Download candidates for emergency contraception

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Emergency contraception
postcoital contraception
morning-after pill
typically refers to the administration of
drugs to prevent pregnancy in women who
have had recent unprotected intercourse
including:
-sexual assault
- those who have had a failure of another
method of contraception
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CANDIDATES FOR EMERGENCY
CONTRACEPTION
consensual or rape within the previous 120 hours
Suspected contraceptive failure within the
previous 120 hours
-Breakage , slippage, or leakage of a male
condomd
- breakage, or incorrect use of a diaphragm
-cervical cap
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CANDIDATES FOR EMERGENCY
CONTRACEPTION
-female condom failure of a spermicide
tablet or film to melt before intercourse
-failure to withdraw before ejaculation
-expulsion of an intrauterine device
- Missed oral contraceptive pills
-late injection of injectable contraceptive (>2
weeks late for a progestin-only formulation
->3 days late for a combined estrogen plus
progestin formulation
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Probability of pregnancy after
unprotected intercourse by timing of
coitus
3 days before ovulation
15 percent
1or 2 days before ovulation
30 percent
day of ovulation
12 percent
1 or 2 days after ovulation
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near zero
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Postcoital contraceptive
methods
Combined Pills
Progestin-only
Pills
Copper-T IUD
Dedicated Product:
Plan B®
Trussell J, Raymond EG. 2007.
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Mechanisms of Action
Inhibit ovulation
Trap sperm in thickened cervical mucus
Inhibit tubal transport of egg or sperm
Interfere with fertilization, early cell
division, or transport of embryo
Prevent implantation by disrupting the uterine
lining
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Postcoital contraceptive methods
Estrogen plus progesterone
100 µg ethinyl estradiol plus 0.5 mg
levonorgestrel, each given twice, 12 hours
apart 75 to 80 percent of pregnancies
prevented
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The Value of a Dedicated
Product
Ovral
Alesse
Preven
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EC in the U.K.
Schering 1998
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In 1998, the United States Food and Drug
Administration (FDA) approved marketing
(by prescription) of the Preven Emergency
Contraceptive Kit, which includes four
combination tablets, each containing 50
mcg of ethinyl estradiol and 0.25 mg of
levonorgestrel, and a pregnancy test to
rule out pregnancy before taking the
tablets .
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Preven
TM
Gynétics 1998-2004
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Combined ECP Effectiveness:
Single Use
100 women have unprotected sex in
the 2nd or 3rd week of their cycle
8 will become pregnant without
emergency contraception
2 will become pregnant using combined ECPs
(75% reduction)
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Source: Trussell, Rodríguez and Ellertson 1998
side effects
Nausea
vomiting
Dizziness
Fatigue
Headache
breast tenderness
lower abdominal pain
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*Levonorgestrel 0.75 mg given twice,
12 hours apart Equivalent to or better
than estrogen-progestin
*a single dose of levonorgestrel 1.5 mg
recommend the levonorgestrel regimen because it
has higher efficacy and lower frequency of side
effects than the combined hormonal regimen
it is an effective alternative for women with a
history of thrombosis or who are otherwise
unable to take estrogen preparations.
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The Value of a Dedicated
Product
Ovrette
Plan B®
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Progestin-only ECP
Effectiveness: Single Use
100 women have unprotected sex in
the 2nd or 3rd week of their cycle
8 will become pregnant without
emergency contraception
1 will become pregnant using progestin ECPs
(88% reduction)
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Source: WHO 1998
Copper intrauterine device
Inserted
within 120 hours after
intercourse Over 99 percent.
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IUD Effectiveness - Single Use
1000 women have unprotected sex in
the 2nd or 3rd week of their cycle
80 will become pregnant without
emergency contraception
1 will become pregnant after IUD insertion
(99% reduction)
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Source: Trussell and Ellertson 1995
Mifepristone Single dose 600 mg
100 percent
Mifepristone, although effective in
preliminary studies, is not FDA approved
for this indication.
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Additional contraception and
doses
advised that a risk of pregnancy still exists
barrier or hormonal methods the day after the last
emergency contraception pill
(hormonal methods require a back-up method for
the first seven days of use)
depot medroxy-progesterone acetate, the
levonorgestrel-releasing IUD, or the implant until
they are sure that pregnancy has not occurred
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• The duration of effectiveness of
emergency contraception has not
been determined.
• There is no contraindication to giving
a second dose of emergency
contraception if a second episode of
unprotected intercourse occurs
anytime after the first dose was
administered
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Follow-up
A routine follow-up office visit is not
required .
menstrual bleeding after emergency
contraception typically occurs within
one week of the expected time.
Exceptions are with the intrauterine
device and mifepristone.
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any form of emergency contraception, a pregnancy
test should be performed to exclude the
possibility of an intrauterine or ectopic
pregnancy if bleeding has not occurred within
three to four weeks or if there is abdominal pain
or irregular bleeding.
*There is no increase in the risk of ectopic
pregnancy.
*Oral contraceptives taken daily are not
teratogenic, although specific data regarding
emergency contraception are not available.
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contraindications
Although the World Health Organization's
Medical Eligibility Criteria for Oral
Contraceptive Use applies
contraindications to daily use of oral
hormonal contraceptives in some women
based on their medical history; these
contraindications do not apply to women
seeking emergency contraception
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contraindications
In particular:
* previous ectopic pregnancy
*cardiovascular disease
* migraine
* liver disease
* breastfeeding
are not considered contraindications to
emergency contraception use.
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