Emergency Contraception - PowerPoint PPT Presentation

1 / 45
About This Presentation
Title:

Emergency Contraception

Description:

Emergency contraception works in three ways. It slows down ovulation, it stops ... the regimen is not effective during pregnancy, not to any teratogenic effects ... – PowerPoint PPT presentation

Number of Views:503
Avg rating:3.0/5.0
Slides: 46
Provided by: Off132
Category:

less

Transcript and Presenter's Notes

Title: Emergency Contraception


1
Emergency Contraception
2
  • Emergency contraceptive pills (ECPs) provide a
    short, high dose of combined estrogen and
    progestin, or progestin alone and are 75
    effective in preventing pregnancy within 72 hours
    after unprotected intercourse

3
  • Indications include
  • unprotected intercourse
  • failure of a barrier method
  • sexual assault
  • potential pill failures
  • recent use of suspected teratogens

4
(No Transcript)
5
  • Emergency contraception works in three ways. It
    slows down ovulation, it stops the fertilization
    of the egg, and it stops the attachment of the
    egg to the wall

6
  • Emergency contraceptive pills do not affect an
    established pregnancy and numerous studies of the
    teratologic risk of conception during regular use
    of oral contraceptives (including the use of
    older, higher-dose preparations) found no
    increase in risk.

7
  • Emergency contraception is safe. The ACOG stated
    in 1996 that no published studies have reported
    evidenced based criteria contraindicating use of
    ECPs

8
  • The World Health Organization noted that because
    ECPs are given over such a short time period,
    experts believe they have no clinical effect on
    conditions such as cardiovascular disease,
    angina, acute focal migraine and severe liver
    disease.

9
  • Both the World Health Organization, and the
    International Planned Parenthood Federation have
    stated that there are no absolute
    contraindications to use of emergency
    contraceptive pills except pregnancy

10
  • The pregnancy exception relates to the fact that
    the regimen is not effective during pregnancy,
    not to any teratogenic effects

11
  • On February 25, 1997, the FDA announced the use
    of certain combined oral contraceptives
    containing ethinyl estradiol and levonorgestrel
    as safe and effective for the prevention of
    pregnancy

12
  • The pills are given in two doses. To prevent
    pregnancy, the first dose of pills must be taken
    by mouth as soon as possible, ideally within 3
    days (72 hours), but no later than 5 days (120
    hours) of having unprotected sex. A second dose
    is taken 12 hours after the first dose. The
    number of pills in the dose depends on the brand
    of pill used. For progestin-only pills, both
    doses can be taken at the same time or 1224
    hours apart

13
(No Transcript)
14
(No Transcript)
15
(No Transcript)
16
  • On September 3, 1998, the Food and Drug
    Administration (FDA) accepted a commercially
    available product containing ethinyl estradiol
    and levonorgestrel designated for use as an
    emergency contraceptive

17
  • On July 28, 1999 the FDA approved the first
    progestin-only contraceptive. The new product's
    efficacy in reducing pregnancies is 83 with less
    incidence of nausea and vomiting compared to the
    combined oral contraceptive containing ethinyl
    estradiol and levonorgesterel.

18
  • There are two distinct pill types, the brand name
    "Preven" and the brand name "Plan B". Preven
    contains the same hormones as regular birth
    control, estrogen and progestin. It causes more
    instances of nausea and vomiting than Plan Bs,
    and decreases the chances of pregnancy by 75.
    However, Preven can be used as an ongoing form of
    birth control. Plan B only contains the hormone
    progestin. It is more effective, decreasing
    chances of pregnancy by 89, and has less of a
    chance for side effects. These pills can be taken
    immediately after the sex, or up to 72 hours
    later.

