Emergency Contraception or Morning After Pill

March 12, 2019, 11:46 489

 

Emergency contraception - also called postcoital contraception is a form of birth control that may be used by women who have had unprotected sex or used a birth control method that failed. The treatment generally is reserved for specific situations and is not a regular method of birth control. Emergencies include being raped, having a condom break or slip off during sex, or missing two or more birth control pills during a monthly cycle. Emergency oral contraception is used to prevent a pregnancy, not end one.

The drug work by either:

  • Stopping or delaying ovulation, the ovaries from releasing an egg or ovum;

  • Preventing sperm from fertilising any egg already released; or

  • Stopping a fertilised egg from attaching itself to the lining of the womb.

It is estimated that these drugs may prevent 85% of expected pregnancies.

 

 

Forms of EC include:

  • Emergency contraceptive pills (ECPs) – sometimes simply referred to as emergency contraceptives (ECs) or the “morning after pill" – are medications intended to disrupt or delay ovulation or fertilization, which are necessary for pregnancy. ECPs and abortion pills are not the same. EPCs work by preventing or delaying ovulation and therefore preventing pregnancy, not by abortion.

  • Intrauterine devices (IUDs) – usually used as a primary contraceptive method, but sometimes used as emergency contraception.

Before EC was used in the general population or defined as "emergency contraception," it was used, beginning in the 1960s and 70s, specifically for women who had been sexually assaulted. Pregnancy rates among rape victims of child-bearing age are around 5%; in the U.S., about half of rape victims who become pregnant have abortions. Although EC is commonly used as an option for victims of sexual assault, some researchers believe such use is a public health measure that is not sufficiently widespread.

Four types of emergency contraceptive pills are available: combined estrogen and progestin pills, progestin-only (levonorgestrel, LNG) pills, and antiprogestin (ulipristal acetate or mifepristone) pills. Progestin-only and antiprogestin pills are available as dedicated (specifically packaged for use as) emergency contraceptive pills. Combined estrogen and progestin pills are no longer available as dedicated emergency contraceptive pills, but certain regular combined oral contraceptive pills may be used as emergency contraceptive pills.

Levonorgestrel

Levonorgestrel is used in emergency contraceptive pills (ECPs), both in a combined Yuzpe regimen which includes estrogen, and as a levonorgestrel-only method.

Levonorgestrel, taken alone in a single high dose, was first evaluated as a form of emergency contraception in 1973 and introduced under the brand name Postinor by 1978.

The levonorgestrel-only method uses levonorgestrel 1.5 mg (as a single dose or as two 0.75 mg doses 12 hours apart) taken within 3 days of unprotected sex, with one study indicating that beginning as late as 120 hours (5 days) after intercourse could be effective.

The primary mechanism of action of levonorgestrel as a progestogen-only emergency contraceptive pill is to prevent fertilization by inhibition of ovulation and thickening of cervical mucus.

Side effects.

After intake of 1.5 mg levonorgestrel in clinical trials, very common side effects included: hives, dizziness, headache, nausea, abdominal pain, uterine pain, delayed menstruation, heavy menstruation, uterine bleeding, and fatigue; common side effects included diarrhea, vomiting, and painful menstruation; these side effects usually disappeared within 48 hours.

Overdose

Overdose of levonorgestrel as an emergency contraceptive has not been described. Nausea and vomiting might be expected.

Ulipristal acetate,

sold under the brand name Ella among others, is a medication used for emergency birth control and uterine fibroids. As emergency birth control it should be used within 120 hours of sex. For fibroids it may be taken for up to six months. It is taken by mouth.

For emergency contraception a 30 mg tablet is used within 120 hours (5 days) after an unprotected intercourse or contraceptive failure. It has been shown to prevent about 62–85% of expected pregnancies and prevents more pregnancies than emergency contraception with levonorgestrel.

Side effects

Common side effects include nausea, abdominal pain, emesis, dysmenorrhea, pelvic pain, breast tenderness, headache, dizziness, mood swings, myalgia, and fatigue.

Is emergency contraception safe if used repeatedly?

Data are not available on the safety of current regimens of emergency contraception if used frequently over a long period. However, oral emergency contraception may be used more than once, even within the same menstrual cycle. Information about other forms of contraception and counseling about how to avoid future contraceptive failures should be made available to women who use emergency contraception, especially those who use it repeatedly.

Hormonal emergency contraception is less effective for long-term contraception than most other available methods. In addition, continued use of hormonal emergency contraception would result in exposure to higher total levels of hormones than would ongoing use of either combined or progestin-only oral contraceptives, and frequent use also would result in more adverse effects, including menstrual irregularities. Therefore, emergency contraception should not be used as a long-term contraceptive.

 

                                                                                                                                                                                                                                                                    by  Mehdiyeva B.

References:

  1. https://en.m.wikipedia.org/wiki/Emergency_contraception

  2. https://www.webmd.com/sex/birth-control/emergency-contraception

  3. https://m.acog.org/Clinical-Guidance-and-Publications/Practice-Bulletins/Committee-on-Practice-Bulletins-Gynecology/Emergency-Contraception

  4. https://en.m.wikipedia.org/wiki/Levonorgestrel

 

 

 

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