Emergency contraception (EC) can prevent as much as over 95% of pregnancies whenever taken within 5 times after sex

  • EC may be used within the following circumstances: unprotected sex, issues about feasible contraceptive failure, wrong utilization of contraceptives, and intimate attack if without contraception coverage.
  • Ways of crisis contraception would be the copper-bearing intrauterine devices (IUDs) and also the crisis contraceptive pills (ECPs).
  • A copper-bearing IUD could be the many form that is effective of contraception available.
  • The crisis contraceptive supplement regimens suggested by that are ulipristal acetate, levonorgestrel, or combined dental contraceptives (COCs) composed of ethinyl estradiol plus levonorgestrel.

What exactly is crisis contraception?

Crisis contraception means types of contraception you can use to stop maternity after sexual activity. They are suitable for used in 5 times but are far better the earlier these are typically used following the work of sex.

Mode of action

Emergency contraceptive pills prevent maternity by preventing or delaying ovulation and 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 a proven pregnancy or damage a developing embryo.

Who is able to make use of crisis contraception?

Any girl or woman of reproductive age may require crisis contraception in order to prevent a pregnancy that is unwanted. There are not any absolute contraindications that are medical the usage of crisis contraception. You can find no age limits for the employment 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.

With what situations can emergency contraception be properly used?

Crisis contraception may be used in several circumstances after intercourse that is sexual. These generally include:

  • Whenever no contraceptive has been utilized.
  • Intimate attack as soon as the girl had not been protected by a fruitful method that is contraceptive.
  • If you find concern of feasible contraceptive failure, from poor or wrong usage, such as for instance:
    • condom breakage, slippage, or wrong usage;
    • 3 or higher consecutively missed combined dental contraceptive pills;
    • a lot more than 3 hours later through the typical period of consumption associated with the progestogen-only tablet (minipill), or even more than 27 hours following the pill that is previous
    • a lot more than 12 hours later through the typical period of consumption associated with desogestrel-containing product (0.75 mg) or maybe more than 36 hours following the pill that is previous
    • a lot more than 14 days late for the norethisterone enanthate (NET-EN) progestogen-only injection;
    • significantly 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 ( ag e.g. ejaculation when you look at the vagina or on outside genitalia);
    • failure of a spermicide film or tablet to melt before sex;
    • miscalculation for the abstinence duration, or failure to abstain or make use of barrier technique regarding the fertile times of the period whenever fertility that is using based techniques; or
    • expulsion of a intrauterine contraceptive device (IUD) or hormonal implant that is contraceptive.

An advance way to obtain ECPs might be fond of a female to make certain them available when needed and can take as soon as possible after unprotected intercourse that she will have.

Moving to regular contraception

After utilization of ECPs, ladies 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 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 usage 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 are able to have an LNG-IUD placed immediately they are not pregnant if it can be determined. The copper can be had by them IUD inserted instantly.

Ways of crisis contraception

The 4 ways of crisis contraception are:

  • ECPs containing UPA
  • ECPs containing LNG
  • combined dental pills that are contraceptive
  • copper-bearing intrauterine devices.

Crisis contraception pills (ECPs) and combined dental pills that are contraceptiveCOCs)

WHO suggests some of the after medications for crisis contraception:

  • ECPs with UPA, taken being a dose that is single of 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 µg of ethinyl estradiol plus 0.50 mg of LNG, accompanied by a 2nd dosage of 100 µg of ethinyl estradiol plus 0.50 mg of LNG 12 hours later on. (Yuzpe technique)

Effectiveness

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

Ideally, ECPs with UPA, ECPs with LNG or COCs should be studied as early as feasible after unprotected sexual intercourse, within 120 hours. ECPs with UPA tend to be more effective between 72–120 hours after unprotected sex than many other ECPs.

Unwanted effects through the usage of ECPs act like those of dental contraceptive pills, such as for instance sickness and sickness, small irregular genital bleeding, my latest blog post and exhaustion. Unwanted effects aren’t common, these are typically moderate, and certainly will generally resolve without further medicines.

If sickness does occur within 2 hours of having a dosage, the dosage should always be duplicated. ECPs with LNG or with UPA are preferable to COCs simply because they cause less sickness and sickness. Routine utilization of anti-emetics before using ECPs just isn’t suggested.

Medications useful for crisis contraception usually do not damage future fertility. There’s no wait into the come back to fertility after taking ECPs.

Health eligibility requirements

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

Some ladies, but, utilize ECPs over repeatedly for just about any associated with reasons stated above, or because their method that is main of. In such situations, further counselling should be offered about what other and much more regular contraceptive options could be more appropriate and much more effective.

Regular and repeated ECP use could 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 usage of emergency contraception can lead to increased side-effects, such as for instance menstrual problems, although their repeated use poses no understood health problems.

Emergency contraceptive pills had been discovered become less effective in overweight ladies (whoever human anatomy mass index is much significantly more than 30 kg/m2), but there are not any safety issues. Overweight ladies really should not be rejected usage of crisis contraception whenever they want it.

Counselling for usage of crisis contraceptive pills will include alternatives for utilizing regular contraception and suggestions about just how to utilize techniques properly in case there is identified technique failure.

Copper-bearing intrauterine products

whom suggests that a copper-bearing IUD, when used as an urgent situation contraceptive technique, be placed within 5 times of unprotected sex. This technique is particularly befitting ladies who want to begin using an efficient, long-acting, and reversible method that is contraceptive.

Effectiveness

When inserted within 120 hours of unprotected sex, a copper-bearing IUD is significantly more than 99% effective in preventing maternity. This is basically the many effective type of crisis contraception available. When placed, ladies can continue steadily to use the IUD as a continuing way of contraception, or might want to alter to some other method that is contraceptive.

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

Healthcare eligibility requirements

Eligibility requirements for basic usage of a copper IUD also make an application for usage of a copper IUD for crisis purposes. Females with an ailment categorized as MEC category three or four (as an example, with present PID, puerperal sepsis, unexplained genital bleeding, cervical cancer, or serious thrombocytopenia) when it comes to copper IUD must not work with a copper IUD for crisis purposes. In addition, a copper-bearing IUD really should not be placed for crisis contraception after sexual assault as the girl can be at high danger of an intimately transmitted illness such as for instance chlamydia and gonorrhoea. A copper-bearing IUD shouldn’t be utilized as crisis contraception whenever a lady has already been pregnant.

The WHO health eligibility requirements for contraceptive usage states that IUD insertion may further raise the danger of PID among ladies at increased risk of intimately sent infections (STIs), although restricted proof shows that this danger if low. Present algorithms for determining increased danger of STIs have actually bad predictive value. Risk of STIs differs by specific behavior and STI that is local prevalence.