of intimately sent infections (STIs), although limited proof suggests that this danger if low. Present algorithms for determining increased danger of STIs have actually bad predictive value.

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