Emergency Contraception

In the first five days following sexual activity, emergency contraception—also known as post-coital contraception—refers to methods of contraception that can be used to prevent pregnancy. It is designed to be used after unprotected sex, the misuse or failure of contraceptives (such as forgetting to take pills or breaking or slipping condoms), rape, or forced unprotected sex.

Indication

• Without the use of a contraceptive.
• When a woman was not protected by an effective method of contraception during a rape or forced sex.
• When a contraceptive fails or is used improperly, such as:
  • Breakage, slippage, or improper use of condoms
  • Oral combination contraceptive tablets that have been missed three times or more in a row
  • Taking a progestogen-only capsule (minipill) more than three hours late
  • Tablet that contains desogestrel (0.75mg) taken over a 12-hour lag
  • Enanthate of norethisterone (NET- EN) injection of only progestogen
  • Depot-medroxyprogesterone acetate, taken more than two weeks after the fact
  • Injection of only progestogen given more than four weeks late.
  • The monthly injection of combined estrogen and progestogen administered more than seven days late
  • Dislodgment, postponed application, or early removal of a hormonal skin patch or ring for contraception
  • Diaphragm or cervical cap dislodgment, breakage, tearing, or early removal
  • Failure to withdraw
  • Not melting a spermicide tablet or film before sexual contact

Complications that may arise after extreme use of emergency contraception

• Sterility
• Infertility
• Sub-fertility
• Menorrhagia

Emergency contraception techniques Three methods of emergency contraception are available:

• Emergency contraception pills (ECPs)
• Combined oral contraceptive pills or the Yuzpe method
• Copper-bearing intrauterine devices (IUDs).

Emergency contraception pills (ECPs)

In order to prevent pregnancy, the WHO advises using one of the following medications within five days (or 120 hours) of an unauthorized sexual encounter:

• 30 mg of ulipristal acetate in a single dose.
• Single-dose levonorgestrel administration (1.5 mg) Alternatively, two doses of levonorgestrel (0.75 mg each, 12 hours apart).

Mode of action

• Emergency contraceptive pills containing levonorgestrel do not work once implantation has started and do not cause abortion.
• Levonorgestrel emergency contraceptives work by stopping or delaying ovulation in order to prevent pregnancy. By affecting cervical mucus or sperm's ability to adhere to the egg, they may also work to stop fertilization of an egg.

Activeness

• The earlier after sexual activity that the regimen is taken, the more effective it is.
• Evidence for ulipristal shows that it prevents pregnancy in at least 98% of cases, particularly when taken within 72 hours following sexual activity.
• The WHO-recommended levonorgestrel regimen is 52-94% effective at preventing pregnancy, according to reports from nine studies involving 10 500 women.

Safety

Emergency contraceptive pills that contain only levonorgestrel are extremely safe and do not harm unborn children or future fertility. Side effects are rare and typically mild, and are comparable to those that women taking oral contraceptives experience.

Contraindication

• Pregnancy is prevented using over-the-counter contraceptives. Women who have a confirmed pregnancy should not receive them. The research that is now available, however, indicates that if a woman accidentally consumes the pills after becoming pregnant, neither the mother nor her fetus will be harmed. These two medications are not used to end pregnancies.
• Due to the higher risk of failure compared to oral contraceptive pills, emergency contraceptive pills are only advised for sporadic use following unprotected intercourse. They are not advised for ongoing use. Even though emergency contraception poses no known health risks, frequent use can increase side effects, such as irregular menstruation.

Follow up

To be sure the lady hasn't given birth after using emergency contraception, follow-up is crucial. Within three to four weeks, menstruation is to be expected. Clinical advice should be sought if there is no menstruation, and an ultrasound should be performed to confirm pregnancy.

[The use of emergency contraceptives is not a form of contraception.]