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

  • EC can be utilized when you look at the following circumstances: unprotected sex, issues about feasible contraceptive failure, wrong utilization of contraceptives, and sexual attack if without contraception protection.
  • Types of emergency contraception will be the copper-bearing intrauterine devices (IUDs) additionally the crisis contraceptive pills (ECPs).
  • A copper-bearing IUD could be the many form that is effective of contraception available.
  • The crisis contraceptive tablet regimens suggested by that are ulipristal acetate, levonorgestrel, or combined contraceptives that are oralCOCs) composed of ethinyl estradiol plus levonorgestrel.

What exactly is crisis contraception?

Crisis contraception relates to types of contraception you can use to stop maternity after sexual intercourse. They are suitable for used in 5 days but are more efficient the earlier they have been used following the work of sexual intercourse.

Mode of action

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

Who is able to utilize crisis contraception?

Any girl or woman of reproductive age might need crisis contraception to prevent a pregnancy that is unwanted. There are not any absolute medical contraindications to the usage crisis contraception. You can find no age limits for the employment of crisis contraception. Eligibility criteria for basic usage of a copper IUD also make an application for utilization of a copper IUD for crisis purposes.

In exactly what situations can emergency contraception be utilized?

Crisis contraception may be used in several circumstances after sexual activity. These generally include:

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  • Whenever no contraceptive has been used.
  • Intimate attack if the girl had not been protected by a fruitful contraceptive technique.
  • If you have concern of feasible failure that is contraceptive from incorrect or wrong usage, such as for instance:
    • condom breakage, slippage, or wrong usage;
    • 3 or maybe more consecutively missed combined oral pills that are contraceptive
    • significantly more than 3 hours late through the typical time of consumption associated with progestogen-only capsule (minipill), or higher than 27 hours following the past capsule;
    • a lot more than 12 hours later through the usual time of consumption for the desogestrel-containing capsule (0.75 mg) or even more than 36 hours following the pill that is previous
    • significantly more than 14 days later for the norethisterone enanthate (NET-EN) progestogen-only injection;
    • significantly more than 4 weeks belated for the depot-medroxyprogesterone acetate (DMPA) progestogen-only injection;
    • a lot more than seven days later for the combined injectable contraceptive (CIC);
    • dislodgment, breakage, tearing, or very early elimination of a diaphragm or cap that is cervical
    • unsuccessful withdrawal ( e.g. ejaculation when you look at 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 barrier method regarding the fertile times of the period whenever utilizing fertility understanding based practices; or
    • expulsion of an intrauterine contraceptive device (IUD) or hormonal implant that is contraceptive.

An advance way to obtain ECPs are directed at a woman to make certain that she’ll keep these things available whenever required and may simply take at the earliest opportunity after unprotected sexual intercourse.

Moving to contraception that is regular

After utilization of ECPs, females or girls may resume or start a method that is regular of. In cases where a copper IUD is employed for crisis contraception, no extra contraceptive protection is necessary.

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 utilization of ECPs with ulipristal acetate (UPA), females or girls may resume or start any progestogen containing method (either combined hormone contraception or progestogen only contraceptives) in the 6th time after using UPA. They are able to have an LNG-IUD placed immediately if it could be determined they’re not expecting. They are able to have the copper IUD inserted straight away.

Types of crisis contraception

The 4 ways of emergency contraception are:

  • ECPs containing UPA
  • ECPs containing LNG
  • combined dental contraceptive pills
  • copper-bearing intrauterine products.

Emergency contraception pills (ECPs) and combined dental contraceptive pills (COCs)

whom advises 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 solitary dosage of 1.5 mg, or alternatively, LNG consumed 2 doses of 0.75 mg each, 12 hours aside.
  • COCs, taken as 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 had a maternity 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 used as early as feasible after unprotected sex, within 120 hours. ECPs with UPA tend to be more effective between 72–120 hours after unprotected sexual intercourse 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 bleeding that is vaginal and tiredness. Unwanted effects aren’t typical, these are generally moderate, and certainly will ordinarily resolve without further medicines.

If sickness happens within 2 hours of having a dosage, the dosage should really be duplicated. ECPs with LNG or with UPA are better than COCs simply beresult they cause less nausea and sickness. Routine usage of anti-emetics before you take ECPs is certainly not recommended.

Medications utilized for crisis contraception don’t harm fertility that is future. There is absolutely no wait into the come back to fertility after taking ECPs.

Healthcare eligibility criteria

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

Some ladies, but, utilize ECPs over and over over repeatedly for almost any regarding the reasons stated above, or because their main way of contraception. This kind of situations, further counselling has to be provided on which other and much more regular contraceptive choices could be appropriate and much more effective.

Regular and repeated ECP use might be harmful for ladies with conditions classified as medical eligibility criteria (MEC) category 2, 3,or 4 for combined hormone contraception or Progestin-only contraceptives (POC). Frequent utilization of crisis contraception may result in increased side-effects, such as for example menstrual problems, although their duplicated use poses no understood health problems.

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

Counselling for usage of emergency contraceptive pills ought to include alternatives for using regular contraception and suggestions about simple tips to make use of practices properly in case there is identified technique failure.

Copper-bearing devices that are intrauterine

whom advises that the copper-bearing IUD, when utilized as an urgent situation contraceptive technique, be placed within 5 times of unprotected sex. This method is very suitable for ladies who wish to begin to use a powerful, long-acting, and reversible contraceptive technique.

Effectiveness

Whenever placed within 120 hours of unprotected sex, a copper-bearing IUD is significantly more than 99% effective in preventing maternity. Here is the many effective kind of crisis contraception available. When placed, females can continue steadily to utilize the IUD as a continuous approach to contraception, or may want to alter to some other contraceptive technique.

A copper-bearing IUD is just a safe type of emergency 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 expulsion or perforation are low.

Healthcare eligibility requirements

Eligibility requirements for basic utilization of a copper IUD also make an application for usage of a copper IUD for crisis purposes. Females with a disorder classified as MEC category three or four (for instance, with present PID, puerperal sepsis, unexplained genital bleeding, cervical cancer tumors, or serious thrombocytopenia) for the copper IUD must not make use of a copper IUD for crisis purposes. In addition, a copper-bearing IUD really should not be placed for emergency contraception after assault that is sexual the lady are at high chance of a intimately transmitted disease such as for instance chlamydia and gonorrhoea. A copper-bearing IUD shouldn’t be utilized as crisis contraception whenever a female has already been expecting.

The whom healthcare eligibility requirements for contraceptive usage states that IUD insertion may increase the risk further 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 chance of STIs have actually poor value that is predictive. Risk of STIs differs by specific behavior and STI that is local prevalence.

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