emergency contraception update
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Transcript of emergency contraception update
Emergency Contraception
What is EC?
EC Emergency Contraception=
Sexual intercourse
Prevent pregnancy
Prevent pregnancy
Emergencycontraception
Regularcontraception
How do you prevent pregnancy after sexual intercourse?
Orally taking pills Intrauterine device
Emergency contraception
Progestin only
Estrogen+Progestin
What are differences between two types of orally taking EC?
Progestin only Estrogen+Progestin
Levonorgestrel 1.5mg EE 0.2mg + Levonorgestrel 1.0mg
Prevent pregnancy - 85% Prevent pregnancy - 75%
Side effectsNausea – 20%Vomiting – 5%
Side effectsNausea – 50%Vomiting - 20%
Yuzpe regimen
Comparing Progestin only Vs Yuzpe Regimen
Progestin only Yuzpe85% effectiveness 75% effectiveness
2 tablets single dose 8 tablets in two divided doses
Nausea: 20%Vomiting: 5%
Nausea: 50%Vomiting: 20%
Which one do you prefer?
What is OK EC?What are its contents?
Mechanism of action
Levonorgestrel
1. Inhibit ovulation
2. Cervical mucous thickening
4. Inhibit implantation
3. Delay ovum/sperm transport
NOT abortifacient
Mechanism of action
Inhibit ovulation is effective if before ovulation
Delay ovum/sperm transport if after ovulation
Cervical mucous thickening if after ovulation
Enodmetrium is unfavorable for implantation if after ovulation?
More effective, if taking earlier
NOT effective if taking after 5 days
Effectiveness of OK EC• Within 24 hours (1 day) 95 %
• Within 48 hours (2 days) 85 %
• Within 72 hours (3 days) 58 %
95%
85%
58%
0%
20%
40%
60%
80%
100%
24 Hours 48 Hours 72 Hours
Effectiveness
When should a client take OK EC to effectively prevent pregnancy?
When should you prescribe OK EC to a client?
Unprotected sex
Regularcontraception
Sex within 5 days before contraception
Failure to take it regularlyand Sex within 5 days
Within 5 daysEffectiveness???
Who can use OK EC?Use Not use
Women with history of stroke
Women with heart disease
Women with liver disease
Women with breast feeding
Any women within reproductive age
Women with pregnancy
There is no known medical conditions in which OK EC should not be used.
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What are the common side effects of OK EC?
Nausea23%
Fatigue17%
Dizziness11%
Vomiting5%
Breast tenderness5%
These symptoms generally resolve within 24 hours
How to manage an OK EC client with vomiting?
Nausea23%
Fatigue17%
Dizziness11%
Vomiting5%
Breast tenderness5%
Before taking OK EC
Taking anti-emetic one hour ahead
After taking OK EC
Repeating the dose if vomiting occurs within 2 hours
When does next menstruation occur?
Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat
1 2 3 4 5 6 7 8 9 10 11 12
13 14 15 16 17 18 19 20 21 22 23 24 25 26
27 28 29 30
Expected time60%
30% 10%
If delay >7 days, important to rule out pregnancy
SummaryOK EC is NOT
AAbortifacient
Regular birth spacing methodR
Safe for sex until start of next menstruationS
OK EC is more
Effective than Yuzpe
Effective if taking as as possible after unprotected sex
CCausing amenorrhea
method
early
Toxic in any medical conditions and breast feeding motherT