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

  • EC can be utilized into the following circumstances: unprotected sexual intercourse, issues about feasible contraceptive failure, wrong usage of contraceptives, and intimate attack if without contraception protection.
  • Ways of crisis contraception will be the copper-bearing intrauterine devices (IUDs) in addition to crisis contraceptive pills (ECPs).
  • A copper-bearing IUD may be the many effective as a type of crisis contraception available.
  • The crisis contraceptive tablet regimens suggested by who will be ulipristal acetate, levonorgestrel, or combined contraceptives that are oralCOCs) consisting of ethinyl estradiol plus levonorgestrel.

What’s crisis contraception?

Crisis contraception relates to types of contraception you can use to avoid maternity after sexual activity. They are suitable for used in 5 times but are more beneficial the earlier they have been utilized following the work of sexual intercourse.

Mode of action

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

Who is able to make use of crisis contraception?

Any girl or girl of reproductive age may require crisis contraception to prevent a unwelcome maternity. There are no absolute medical contraindications to the utilization of crisis contraception. You will find no age limits for the application of emergency 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 can be utilized in several circumstances after intercourse that is sexual. Included in these are:

  • Whenever no contraceptive has been utilized.
  • Intimate attack once the girl had not been protected by a fruitful contraceptive technique.
  • If you find concern of feasible failure that is contraceptive from poor or wrong usage, such as for instance:
    • Condom breakage, slippage, or use that is incorrect
    • 3 or even more consecutively missed combined dental pills that are contraceptive
    • A lot more than 3 hours later through the typical time of consumption of this progestogen-only product (minipill), or maybe more than 27 hours following the pill that is previous
    • A lot more than 12 hours later through the usual time of intake associated with the desogestrel-containing tablet (0.75 mg) or maybe more than 36 hours following the pill that is previous
    • Significantly more than two weeks later for the norethisterone enanthate (NET-EN) progestogen-only injection;
    • A lot more than 4 weeks belated for the depot-medroxyprogesterone acetate (DMPA) progestogen-only more injection;
    • Significantly 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 within the vagina or on outside genitalia);
    • Failure of a spermicide tablet or movie to melt before sexual intercourse;
    • Miscalculation associated with abstinence duration, or failure to abstain or work with a barrier technique from the fertile times of the cycle whenever fertility that is using based practices; or
    • Expulsion of an intrauterine contraceptive device (IUD) or hormonal implant that is contraceptive.

An advance availability of ECPs might be directed at a lady to make sure that she’ll ask them to available whenever required and that can simply take as quickly as possible after unprotected sexual intercourse.

Moving to regular contraception

After utilization of ECPs, ladies or girls may resume or start a method that is regular of. In case a copper IUD can be used for crisis contraception, no extra contraceptive protection is required.

After management of ECPs with levonorgestrel (LNG) or combined dental contraceptive pills (COCs), females or girls may resume their contraceptive technique, or start 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) regarding the 6th time after taking UPA. They could have an LNG-IUD placed immediately they are not pregnant if it can be determined. They could have the copper IUD inserted straight away.

Ways of crisis contraception

The 4 types of crisis contraception are:

  • ECPs containing UPA
  • ECPs containing LNG
  • Combined dental pills that are contraceptive
  • Copper-bearing intrauterine products.

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

Whom suggests some of the drugs that are following crisis contraception:

  • ECPs with UPA, taken as being a single dosage of 30 mg;
  • ECPs with LNG taken being a solitary dosage of 1.5 mg, or alternatively, LNG consumed 2 doses of 0.75 mg each, 12 hours aside.
  • COCs, taken being a split dosage, one dosage of 100 ?g of ethinyl estradiol plus 0.50 mg of LNG, followed closely by a 2nd dosage of 100 ?g 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 maternity price of 1.2per cent. Research indicates 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 taken as early as feasible after unprotected sexual intercourse, within 120 hours. ECPs with UPA are far more effective between 72–120 hours after unprotected sex than many other ECPs.

Negative effects through the utilization of ECPs resemble those of dental contraceptive pills, such as for instance sickness and nausea, slight irregular bleeding that is vaginal and weakness. Side-effects aren’t typical, they truly are moderate, and can typically 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 COCs simply because they cause less vomiting and nausea. Routine utilization of anti-emetics prior to taking ECPs is certainly not recommended.

Medications useful for crisis contraception try not to harm fertility that is future. There is absolutely no wait when you look at the go back to fertility after using ECPs.

Health eligibility requirements

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

Some females, but, utilize ECPs over repeatedly for almost any regarding the reasons stated above, or because their primary approach to contraception. Such situations, further counselling has to be provided on which other and much more regular contraceptive choices could be right and much more effective.

Regular and repeated ECP use are 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 utilization of crisis contraception can lead to increased side-effects, such as for instance 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 body mass index is significantly more than 30 kg/m2), but there are not any security concerns. Overweight females shouldn’t be rejected usage of crisis contraception whenever it is needed by them.

Counselling for use of crisis contraceptive pills will include choices for utilizing regular contraception and suggestions about how exactly to utilize practices precisely in case there is sensed technique failure.

Copper-bearing intrauterine products

Whom suggests that the copper-bearing IUD, when utilized as a crisis contraceptive technique, be placed within 5 times of unprotected sexual intercourse. This process is especially suitable for women that wish to begin to use an efficient, long-acting, and reversible contraceptive technique.

Effectiveness

Whenever placed within 120 hours of unprotected sexual intercourse, a copper-bearing IUD is significantly more than 99% effective in preventing pregnancy. This is actually the most form that is effective of contraception available. As soon as placed, females can continue using the IUD as a continuing way of contraception, or might want to switch to another contraceptive method.

A copper-bearing IUD is a safe kind of crisis contraception. It’s estimated that there could be significantly less than 2 situations 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 utilization of a copper IUD also submit an application for usage of a copper IUD for crisis purposes. Ladies with an ailment categorized as MEC category three or four (for instance, with present PID, puerperal sepsis, unexplained genital bleeding, cervical cancer tumors, or serious thrombocytopenia) when it comes to copper IUD must not make use of copper IUD for crisis purposes. In addition, a copper-bearing IUD shouldn’t be inserted for crisis contraception after assault that is sexual the girl could be at high chance of an intimately transmitted illness such as for instance chlamydia and gonorrhoea. A copper-bearing IUD really should not be used as crisis contraception whenever a female has already been expecting.

The whom health eligibility requirements for contraceptive usage states that IUD insertion may increase the risk further of PID among females at increased risk of intimately 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.