During sexual intercourse, something unexpected can happen, it can happen contrary to circumstances, or a woman, while preparing for it, forgets to use contraceptives. All these events require urgent measures, especially if they occurred during the period when the woman entered the ovulation phase. Emergency contraception as a method of preventing unwanted pregnancy fully lives up to its name and is used quite often. The main requirement for her is the use of contraceptives no later than three days after sexual contact.
In what cases is EC needed?
Firefighter, as it is also called, contraception must be truly operational. The sooner a contraceptive is used, the higher the likelihood that an unwanted pregnancy can be avoided. In addition, her methods must be used strictly according to the instructions, otherwise the desired effect may not be achieved.
Contraceptives that are related to emergency contraception, contain a critical dose of hormones that actively affect the woman’s body. They do not allow sperm to penetrate into the uterine cavity, and create unfavorable conditions for the egg to attach to the endometrium.
The great advantage of such products is their availability, no need for a prescription and constant availability in pharmacies.
Urgent use of special-purpose contraceptives is required if:
- people did not plan sexual contact and were not ready for it;
- the man's condom broke;
- the woman forgot about taking contraceptives daily;
- her IUD or cervical cap fell out;
- the partner was unable to control himself, using the tactic of interrupted sexual intercourse;
- for various reasons, the ejaculate ended up in the woman’s genital tract;
- the numbers in the calendar were mixed up;
- spontaneous peeling off of the contraceptive patch occurred;
- the next injection of the drug was missed;
- rape happened, etc.
All these unpleasant circumstances may well lead to an unwanted pregnancy, and if the partners are not spouses or are not connected by love, then in the event of the birth of a child, an excessive burden will fall on them.
It also happens that a husband and wife are not yet planning to expand their family due to housing or financial circumstances and are preparing for parenthood a little later.
Representatives of the fair sex who have recently become mothers and are in the period of breastfeeding should avoid using such EC methods. And yet, if they are necessary, they can only be used once. But in this case, you can continue to breastfeed the baby only after a day or another period of time when the drug is completely removed from the body.
Despite the fact that such contraceptives are not the method of choice for preventing unwanted pregnancy, they are still preferable to abortion. Therefore, it is better to use them at the right time.
And it’s even better to be careful, not to enter into casual relationships, and carefully monitor the phases and use of daily contraceptives.
In addition, do not forget that most emergency contraception methods are not able to protect against sexually transmitted diseases.
Failure to conceive also does not guarantee the occurrence of negative reactions in the body. Therefore, after using such drugs, it is still advisable to donate blood for infections, do a smear for microflora, and also undergo an examination by a gynecologist.
EC methods and methods
Various options for protection against unwanted pregnancy are used. The first type of contraceptives contains levonorgestrel. These drugs must be taken once no later than three, maximum four days that have passed since the intimate meeting. It is also possible for a woman to take one tablet twice every twelve hours. This is enough reliable method contraception, suppressing the ovulation phase.
This method of protection against unplanned pregnancy is reliable in approximately seventy percent of cases. The sooner a woman takes the necessary emergency contraception, the more confident she is that fertilization will not occur.
These drugs are quite safe, they have minimal negative influences on the body. But they are not suitable for permanent use. Excessive passion for them can lead to disruption of the menstrual cycle and changes in hormonal levels.
Second type of contraceptives is an intrauterine device with a high copper content. It must be urgently implanted no later than five days after sexual intercourse. Installing an IUD can become a reliable protection against unwanted conception in the future.
The action of the intrauterine device is reduced to the chemical contact of the ions of the substance with the vaginal mucus. They negatively affect both the ejaculate and the egg. This method of protection is almost one hundred percent effective.
After the IUD is installed, a woman can use it for three to five years, depending on the manufacturer’s recommendations. After this, she will decide for herself whether to continue using the IUD or choose another method of contraception.
This emergency method cannot be used if pregnancy has already occurred. In addition, individual intolerance to copper must be taken into account.
The third type of contraception is the use of daily combined oral contraceptives containing the hormones estrogen and gestagen. They should be taken according to a certain scheme: take two tablets immediately after sexual contact and two more twelve hours later.
