Emergency Contraception

Emergency contraception is a method that prevents the occurrence of an unplanned pregnancy. Emergency postcoital contraception can suppress the ovulatory process in the body and thereby prevent a male sperm from meeting with a female egg. If fertilization did happen, then as a result of this method, it is possible to prevent the egg from attaching to the uterine mucosa. Variants of situations in which a woman may be forced to resort to emergency contraception are as follows:

- unprotected contact, which means not using a condom during sexual intercourse;

- there was a malfunction during the usual method of contraception, for example, improper dressing of a condom, as a result of which it burst or slipped;

- an error with a constant intake of oral contraceptives, for example, skipping more than 2 tablets;

- incorrect calculation of the onset of so-called unfavorable days for conception when using the calendar method as a protection against pregnancy.

In all of the above cases, there is a high risk of conception. And if such an option for a woman is unacceptable, then it is necessary to resort to the method as emergency contraception after sexual intercourse as soon as possible and faster. However, despite the fact that the pharmacy has a variety of medicines that can be used as an emergency contraceptive, the best and most safe way for a woman's health is to contact the doctor for the proper selection of the medication. Do not often resort to these methods. On that they also have the status of emergency, to be used in the most extreme cases, namely, no more than 2 times during the year.

Methods and methods of emergency contraception

Emergency postcoital contraception is based on the use of specially developed medications for a limited period after unprotected intercourse. Also, the best-known methods of immediate protection against unplanned pregnancy include setting an intrauterine device in a medical facility. There is also the so-called syringing method, which, according to many women, is able to provide protection from pregnancy in case of an emergency. However, this myth should be dispelled: douching can not prevent the onset of conception. Spermatozoa reach the cervix for 1 minute after ejaculation. In addition, it has been established that, together with the lubricant, a small part of them is also isolated, capable of penetrating the genital tract, and then of the female genital organs. Another important aspect of the negative effect of syringing is that the normal microflora of the vagina is disrupted and the pH varies from acidic to alkaline, which can lead to gynecological diseases.

Let's consider in more detail such method of prevention of undesirable pregnancy, as emergency contraception after the sexual certificate or act.

The method of using special medicines is the most known and widespread in many countries. According to the pharmacological composition, these drugs are represented by large doses of hormonal substances that, when ingested, can prevent the development of unwanted pregnancies. The following methods are distinguished:

• Yuzpe method, based on taking oral contraceptives at a certain dose;

• use of drugs containing high dosage of the hormone for 1 or 2 times;

• taking tablets with a low dosage of Progesterone antagonist, which is possible once.

The mechanism of action of these medications is based on the ability to suppress ovulation by reducing the production of follicle-stimulating hormone, which is synthesized in the pituitary gland. They are also able to interfere with fertilization, when the likelihood of its onset is extremely high, as is the case with unprotected intercourse in the preovulatory phase of the cycle. As a result of taking these medications, the growth of the endometrium decreases, which prevents the fertilized egg from penetrating into the endometrium. All these medications, created for emergency postcoital contraception, are chemically represented by hormones or so-called antihormones. Antihormones in certain dosages can be directed to suppress the activity of hormones that are produced in the human body, which ensures the effectiveness of contraception. Depending on the active substance of the drug, the time is also different when they should be applied to achieve the desired result. However, it is always worth remembering that the earlier one or another medication has been taken, the higher its effectiveness.

It is necessary to take these medications only after preliminary careful reading of the attached instructions, in order that this method was not only effective, but, and, most importantly, safe for the body of a woman. However, we should not forget that after a while, after taking these medications, you should definitely visit a gynecologist, for a thorough examination for possible infection with sexually transmitted infections, because the drugs of emergency contraception do not protect them in any way. Also a visit to the gynecologist is necessary in order to make sure that there was no pregnancy after emergency contraception, to track the establishment of monthly after emergency contraception. You should always remember about the possible adverse effects of emergency contraception and that all these special medicines are not harmless at all and can cause enormous damage to the woman's body.

There are the following contraindications for the use of any tablet form of emergency contraception: acute, chronic renal, hepatic insufficiency;pregnancy;Data on the presence in the history of intolerance or hypersensitivity to the main active substances of the drug;The period of breastfeeding;Long-term treatment with glucocorticosteroids;Violations of hemostasis.

The method of installing an intrauterine device is the most effective method of contraception after intercourse. The spiral introduced into the uterus will not allow the egg to meet the spermatozoon, or, if this has already happened, it will not allow the fertilized egg to penetrate into the uterine mucosa. It should be noted that the spiral is also a means for permanent contraception. A medical spiral is introduced only in a medical institution and directly by a gynecologist. There are the following contraindications for its introduction: the presence of infectious diseases of internal, external genital organs;The presence of bleeding from the genital tract of unknown origin;Oncological diseases of genital organs;Uterine myoma;Data on allergic reactions to the components of the spiral;Setting her up for women who did not give birth.

