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• EC may be used within the following situations: unprotected sex, issues about feasible contraceptive failure, incorrect usage of contraceptives, and intimate attack if without contraception protection.
• Types of crisis contraception will be the copper-bearing intrauterine devices (IUDs) and also the crisis contraceptive pills (ECPs).
• A copper-bearing IUD could be the most form that is effective of contraception available.
• The crisis contraceptive capsule regimens suggested by who will be ulipristal acetate, levonorgestrel, or combined dental contraceptives (COCs) composed of ethinyl estradiol plus levonorgestrel.

What exactly is crisis contraception?

Emergency contraception means types of contraception which you can use to stop maternity after sexual activity. They are suitable for used in 5 times but are more efficient the earlier they’ve been utilized following the work of sexual intercourse.

Mode of action

Emergency contraceptive pills prevent maternity by preventing or ovulation that is delaying they don’t cause an abortion. The copper-bearing IUD stops fertilization by causing a chemical improvement in egg and sperm before they meet. Crisis contraception cannot interrupt a recognised pregnancy or damage a developing embryo.

Who are able to utilize crisis contraception?

Any girl or woman of reproductive age might need crisis contraception in order to avoid a pregnancy that is unwanted. There are not any absolute contraindications that are medical the utilization of emergency contraception. You will find no age limits for making use of emergency contraception. Eligibility requirements for basic usage 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 may be used in many different 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 successful contraceptive technique.
• If you find concern of possible contraceptive failure, from poor or wrong usage, such as for example:
  • Condom breakage, slippage, or incorrect usage;
  • 3 or maybe more consecutively missed combined dental pills that are contraceptive
  • A lot more than 3 hours later through the usual period of consumption for the progestogen-only supplement (minipill), or higher than 27 hours following the previous product;
  • A lot more than 12 hours later through the typical period of consumption associated with desogestrel-containing tablet (0.75 mg) or higher than 36 hours following the pill that is previous
  • A lot more than 14 days 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 injection;
  • Significantly more than seven days later for the combined contraceptive that is injectableCIC);
  • Dislodgment, breakage, tearing, or very very very early elimination of a diaphragm or cap that is cervical
  • Unsuccessful withdrawal ( ag e.g. Ejaculation into the vagina or on outside genitalia);
  • Failure of a spermicide film or tablet to melt before sexual intercourse;
  • Miscalculation regarding the abstinence duration, or failure to abstain or make use of a barrier technique from the fertile times of the period whenever making use of fertility understanding based practices; or
  • Expulsion of an intrauterine contraceptive device (IUD) or hormonal implant that is contraceptive.

An advance supply of ECPs might be fond of a girl to make sure that she’ll keep these things available whenever required and may just take at the earliest opportunity after unprotected sexual intercourse.

Moving to contraception that is regular

After utilization of ECPs, women or girls may resume or start a regular way of contraception. No additional contraceptive protection is needed if a copper IUD is used for emergency contraception.

After administration of ECPs with levonorgestrel (LNG) or combined dental contraceptive pills (COCs), ladies or girls may resume their contraceptive technique, or begin any contraceptive technique straight away, including a copper-bearing IUD.

After usage of ECPs with ulipristal acetate (UPA), ladies or girls may resume or begin any progestogen method that is containing combined hormone contraception or progestogen only contraceptives) regarding the 6th time after using UPA. They are able to have an LNG-IUD placed immediately they are not pregnant if it can be determined. The copper can be had by them IUD inserted straight away.

Ways of crisis contraception

The 4 ways of crisis contraception are:

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

Crisis contraception pills (ECPs) and combined dental pills that are contraceptiveCOCs)

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

• ECPs with UPA, taken being a dose that is single of mg;
• ECPs with LNG taken being a dose that is single of mg, or alternatively, LNG drawn in 2 doses of 0.75 mg each, 12 hours aside.
• COCs, taken as a split dosage, one dose of 100 ?g of ethinyl estradiol plus 0.50 mg of LNG, accompanied by a second 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 showed that ladies who utilized ECPs with UPA possessed a maternity price of 1.2per cent. Studies have shown that ECPs with LNG had a maternity price of 1.2% to 2.1per cent (1) (2).

Preferably, ECPs with UPA, ECPs with LNG or COCs should be used as soon as possible after unprotected sex, within 120 hours. ECPs with UPA are far more effective between 72–120 hours after unprotected sexual intercourse than many other ECPs.

Unwanted effects through the utilization of ECPs act like those of dental contraceptive pills, such as for example sickness and nausea, small irregular genital bleeding, and exhaustion. Negative effects aren’t typical, they truly are moderate, and certainly will generally resolve without further medicines.

If sickness does occur within 2 hours of having a dosage, the dosage must be duplicated. ECPs with LNG or with UPA are better than COCs simply because they cause less sickness and sickness. Routine utilization of anti-emetics before you take ECPs just isn’t suggested.

Medications utilized for crisis contraception usually do not damage future fertility. There isn’t any wait when you look at the go back to fertility after using ECPs.

Health eligibility requirements

There aren’t any limitations for the eligibility that is medical of may use ECPs.

Some females, however, utilize ECPs over over repeatedly for just about any for the reasons stated above, or because their primary approach to contraception. Such situations, further counselling should be provided on which other and much more regular contraceptive choices can be appropriate and much more effective.

Regular and repeated ECP use might be harmful for ladies with conditions categorized as medical eligibility criteria (MEC) category 2, 3, or 4 for combined contraception that is hormonal Progestin-only contraceptives (POC). Regular usage of crisis contraception may result in increased side-effects, such as for example menstrual problems, although their duplicated use poses no understood health problems.

Emergency contraceptive pills had been found become less effective in overweight females (whoever human body mass index is much a lot more than 30 kg/m2), but there aren’t any safety issues. Overweight females really should not be denied usage of crisis contraception whenever it is needed by them.

Counselling for usage of crisis contraceptive pills will include choices for utilizing regular contraception and suggestions about how exactly to make use of practices precisely in the event of recognized technique failure.

Copper-bearing devices that are intrauterine

Whom advises that the copper-bearing IUD, when used as a crisis contraceptive technique, be placed within 5 times of unprotected sexual intercourse. This technique is especially right for ladies who want to begin to use an efficient, long-acting, and reversible method that is contraceptive.

Effectiveness

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

A copper-bearing IUD is a form that is safe of contraception. It’s estimated that there might be not as much as 2 instances of Pelvic Inflammatory Disease (PID) per 1000 users (3). (FP Global Handbook). The potential risks of perforation or expulsion are low.

Health eligibility requirements

Eligibility requirements for basic utilization of a copper IUD also make an application for usage of a copper IUD for crisis purposes. Females with a disorder categorized as MEC category three or four (as an example, with present PID, puerperal sepsis, unexplained genital bleeding, cervical cancer tumors, or serious thrombocytopenia) for the copper IUD must not make use of copper IUD for crisis purposes. In addition, a copper-bearing IUD really should not be placed for emergency contraception following intimate attack as the girl might be at high chance of an intimately transmitted illness such as for instance chlamydia and gonorrhoea. A copper-bearing IUD shouldn’t be utilized as crisis contraception whenever a female has already been expecting.

The whom healthcare eligibility requirements for contraceptive usage states that IUD insertion may further raise the danger of PID among women at increased risk of intimately transmitted 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.