When taking such drugs, various adverse reactions may occur in the form of nausea or even vomiting. Therefore, if this happens within an hour after taking the contraceptive, then you need to take another pill. It is better to endure the unpleasant sensations right away, as they will soon pass and do not create additional stress on the body.
Means and preparations for emergency contraception
You can take a closer look at these effective methods for EC.
The use of pharmacological drugs includes pills that dramatically change a woman’s hormonal levels. For urgent protection against unwanted pregnancy, contraceptives containing Levonorgestrel or Mifepristone are used.
Levonorgestrel-dominant drugs(Postinor, Escapelle or Eskinor F):
- stop the process;
- prevent the appearance of an egg formed from a follicle;
- affect the composition of vaginal and uterine mucus.
These effects make it possible to create unfavorable conditions for the fertilization process.
In addition, they do not allow the egg to gain a foothold in the endometrium. The fallopian tubes stop actively contracting. The internal structure of the mucous membrane of the organ also changes, which leads to its rejection. After taking Postinor or Escapel, uterine bleeding immediately begins and does not stop for several days. Sometimes it coincides with the beginning of menstruation.
If a sperm penetrates the uterine cavity and manages to reach the egg, it will still not be able to attach to the endometrium. The embryo will not develop. The cells will die or remain immobilized and come out along with the ensuing bleeding.
Contraceptives containing Mifepristone(Zhenale, Miropriston, Mifegin or Pencrofton) also effectively stop the ovulation phase, affect the epithelium lining inner surface uterus, do not allow it to interact with the egg, and also create conditions unsuitable for fertilization. The organ itself significantly increases its tone and enhances contractility, which prevents pregnancy from occurring.
Combined contraceptives, taken according to the relevant recommendations (Logest, Marvelon, Mercilon, Microgynon, Miniziston, Novinet, Regulon, Rigevidon or Femoden). They actively influence the general hormonal background of a woman, thereby making the process of fertilization absolutely impossible. These pills are slightly less effective and are approximately eighty percent reliable. In addition, they have whole line traffic jams.
About application high copper intrauterine device has already been described in detail. It should be implemented no later than the fifth day following the sexual contact. Ions chemical substance actively influence the secretion secreted by the female genital organs, preventing possible fertilization. It is better not to use this method of contraception for women who do not yet have children, and especially for those who suffer from any diseases. For healthy women who have given birth, this method of contraception is recommended due to the smallest amount side effects.
Whether the contraceptive worked can be determined by some characteristic signs. These include the following important factors:
- menstruation did not appear three days after using EC;
- instead, weak bleeding appeared;
- breast enlargement began with swelling of the nipples;
- the woman feels sleepy all the time;
- she feels marked weakness, etc.
These signs indicate an incipient pregnancy. Therefore, before using any drug, you must carefully read the instructions for use attached to it. Any minor mistake can lead to fertilization occurring.
Folk remedies EC
Many women quite effectively use home methods to prevent unwanted pregnancy. They were used by our distant ancestors when there were no methods of contraception.
Folk remedies are especially indicated in cases where it is not possible to carry out any other procedure to protect against fertilization (the partners are in a distant village or the woman has many contraindications).
Of course, it is advisable to use more reliable methods of protection, but in such cases you have to get out of this situation on your own.
Folk methods of emergency contraception most often include:
- Vaginal microenema with citric acid. The solution is prepared as follows. A glass of boiled water is mixed with freshly squeezed juice or a teaspoon of the substance. After this, the stream is directed into the vagina and the product should remain there for at least ten minutes. Then you need to wash yourself well so as not to burn the mucous membranes.
- Application of manganese. A small amount of powder should be dissolved in a glass of water and douched. The solution must be pink, otherwise severe damage to the internal cavity of the organs may occur. Acidic environment prevents motor activity sperm. In this case, also after the procedure, you need to wash yourself thoroughly with a large amount of soap that creates an alkaline environment.
- Peel the lemon fruit, separate one segment and place it in the vagina. A sharply acidic pH will create extremely unfavorable conditions for conception. After applying this method, exposure is also necessary large quantity soap
- An Aspirin tablet inserted into a woman’s genital tract works in a similar way, which also creates a sharply acidic environment, neutralizing the activity of sperm.