When comparing all the tablet methods used as emergency contraception, it is established that the use of antihistagens is the most safe, effective and less aggressive in comparison with the use of progestogens. But it is worth noting that much depends primarily on the time of reception and the phase of the cycle in which it was used. It is scientifically proven that if sexual intercourse occurred before the onset of the ovulation process, then it is possible to safely and confidently take preparations based on gestagens. If a woman chooses antigestagensoderzhaschie drugs, they will maximize their effect in all phases of the menstrual cycle.

Thus, it is very important to make the right choice of a method based on the possibility of safe emergency contraception.

Signs that any of the above methods did not work are the delay of menstrual periods( longer than 1 week), the coming menstruation is accompanied by rather scant excretions and short duration, the manifestation of all sorts of other signs that a pregnancy has come.

Emergency contraceptive funds and preparations

The main means of emergency contraception include tableted formulations and an intrauterine device that is a small tool made of plastic with the addition of copper, silver or gold. Let us consider them in more detail.

The intrauterine device is a drug that can act as an emergency contraceptive. However, it also serves as a regular or permanent method of preventing an unplanned pregnancy. By its action it is much more effective than drugs for emergency contraception. Introduction of it must be provided during 5 days after unprotected intercourse and only with a gynecologist. The intrauterine device prevents pregnancy, but does not provide protection from various infections. Monthly after emergency contraception, this method usually becomes plentiful, painful and prolonged. If spiral staging was necessary only to prevent pregnancy and was used as an emergency contraceptive, then, after 1 month, it is necessary to remove it from the doctor. It is not recommended to try to get rid of the spiral yourself.

Emergency contraceptive medicines are presented in tablets, the main substance of which are large doses of hormones. This is the most common method of preventing conception. Depending on the hormone included in the tablet, several methods of emergency contraception are identified based on their use:

- taking two equal doses of combined oral contraceptives after 12 hours containing 200 mg of ethinylestradiol and 1.5 mg of levonorgestrel( The so-called Yuzpe method);

- taking tablets containing only one levonorgestrel in a dose of 1.5 mg divided by 2 times or taking a high dose of this hormone for 1 time;

- taking the drug, on the basis of Mifepristone or a hormone progesterone antagonist Progesterone, which is administered once in a dose of 10 mg.

According to some reports, Yuzpe's method involves many side effects and is somewhat less effective, which calls into question its possible attribution to such a method as safe emergency contraception, because for every woman it is important that the consequences of emergency contraception be minimal and not aggressively affect the body. In 2011, during research, it was found that the action of Levonorgestrel is mainly aimed at suppressing ovulation, but does not prevent the implantation of a fertilized egg. Therefore, it should be taken into account that the drug containing levonorgestrel and taken on or after the ovulation process may not lead to the desired effect and do not interfere with the development of unwanted pregnancy.

Active substance Mifepristone, as a component of emergency contraception, by its nature inhibits the process of ovulation and prevents implantation. In addition, it was found that Mifepristone can even delay the onset of the ovulation process for a period of 4 or more days, which is very important, since spermatozoa are viable in the female genitalia for a minimum of 3, and a maximum of 5 days. But it is those spermatozoa that are able to fertilize the egg, according to scientific data, retain mobility just 3-4 days. Thus, if the reception of Mifepristone occurred just on the day of ovulation, it is able to have its emergency contraceptive effect with duration these days.

Nevertheless, all these drugs have the ability to cause the following list of side effects: headache, nausea, vomiting, loose stool, abdominal pain, spotting. It is also possible to develop reactions of an allergic type after taking any of the above-mentioned emergency contraceptive preparations.

Monthly after emergency contraception almost always changes a little, namely the first cycle, as a rule, gets bogged down, but after everything is restored. It should be expected that the date of the expected menstruation may shift to a later date or an earlier date. There may also be minor bleeding between menstruations. In any case, an obligatory visit to a gynecologist is recommended, regardless of the method of emergency contraception chosen by the woman.

In order to ensure that the consequences of emergency contraception are manifested only in the form of non-occurrence of unwanted pregnancies, in the presence of chronic diseases or with the simultaneous reception of other medications, it is necessary to carefully study their instructions for use, since the following is established:

- there is a decrease in the effectiveness of these drugs while taking them with Barbiturates, Ampicillin, Tacrolimus, Tetracyclin, Griseofulvin and others;

- emergency contraceptive medications are able to reduce the effect of drugs for lowering glucose and anticoagulants;

- when combined with Glucocorticosteroids, emergency contraception can provide a cumulative effect in blood plasma;

- it is necessary to exclude the use of non-steroidal anti-inflammatory substances when choosing Mifepristone as a contraceptive after unprotected sex;

- not studied how levonorgestrel and mifepristone affect car control and other precise mechanisms.

