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

  • EC may be used into the following circumstances: unprotected sexual intercourse, concerns about feasible contraceptive failure, wrong utilization of contraceptives, and intimate attack if without contraception protection.
  • 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 most form that is effective of contraception available.
  • The crisis contraceptive capsule regimens suggested by who’re ulipristal acetate, levonorgestrel, or combined contraceptives that are oralCOCs) composed of ethinyl estradiol plus levonorgestrel.

What exactly is crisis contraception?

Crisis contraception relates to ways of contraception which can be used to avoid maternity after intercourse. They are suitable for used in 5 times but they are more effective the earlier they truly are used following the work of sexual intercourse.

Mode of action

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

Who is able to utilize crisis contraception?

Any girl or woman of reproductive age may require crisis contraception to avoid a unwelcome pregnancy. There are not any absolute medical contraindications to making use of crisis contraception. You will find no age limits for the application of crisis contraception. Eligibility requirements for basic usage of a copper IUD also submit an application for usage of a copper IUD for emergency purposes.

With what situations can emergency contraception be properly used?

Crisis contraception can be utilized in many circumstances after sexual activity. These generally include:

  • Whenever no contraceptive has been utilized.
  • Intimate attack as soon as the girl had not been protected by a powerful method that is contraceptive.
  • If you have concern of feasible contraceptive failure, from wrong or wrong usage, such as for instance:
    • Condom breakage, slippage, or use that is incorrect
    • 3 or higher consecutively missed combined dental contraceptive pills;
    • Significantly more than 3 hours late through the usual time of consumption associated with the progestogen-only tablet (minipill), or maybe more than 27 hours following the past tablet;
    • A lot more than 12 hours later through the typical period of intake for the desogestrel-containing capsule (0.75 mg) or maybe more than 36 hours following the pill that is previous
    • A lot more than two weeks 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;
    • 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;
    • Failed withdrawal ( ag e.g. Ejaculation into the vagina or on outside genitalia);
    • Failure of a spermicide tablet or movie to melt before sex;
    • Miscalculation regarding the abstinence duration, or failure to abstain or work with a barrier technique in the fertile times of the period whenever fertility that is using based practices; or
    • Expulsion of an intrauterine contraceptive device (IUD) or hormonal contraceptive implant.

An advance availability of ECPs could be provided to a female to make sure them available when needed and can take as soon as possible after unprotected intercourse that she will have.

Moving to contraception that is regular

After utilization of ECPs, females or girls may resume or start a regular way of contraception. 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), ladies or girls may resume their contraceptive technique, or begin any contraceptive method straight away, including a copper-bearing IUD.

After utilization of ECPs with ulipristal acetate (UPA), females or girls may resume or begin any progestogen containing method (either combined hormone contraception or progestogen only contraceptives) regarding the 6th time after taking 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 oral pills that are contraceptive
  • Copper-bearing intrauterine products.

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

Whom suggests some of the after medications for crisis contraception:

  • ECPs with UPA, taken as a dose that is single of mg;
  • ECPs with LNG taken being 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 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. (Yuzpe technique)

Effectiveness

A meta-analysis of two studies indicated that ladies who utilized ECPs with UPA had a maternity price of 1.2per cent. Research indicates that ECPs with LNG possessed a maternity price free indian brides 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 possible after unprotected sexual intercourse, within 120 hours. ECPs with UPA are far more effective between 72–120 hours after unprotected sex than other ECPs.

Unwanted effects through the utilization of ECPs act like those of dental contraceptive pills, such as for instance nausea and sickness, slight irregular bleeding that is vaginal and weakness. Negative effects aren’t typical, these are generally moderate, and certainly will usually 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 beresult they cause less sickness and nausea. Routine utilization of anti-emetics before you take ECPs is certainly not recommended.

Medications useful for crisis contraception usually do not damage fertility that is future. There’s absolutely no wait within the go back to fertility after taking ECPs.

Healthcare eligibility requirements

There are not any limitations for the eligibility that is medical of may use ECPs.

Some females, but, utilize ECPs over and over over repeatedly for just about any regarding the reasons stated above, or because their method that is main of. Such situations, further counselling has to be offered about what other and much more regular contraceptive choices can be appropriate and much more effective.

Regular and repeated ECP use can be harmful for females with conditions categorized as medical eligibility criteria (MEC) category 2, 3, or 4 for combined contraception that is hormonal 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 known health problems.

Emergency contraceptive pills were discovered to be less effective in overweight females (whoever human body mass index is much more than 30 kg/m2), but there are not any safety concerns. Overweight ladies shouldn’t be rejected use of emergency contraception whenever they want it.

Counselling for usage of crisis contraceptive pills will include choices for utilizing contraception that is regular suggestions about just how to make use of techniques precisely in the event of observed technique failure.

Copper-bearing intrauterine products

Whom suggests that a copper-bearing IUD, when utilized as an urgent situation contraceptive technique, be placed within 5 times of unprotected sex. This process is very right for ladies who 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 basically the many form that is effective of contraception available. As soon as placed, ladies can continue steadily to utilize the IUD as a continuous approach to contraception, or might want to switch to some other contraceptive technique.

A copper-bearing IUD is really a safe as a type of crisis contraception. It’s estimated that there could be not as much as 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 criteria

Eligibility criteria for basic 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 a few (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 shouldn’t be placed for crisis contraception after assault that is sexual the girl might 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 emergency contraception whenever a lady has already been expecting.

The whom health eligibility requirements for contraceptive use states that IUD insertion may increase the risk further of PID among ladies at increased risk of sexually sent infections (STIs), although restricted proof shows that this danger if low. Present algorithms for determining increased threat of STIs have actually bad value that is predictive.