- Immediately after sexual intercourse, a quarter of a piece should be placed in the vagina laundry soap, after wetting it. It should remain there for about half a minute, then it is removed and thoroughly washed with plenty of water.
It is not recommended to use these methods constantly. They can be used no more than three times a year. But, as a one-time emergency remedy, they are quite reliable. All of them have side effects and negatively affect the mucous membrane of the female genital tract. In addition, they can cause severe allergic reactions.
Contraindications
Emergency contraception, as already mentioned, should only be used in the most extreme cases. But even so, there are a number of contraindications to it.
The most common ones include:
- liver failure;
- cirrhosis;
- malignant neoplasms;
- tendency to bleeding;
- increased blood clotting;
- varicose veins;
- mastitis;
- myoma;
- early adolescence;
- pregnancy;
- breast-feeding;
- allergy;
- inflammatory processes;
- individual intolerance to substances included in contraceptives, etc.
These diseases do not allow you to quickly remove drugs from a woman’s body and provoke an exacerbation in her chronic diseases and increase the symptoms of inflammation.
In addition, even healthy women should not use EC constantly, much less take it into service as a daily contraceptive. This method can cause a number of complications in the body. Even its one-time use is permissible only in case of emergency, and it is completely unsuitable for regular use.
Side effects
However, even women who use emergency contraception only occasionally may experience a number of negative responses from the body. Among them, the most common is disruption of the menstrual cycle, the appearance of bleeding in the middle, a significant delay or too early onset of the next period. The process itself may also undergo dramatic changes. The discharge can become extremely scanty or excessively abundant, disappear completely within three days or drag on for ten days.
The duration of the menstrual cycle also changes in any direction, and there is also a loss of its regularity.
EC, as already mentioned, should only be used in the most extreme cases. And women must not forget that sperm are capable of long time remain in the genital tract, therefore, after the expiration of these contraceptives, nothing will interfere with the possibility of fertilization.
In addition, the time factor is of great importance. The sooner a certain drug was applied, the more reliable the result.
Despite the presence of a large number of side effects, women actively use emergency contraception. It is better to choose such contraceptives in advance in consultation with a gynecologist and have them in the house only for extreme case. Sometimes it becomes the only means of protection against unwanted pregnancy. Therefore, representatives of the fair sex take this risk in order to avoid an even more serious consequence in the form of abortion.
After using emergency contraception, a woman needs to think about choosing a permanent method of birth control that more reliably protects against the possibility of unexpected conception, and also has a minimum of contraindications and side effects.
Photo: CITAlliance/depositphotos.com
Emergency or postcoital contraception is intended to prevent pregnancy as a result of unprotected intercourse and includes various methods and drugs. Its essence comes down to preventing the fertilized egg from attaching to the wall of the uterus and starting to develop. The effectiveness of this method directly depends on the time of taking the drug - the earlier the drug is used after sex, the higher its effectiveness.
When is emergency contraception needed?
If emergency contraception is taken within 24 hours of sexual intercourse, it is about 95% effective. If the tablet was taken after 25–48 hours, the effectiveness is reduced by 10%. If the product was used after 49–72 hours, the result is 55–60%.
This method can be used very rarely. Under no circumstances should it be used as permanent protection against unwanted pregnancy.
If a woman is breastfeeding, emergency contraception can be used in exceptional cases. To do this, you need to stop breastfeeding for one day until the drug taken is completely eliminated from the body. The use of emergency contraception is justified after physical violence and in cases where pregnancy may threaten the woman's health.
Types of drugs
These products differ in composition and method of application.
Combined oral contraceptives
Taken no later than three days after sexual intercourse. Drugs based on ethinyl estradiol (Marvelon, Miniziston, Microgynon, Femoden, Rigevidon) are usually taken several times. Products based on ethinyl estradiol (Non-ovlon, Bisekurin, Ovulen, Ovidon, Anovlar) should also be taken several times with an interval of 12 hours between doses.
Progestin-only oral contraceptives
The drugs are taken no later than two days after sexual intercourse. Nowadays it is not difficult to purchase escapelle and postinor at the pharmacy. Both medications contain a large dose of the hormone levonorgestrel. The drugs differ in the number of tablets: in escapelle - one, and in postinor - two.