According to the doctors' recommendations, in the event that pregnancy has nevertheless ensued after emergency contraception, the best option will be its interruption, as the effect of taking high doses of hormonal drugs on the future health and development of the child remains unclear. However, according to the conducted studies, if a woman used Levonorgestrel, and conception did come, then it is possible not to interrupt pregnancy, since its damaging effect on the developing fetus has not been established. According to some reports, the above recommendations on the preservation of pregnancy can also be applied to the administration of Mifepristone.

One of the terrible complications for the body of a woman after taking pills related to emergency contraception is the possibility of developing an ectopic pregnancy. This aspect relates only to the drug, based on Levanorgestrel, since the mechanism of its action is based on the process of slowing the movement of the oocyte after ovulation in the fallopian tube. This effect, of course, reduces the risk of fertilization, but at the same time contributes to the occurrence of ectopic pregnancy. As for Mifepristone, then, on the contrary, by its mechanism of action, it accelerates the process of movement. The incidence of this complication is about 2%.According to some studies, Mifepreston can be used as a remedy for the treatment of an ectopic pregnancy along with other drugs.

Tablets for emergency contraception

All tablet forms of drugs are divided into the following groups depending on the hormone that is included in their composition:

- preparations containing Levonorgestrel - Escapel, Postinor, Levonelle;

- preparations containing Mifepristone - Ginepristone, Agesta, Genale;

- oral contraceptives - Marvelon, Microgenon, Ovidon, Ovret and others.

Let us consider in more detail the most commonly used tablets, the rules for their administration and possible side effects.

1. Postinor - the most famous drug used for emergency contraception, contains 0.75 mg of levonorgestrel. The method of its application consists in dividing the total dose into 2 stages: the first tablet should be drunk no later than 3 days after unprotected sexual intercourse, and the second tablet must be drunk no later than 12 hours after the first one. If the drug is taken within a day, then its effectiveness reaches about 94%, if within 2 days, the effectiveness drops to 86%, and if the tablet is drunk for 49-72 hours, its effectiveness reaches only 57%.The use of Postinor is often accompanied by the following side effects: symptoms of nausea, even vomiting, upset of the chair, headaches, discomfort and often pain in the lower abdomen, sometimes an increase in temperature. Preference is given to taking this medication in women with regular menstruation.

2. Escapel is a modern analogous preparation of Postinor, with the content of the hormone Levonogestrel in a dosage of 1.5 mg. The convenience of taking this medication is that, based on the large dose contained in the pill, you only need to drink one. It is important to drink this medication no later than 4 days after unprotected sexual intercourse. For this drug substance is also characteristic of the development of the same side effects, but not always. The risk of developing pregnancy after taking Escapel is 1.1%.

3. Ginepreston( Agesta) is a drug containing Mifepristone, which is a progesterone antagonist. According to numerous studies, this type of hormone is the most effective to protect against the onset of unwanted pregnancy. The therapeutic dose is one tablet that contains 10 mg of Mifepristone, and it should be drunk no later than 3 days after unprotected sexual intercourse. Side effects are similar to those that occur after taking Postinor and Escapel: pain in the lower abdomen, weakness, vomiting, nausea. Besides, the development of allergy to the components of the drugs is not an exception.

4. Oral contraceptives are drugs that can also be used as emergency contraception in the absence of other drugs specifically designed for this purpose. The active substance of these drugs is Ethinyl estradiol. The maximum period of delayed admission is no more than 3 days. Use them must be divided into 2 doses, of which the second dose should be used 12 hours after the first. But you need to know that the number of tablets will depend on what dosage of the hormone is contained initially in these oral contraceptives. For example, if you have Marvelon or Microgen, then you need to drink 4 tablets at a time, the total dose is 8 tablets. If Ovidon or Ovulen is available, the one-time dose consists of 2 tablets. Reception of oral contraceptives, namely mini-pili will be a shock dose - 20 tablets.

5. Currently, a new generation of drugs has been invented, which also applies to oral contraceptives, and contains a hormonal component that can disrupt the ovulation process, thereby also providing the effect of emergency contraception - EllaOne. You can take it even after 5 days after unprotected intercourse. EllaOne also has an abortive effect, preventing the implantation of a fertilized egg. Side effects of this drug are quite active and are the same as all of the above.

Basic rules for taking emergency contraceptive tablets:

- thorough examination and strict adherence to the instructions;

- for maximum effectiveness it is recommended to take them on an empty stomach( the extreme variant is 2 hours after eating), the pill must be filled with water;

- do not take the entire dose of the drug at a time, if the instruction is recommended for taking 2 times, as this leads to increased side effects and does not give a final positive effect.

It should be noted that the presence of a woman overweight, according to recent studies has an effect on the result of all of the above drugs. Most depends on the body mass index of women in drugs with Levanorgestrol, since it is established that its use can be ineffective in the presence of obesity. With regard to the use of antihistagens, here again they are preferable, since the percentage of onset of unwanted pregnancy after taking the medication is much lower, but still exists. In the presence of excess weight, obesity should resort to the method of setting the intrauterine device.