19
  • Dose Two doses of 100ug ethinyl estradiol and
    500ug levonorgestrel taken 12 hours apart. 
  • 4 tablets stat of Nordette or Microgynon 30 (or
    generic equivalent) and another 4 tablets 12
    hours later

20
(No Transcript)
21
  • As nausea and vomiting are very common with the
    Yuzpe method, an anti emetic, to be taken 30-60
    minutes prior to the hormonal doses, should be
    supplied/prescribed with this regimen

22
  • Less common side effects including headache,
    breast tenderness and lower abdominal pain can
    occur with this method.1
  • No adverse effects on foetal development have
    been reported with the method in cases where
    pregnancy has occurred

23
  • Two methods of birth control can be used for
    emergency contraception. The most commonly used
    method is pills (also known as the morning-after
    pill). Birth control pills contain the hormones
    estrogen and progestin or, in some cases,
    progestin only. The progestin-only method is more
    effective and is less likely to cause nausea. The
    intrauterine device (IUD) also can be used for
    emergency contraception

24
  • Dose Two doses of levonorgestrel 750 ug taken 12
    hours apart. 
  • Postinor-2 one tablet and another tablet 12 hours
    later 
  • Microlut or Microval twenty-five (25) tablets and
    twenty-five (25) tablets 12 hours later.

25
(No Transcript)
26
(No Transcript)
27
  • Both levonorgestrel and Yuzpe methods have been
    shown to be most effective when commenced within
    12-24 hours of sexual intercourse, with
    commencement of the first dose recommended before
    72 hours

28
  • A recent study, using the Yuzpe regimen, found
    that emergency contraception may still be
    effective (though to a lesser degree) in
    preventing pregnancy, when commenced up to 120
    hours after intercourse

29
The IUD for Emergency Contraception
  • The IUD can be used as emergency contraception.
    It works best if inserted within 5 days of having
    unprotected sex. The presence of the IUD prevents
    the fertilized egg from attaching to the wall of
    the uterus

30
(No Transcript)
31
  • A benefit of the IUD is that it can be left in
    for long-term use. The IUD may be a good choice
    if you cannot take birth control pills. The IUD
    does not prevent sexually transmitted diseases

32
  • Copper bearing IUCDs provide an effective method
    of postcoital contraception. The failure rate is
    less than 1. Careful assessment and counselling
    should take place before insertion is decided
    upon. The IUCD is not suitable for women who have
    risk factors for pelvic inflammatory disease

33
(No Transcript)
34
  • An emergency IUCD can be inserted at any time in
    the cycle provided the earliest episode of
    unprotected intercourse occurred no more than 5
    days previously. Where the earliest episode of
    unprotected intercourse was more than 5 days
    previously, an IUCD can be considered up to 5
    days after the calculated earliest day of
    ovulation (ie. up to day 19 of a 28 day shortest
    cycle by history)

35
  • This limit is well within the period before
    implantation. If the woman does not wish to
    continue using the IUCD as a contraceptive
    method, it may be removed at the time of the next
    period. If hormonal contraception has been
    commenced, the IUCD may be removed after 7 active
    pills have been taken

36
(No Transcript)
37
(No Transcript)
38
(No Transcript)
39
(No Transcript)
40
Frequency of Use
  • Emergency contraceptive pills (ECP) should not
    replace the use of regular contraception, as the
    cumulative pregnancy rate for frequent use of ECP
    is higher than with regular contraception.
    However, if unprotected sex occurs in a cycle
    where the ECP has already been used it can be
    used again

41
  • Women should understand that the use of the ECP
    cannot protect them from the possibility of
    pregnancy if unprotected intercourse occurs later
    in the cycle.
  • In cycles, where unprotected intercourse has
    occurred more than once, ECP can be used,
    although efficacy will be influenced by the time
    interval since the first act of unprotected
    intercourse. The woman must understand that, if a
    pregnancy has already occurred, the ECP will not
    be effective

42
Drug interactions
  • Hepatic enzyme inducing drugs
  • Hepatic enzyme inducing drugs enhance the
    metabolism of levonorgestrel and ethinyl
    estradiol. If a woman taking these drugs (e.g.
    phenytoin, carbamazepine, rifampicin,
    griseofulvin) uses emergency hormonal
    contraception the recommendation is to double
    each dose. This increases the risk of side
    effects

43
(No Transcript)
44
  • Antibiotics
  • Antibiotics taken concurrently with hormonal
    emergency contraception are unlikely to alter its
    efficacy and no alteration in dose is advised.
    The exceptions are the enzyme inducers rifampicin
    and griseofulvin as detailed above

45
(No Transcript)
Write a Comment
User Comments (0)
About PowerShow.com