Mifepristone
Mifepristone is not hormonal. Its action is aimed at suppressing the female hormone at the level of receptors in the uterus and increasing contraction of its muscles.
Mifepristone - effective remedy emergency contraception. It blocks the egg so that it cannot enter the uterine lining and also stimulates its rejection. It is used to terminate an unwanted pregnancy early stages. Mifepristone should only be used after consulting a doctor.
Intrauterine devices
T-shaped copper-containing intrauterine devices are inserted no later than five days after sexual intercourse in the gynecologist's office. If a woman is prescribed an intrauterine device as emergency contraception, then her individual characteristics and contraindications to the use of this method must be taken into account.
The effect of emergency contraception on the body
Doctors do not advise using this type of contraception all the time, as it has a bad effect on a woman’s reproductive system. In the future, this can lead to dysfunction of the ovaries.
With the constant use of purely progestin or combined contraceptives, the woman’s body receives small doses of the drug, designed for the entire menstrual cycle. Taking a hormonal drug does not disrupt the duration of the cycle, its normal cyclicity, and ovarian function becomes better. Hormonal problems, if any, are also eliminated.
If a woman takes the same drug for emergency contraception, then the body receives a dose of the hormonal drug that is many times higher. As a result of constant use of such contraception, the menstrual cycle will become anovulatory (without the formation of an egg), which threatens infertility.
Violation of normal ovarian function leads to the development of metabolic disorder syndrome. It is expressed in increased blood sugar, increased blood pressure, and the appearance of excess weight.
As for douching with various solutions, this method does not have the desired effect, since sperm penetrate into the cervix within 1 minute after intercourse. In addition, too frequent douching can lead to vaginal dryness and disruption of microflora.
Cons and side effects
Emergency contraception is completely useless while the egg is implanting in the uterus. The effectiveness of combined oral contraceptives can be observed only if the drug is used no later than 72 hours after sexual intercourse.
The first dose of progestin-only oral contraceptives should be taken no later than 48 hours after sex. Intrauterine contraception will be effective if these drugs were introduced into the uterus within 5 days after the act. Mifepristone should only be taken in a clinic setting under the supervision of a physician. Another disadvantage of Mifepristone is its high price.
Emergency contraception should be used only in exceptional cases, if there is simply no other option. It is advisable that it be used no more than three times a year. The less often the better.
The most common side effect of such methods is uterine bleeding, which occurs 2-3 days after administration. And some women, on the contrary, experience delays in menstruation with severe disruption of the menstrual cycle.
Other side effects such as dizziness, headaches, vomiting and diarrhea, and various allergic reactions are uncommon.
You may experience chest pain, rashes on your arms, legs, feet, and shoulders, blurred vision, difficulty breathing, and vomiting 2 hours after taking the tablet. This indicates an incorrect dose of the hormone.
When using Mifepristone, discomfort in the lower abdomen, vomiting, nausea, weakness, dizziness often occurs, and body temperature rises noticeably.
When using intrauterine contraceptives, during the first few days you may experience severe cramping pain in the lower abdomen and an increase in the amount of discharge during menstruation. In addition, there is a high risk of ectopic pregnancy due to disruption of the contraction of the fallopian tubes and the movement of the egg through them. Less commonly, spontaneous prolapse of the intrauterine device and damage to the uterus during its insertion may occur.
Contraindications for emergency contraception:
- intolerance to the components of the drug;
- previous hepatitis;
- diseases of the biliary tract or liver in severe form;
- puberty;
- ongoing pregnancy.
- The time for taking the dose of the drug should be chosen so that it is convenient to take the next one (for example, 21:00 and 9:00).
- To avoid unpleasant sensations (vomiting, nausea), it is best to take emergency contraceptive pills with low-fat milk.
- In the period before the start of the next menstruation, you need to use additional means of protection (barrier method).
- Emergency contraception is suitable for one-time use. For permanent protection, you need to choose a different method of contraception with your doctor.
- In cases of menstruation occurring a week or more late, you should consult a gynecologist to rule out pregnancy.
