Post coital Contraception

Emergency contraception or post-coital contraception refers to methods of

contraception that can be used to prevent pregnancy in the first few days after
intercourse.
Indications
Emergency contraception is indicated in a number of situations following sexual
intercourse.
1) When no contraceptive has been used ie. unprotected intercourse.
2) When there is a contraceptive failure or incorrect use like
ondom breakage! slippage! or incorrect use
"hree or more consecutively missed combined oral contraceptive pills.
"he progestogen #only pill $minipill) taken more than three hours late $or
more than 12hours late if taking a %.&'mg desogestrel #containing pill)
(orethisterone enanthte $(E"-E() progestogen # only in)ection taken
more than 2weeks late
*epot-medroxyprogesterone acetate $*+,-) progestogen # only in)ection
taken more than .weeks late
"he combined estrogen plus progestogen monthly in)ection taken more
than & days late
*islodgment !delay in placing !or early removal of a contraceptive
hormonal ring or skin patch
*islodgement!breakage !tearing or early removal of a diaphragm or
cervical cap
/ailed withdrawal
/ailure of a spermicidal tablet or film to melt before intercourse.
+iscalculation of the periodic abstinence method! or failure to abstain or
use a barrio method on the fertile days of the cycle.
0) 1n cases of sexual assault when the woman was not protected by an effective
contraceptive method.
Mechanism of action
Emergency contraception is effective only in the first days following intercourse
before the ovum is released from the ovary and before the sperm fertili2es the
ovum. Emergency contraceptive pills cannot interrupt an established pregnancy
or harm a developing embryo.
"he emergency contraceptive pills act as interceptive agents that is! prevent
ovulation! fertili2ation or implantation depending upon phase of menstrual cycle.
1f used before ovulation! follicular maturation as well as ovulation disrupted.
/ollowing ovulation! implantation of blastocyst is interfered with by causing
asynchronous endometrial maturation.
Methods of emergency contraception

Methods Dosage
ombined 3,s %.1mg EE 4%.'mg 5(6
2doses 12hours apart within &2hours
,rogestin only pills 5(6 1.'mg single dose or 2doses
each of %.&'mg 12hours apart within
&2hours
-ntiprogestins +ifepristone 1%- '%mg within 12% hours
7lipristal 0%mg single dose
entchroman '% mg two doses 12 hours apart within
12% hours
*ana2ol .%% mg 2 doses within &2hours
u 17* Within five days of 7,81
Effectiveness
Effectiveness of combination method ranges between '' and 9.: with a
weighted average of &%-&.:."he true effectiveness rate is &':.
With 5evonorgestrel $5(6) only regimen! W;3 reports a pregnancy rate of 1.1:
and '2-9.: effectiveness in preventing pregnancy.
+ifepristone is more effective in preventing pregnancy compared with 5(6.
7lipristal acetate has a reported effectiveness of <2 to =':.
When inserted within five days of unprotected intercourse! a copper bearing 17*
is over 99: effective in preventing pregnancy. "his is the most effective form of
emergency contraception available. 3nce inserted! the woman can continue to
use the 17* as an ongoing method of contraception! and she may choose to
change to another contraceptive method in the future.
Safety
-ccording to 7.8 +edical Eligibility riteria for ontraceptive 7se $78 +E)!
there are no situations in which the risks of using combined or progestin #only
E,s outweigh the benefits. "he 78 +E notes specifically that woman with
previous ectopic pregnancy! cardiovascular disease> migraines and liver disease
and women who are breast feeding may use E,s.
Side Effects
(ausea and vomiting are the common side effects!more with combined
pills.
1rregular bleeding or spotting in the week or month after treatment.
,elvic pain! abnormal bleeding pelvic infection! uterine perforation and
expulsion are the possible complications of 17*.
*elayed menstruation is the notable side effect of +ifepristone.
Effects on pregnancy
"here have been no conclusive studies of births to women who were already
pregnant when they took combined E,s or following failure of combined E,s.
;owever one study of 002 pregnant women who had used levonorgestrel #only E,s in
the conception cycle found no increased risk of birth defects. E,s do not interrupt an
established pregnancy!hence are not abortificient.
Emergency contraception and breastfeeding
"here are no restrictions on use of combined or progestin-only E,s by breast
feeding women. - study recommends that to limit infant exposure to the period of
maximum 5(6 excretion in milk! mothers should discontinue nursing for at least =
hours! but not more than 2. hours! after taking E,s.
Conclusion
"here is a need to focus on how to advance awareness and better education to
women about accessing and utili2ing E when necessary!if areduction in the abortion
rate are world wide to be reali2ed.
References
1. -ssosiation of 3bstetricians and 6ynaecologists of *elhi.-36* ?ulletin
@olume 10!Aanuary 2%1.!+onthly issue 9
by
Dr Rekha Thomas
Reader Dept of !ynaecology and "bstetrics
#$MC%$ Defence colony