Popular means
Among the most well-known drugs for emergency contraception, the leading places are occupied by postinor and escapelle.
Postinor
Postinor is a popular drug that helps prevent unwanted conception. At correct intake With this remedy, as a rule, it is possible to avoid unwanted conception. The tablets contain a synthetically created analogue of the hormone levonorgestrel.
This hormone is also included in medications intended for routine contraception. However, its content in Postinor is significantly higher than in planned oral contraceptives.
Postinor should be taken at intervals of 12 hours. The package contains two tablets, one of which is drunk after sexual intercourse, and the second - after 12 hours. This drug can prevent unwanted conception within three days (72 hours). Sometimes two doses are required. This may happen if vomiting occurs after taking at least one of the tablets and the drug is not absorbed. It is advisable to take these tablets after meals. This will reduce the risk of vomiting.
Postinor does not terminate an existing pregnancy; it can only prevent its development. This means that using the drug for abortion will not work. The advantage of postinor is that it does not harm the fetus, and the child can be saved.
Postinor does not prevent sexually transmitted diseases. If you have been physically assaulted or had unprotected sex with an untrusted person, consult a doctor immediately.
The drug, like other emergency contraceptives, may increase the risk of ectopic pregnancy. An ultrasound will show the location of the fetus if in doubt.
Escapelle
Unlike postinor, one capsule of escapelle contains 150 mg of the hormone levonorgestrel. Therefore, there is only one tablet in the package. The remedy is most effective if taken on the first day after unprotected sex. The drug may cause nausea and even vomiting. If vomiting occurs earlier than three hours after administration, then you need to re-use the escapelle.
The drug can provoke disruptions in the menstrual cycle, promote the appearance of bloody discharge from the vagina, cause a delay in menstruation, as well as chest pain. If your period is more than five days late, it is recommended to take a test to determine whether you are pregnant.
It happens that during sexual intercourse the condom breaks, so seminal fluid penetrates into the female body. Also, unwanted penetration of sperm can occur during rape. What should a woman do to avoid a deeply unwanted conception, should she really resort to such an unsafe method as abortion. There is a way out, and it’s not so dangerous. There are emergency birth control pills, which are intended to prevent unnecessary conception and prevent the consequences of unprotected sex. But these drugs can be taken only in truly emergency cases, since frequent use is fraught with dangerous complications for the woman.
During intimacy, anything can happen - the condom came off, the COC was missed, or the partners simply forgot about protection. What should a woman do in such a situation to still avoid pregnancy?
- A woman needs to immediately get out of bed so that the seminal fluid flows out of the vagina without reaching the female cell. But you cannot completely rely on such a method, because it does not guarantee one hundred percent reliability.
- Immediately after sexual contact, you must take a bath and wash thoroughly with soap. This should be done in the first 10 minutes after sex. This action will help reduce the chance of conception by 10%. You can also syringe with something sour, for example, a lemon or vinegar aqueous solution. Such means lead to the creation of aggressive conditions for sperm in the vagina, but such douching must be carried out extremely carefully to avoid burn damage to the mucous tissues.
- If a woman regularly takes any contraceptive drug, then you need to carefully study its instructions; usually it contains an algorithm for actions if you miss taking a pill.
- If you had sex with an unreliable partner, then the woman needs to treat her genitals and vagina in the very next few minutes with products that prevent the development of STDs. Similar drugs include Miramistin, but the possibility of its use should be discussed with a gynecologist.
When will emergency contraceptives help?
Any means and categories of such contraception cannot be called completely safe and useful for the female body, and therefore they are resorted to only in extreme situations, when coitus has already occurred, or the woman has been raped, etc. In general, every emergency contraceptive is intended more for women living intimate life is quite rare, and also indispensable in unforeseen situations when sex occurred without protection.
Such medications are called post-coital, since they are used after the fact that sperm enters the vaginal environment. If sexual intercourse occurred before the onset of the ovulatory period, then a high dose of hormonal substances will prevent its onset and the woman’s given cycle will be anovulatory. If fertilization occurs, then emergency contraception will prevent the embryo from consolidating. Such medications contain a very high dose of hormonal substances, so such high-dose hormone-containing drugs should be taken as rarely as possible.
How does emergency contraception work?
The medicinal effect of emergency contraception comes down to such effects as suppressing the maturation of the female cell, preventing the cell from meeting the sperm and preventing its implantation into the uterine wall. Therefore, after taking the drug in female body There is a thickening of the cervical secretion, which does not allow sperm to enter the uterus. Also, at the same time, high dosages of hormonal components prevent ovulation, so the cell does not come out and the sperm die safely.
If the sperm nevertheless penetrated the uterus, reached the cell and fertilized it, then under the influence of the hormonal components of the drug, hypotrophy of the endometrial layer occurs, which does not allow the zygote to gain a foothold on it, therefore, further development of pregnancy does not occur, and the embryo leaves the uterus during the next menstruation along with bloody discharge. The effectiveness of emergency contraceptives reaches fairly high levels, amounting to about 97-99%. But there are also pitfalls here. A high contraceptive effect is achieved due to high content hormonal substances that do not have the best effect on the female body.
Types of contraception
Experts distinguish several categories of emergency contraceptives.
How to take emergency contraceptives
To get the proper effect from taking emergency contraception, you need to follow the rules for its use. When taking medications with levonorgestrel as an active ingredient (Postinor, etc.), you need to take into account that they should be taken no later than 72 hours after unprotected intimacy. The first pill must be taken immediately, and the sooner, the higher the contraceptive effect. The second pill is taken after 12-16 hours. If a woman vomits, then she needs to take another Postinor tablet. If we talk about other drugs with levonorgestrel, for example, Eskinor F or Escapel, then they are taken once, one pill, also within a 72-hour period. The effectiveness of such drugs depends on how quickly the drug was taken after sex. Taking a day or less provides a contraceptive effect by 95%, after 25-48 hours - by 85%, and after 2-3 days - by only 58%.
Preparations with gestagen and estrogen are taken according to the Yuspe regimen. This technique involves taking COCs, but in higher dosages. For the first time, take 2-4 pills no later than the third day after intimacy. The second dose of the same number of tablets is taken after 12 hours. Typically, combined oral agents such as Ovidon or Rigevidon, Silesta and Non-ovlon are used as fire contraception. The effectiveness of this method reaches 75-85 percent.
Mifepristone pills like Mifolian and Agesta, Ginepristone or Zhenale are recommended to be taken during the first 3 days. Take just one pill. An important condition is an empty stomach, so you can’t eat a couple of hours before and after taking the pill.
Adverse reactions
Emergency contraception due to a large dose of hormonal substances causes many side effects, which include nausea and vomiting reactions and intermenstrual bleeding, breast tenderness and migraine symptoms. If the patient already has varicose veins, then taking fire contraception can provoke blood clots. Also among adverse reactions Menstrual irregularities and dizziness are common. Taking high-dose hormonal drugs often leads to menstrual disorders, when the patient's periods begin to last longer or become heavier.
Also, in response to taking fire contraception, allergic reactions and pain in the uterus and genital tract may develop. But adverse reactions occur only in a fifth of patients; the rest of the women tolerate the effects of this category of drugs more easily. If the instructions are followed, emergency contraception will help avoid unwanted motherhood.
The best emergency contraceptives
Doctors identify several popular fire contraception drugs that are most often used to prevent unwanted conception:
Contraindications for use
But such high-dose hormonal contraception has a number of specific contraindications, which include a long history of nicotine addiction and mature age after 35, and the presence of a hereditary tendency to thromboembolism. In addition, patients suffering from severe migraine pain, a predisposition to uterine bleeding, or advanced liver and biliary pathologies will have to abandon the use of emergency contraceptives. Also, the use of such contraception is not recommended for young girls (under 16), pregnant women, and lactating patients.
If completely unformed girls of puberty take such contraceptives, they will experience serious cycle disturbances, and in some cases, irreversible infertility may develop. Also, fire contraception is not recommended for lactose intolerance, Crohn's disease, unstable and irregular menstrual cycle, for hormonal-dependent reproductive tumor processes, as well as for women with a history of ectopic pregnancy.
Emergency contraception is a fairly serious category of drugs that are unsafe to take on your own, therefore a gynecological prescription and strict adherence to the rules of administration are necessary, then unwanted conception and further abortion can be avoided.
In a woman's life there are unprotected intimacy, after which emergency contraception is necessary to prevent unwanted pregnancy. In gynecological practice they use pills against unwanted pregnancy, folk remedies with a similar effect, spirals.
Many women know about these methods, but not everyone knows how to take them correctly. Most women are sure that emergency contraceptive pills, are a panacea for unwanted pregnancy. The use of these remedies is obvious, but so is the harm. Therefore, when using them, it is worth assessing the pros and cons of the action, assessing the degree of risk and providing possible dangerous consequences.
Indications for emergency contraception
For about thirty years, emergency contraception methods have been studied by doctors, many of them have proven their effectiveness and their tolerability by women. Their gynecologists recommended after sexual intercourse, the consequences of which can lead to unwanted pregnancy, namely the following situations:
- there was no planned protection;
- there has been a shift in barrier contraceptive devices;
- the condom broke;
- oral contraceptives have not been taken for at least two days;
- injection long term action not taken;
- the spermicidal tablet did not have time to dissolve;
- ejaculation (during interruption of sexual intercourse) partially occurred in the vagina;
- incorrect definition of the “safe” period if a calendar method of protection was used;
- rape occurred.
Types of emergency contraception
If a woman does not plan pregnancy and childbirth, she should know types of emergency contraception. These include:
- intrauterine devices;
- traditional methods;
- hormonal drugs, tablets.
Timely emergency postcoital contraception will help avoid fertilization of the egg. It is enough to have an idea about the features of each possible options protection and be able to use them.
Intrauterine devices
There are reliable methods of contraception that are not medicinal. You can protect a woman from pregnancy that she does not plan with the help. This procedure is performed by a doctor within 5 days after intimacy, during which there were no means of protection.
The mechanical device provides a protective effect of 99%. IUD for emergency contraception used for women with children, victims of rape, and teenage girls.
Traditional methods
An alternative to traditional (medical) methods are folk remedies for emergency contraception. It is worth noting that they do not provide a guaranteed result. They are used when there is no opportunity to use medications.
The most effective among “grandmother’s recipes” are:
- Douching using a weak solution of fresh lemon juice. To do this, mix 200 ml of water with the juice of one large lemon and wash the vagina. To avoid disruption of the microflora, after douching, the mucous membranes must be thoroughly rinsed.
- Douching with a very weak solution of potassium permanganate. The protective effect of this procedure is about 60%, but this method must be used extremely carefully. If the concentration of the solution is incorrect, it can only cause harm. The solution is prepared in a ratio of 1:18. After douching, the genitals should be washed using mild soap for intimate hygiene.
- A slice of peeled lemon inserted into the vagina immediately after intimacy is a dangerous but effective method. Under the influence of acid, emergency contraception will occur in a few seconds. Next, the pulp is removed, the genitals need to be washed warm water with soap.
- Dangerous methods of protection include inserting a small piece of laundry soap into the vagina. After 15-20 seconds it is removed, the mucous membranes must be rinsed well. After this, it is advisable to treat them with a special moisturizer.
- For immediate protection, use an aspirin tablet. The effectiveness of its protection is about 60%.
All of the above methods of emergency intervention have a certain effect only within 5-7 minutes after intercourse. They disrupt the acid-base balance in the vagina, which has a detrimental effect on sperm, they lose the ability to fertilize.
The same destructive effect traditional methods also have an effect on the mucous membranes of the female genital organs. You can use them extremely rarely, and do not combine them for protection purposes. After using them, you need to contact your gynecologist and talk about contraception performed in a similar way.
Emergency contraception using hormonal pills
Emergency contraception is effective with the help of hormonal drugs. They contain hormones that have a suppressive effect on the maturation of the egg, inhibit the penetration of the fertilized egg into the uterus, and reject it from the uterus, disrupting the implantation process.
Valid hormonal pills differently. They cannot be used constantly; these are emergency contraceptive drugs.
If there is a risk of becoming pregnant after sexual intercourse, it is important take the pills right away after him. Their effectiveness in the first hours of admission is 94%, by the end of the third day the probability of protecting everything 57% . When resorting to emergency contraception using pills, you need to take into account the rules of administration and possible contraindications.
Applying hormonal remedies at home, You need to know that there are drug options:
- Only 1 tablet is needed to protect against possible pregnancy;
- The drug is required to be taken according to the regimen for 3 days, up to 6 tablets.
The choice of emergency contraceptive measures depends on the length of time after the act.
All contraceptive pills after an act that may have consequences must be taken strictly according to the instructions, taking into account individual characteristics body and possible complications.
Taking a hormonal contraceptive during the day
Exist medications, which will provide reliable protection if taken immediately after intimacy or within twelve hours after it. List of names of such drugs:
- Ovidon – 2 tablets;
- Non-Ovlon – 2 tablets;
- Ministison – 3 tablets;
- Rigevidon – 3 tablets;
- Marvelon – 4 tablets.
Reliably protect tablets that contain an artificial analogue of progesterone - levonorgestrel. This medicines Eskinor F, Escapelle, Postinor. The action of these drugs is based on decreased egg activity after ovulation,reducing the speed of movement of the fallopian tubes.
The egg dies under the influence of these hormonal contraceptives before reaching the uterine cavity. Even if the egg has penetrated the uterus, the mucous membrane is rejected and it is not able to implant.
Protection after the act for 72 hours
This group includes combined oral medications that contain a high concentration of hormones (estrogen, gestagen). They should be used according to the schedule in a certain dosage. They cause the endometrium to slough and cause bleeding.
Non-hormonal pills as a means of protection
Emergency contraception is possible using the latest drugs that do not contain hormones. The active ingredient is mifepristone. These drugs are: Zhenale, Mifolian, Mifetin, Ginepristone.
Their action is based on changing the inner lining of the uterus and increasing its contractile activity. As a result of these processes, the fertilized egg is unable to implant and is rejected. It is enough to drink one contraceptive capsule at any phase of the cycle.
Emergency contraception during lactation
After childbirth, the female reproductive system does not recover immediately. With the onset of lactation, she works in a special mode; contraception during lactation is difficult due to the absence of menstruation. To avoid unwanted pregnancy, which is not uncommon during breastfeeding, emergency contraception methods are used.
A reliable method of contraception when breastfeeding is insertion of an intrauterine device. There is no need to stop feeding the newborn for this. It is important to install a contraceptive no later than the fifth day after unprotected sex; it will continue to protect the woman in the future.
At breastfeeding You can use hormonal contraception after intercourse, but in this case you should adhere to strict rules:
- after taking the first protective tablet, feeding stops for 36 hours;
- in order not to disrupt the lactation process during a forced break, breast milk should be expressed and the baby should be fed with recommended milk formulas;
- You can start feeding only 36 hours after taking the last hormonal pill.
Names of drugs prescribed to breastfeeding women:
- Postinor, Escapel (contain gestagens - analogues of progesterone);
- Mifegin, Mifepristone, Agesta, Zhenale (contain antigestagens - substances that block the production of progesterone).
Very popular during breastfeeding Escapelle, as it is taken once within 72-96 hours after sexual intercourse has occurred.
Of the antigestagenic drugs, preference is often given to Zhenale, Ageste, and Ginepristone. The concentration of the active substance is only 10 mg in one tablet. This amount is quite sufficient for emergency protection, and significantly fewer adverse reactions occur.
Regular birth control pills are not suitable for emergency contraception
Despite the fact that today hormonal contraception is the most effective method of protection, the effect regular birth control pills and the means for “fire” contraception are different. Although both are developed on the basis of hormones. 
Conventional birth control pills are selected individually and are used by a woman every day throughout her menstrual cycle. Their action is aimed at suppressing the ovulation process, changing the uterine lining, and thickening cervical mucus. When asked whether regular birth control pills will help after intercourse, the answer is clear - no, if the woman has not taken them before.
Emergency contraception using hormonal drugs taken immediately after unprotected sex once, according to the instructions for the drug. The effect of such contraceptives based on egg rejection decreased peristalsis of the fallopian tubes, changes in the endothelium.
The dangers of emergency contraception
Emergency contraception is best used only in cases of extreme necessity; the consequences of such protection may become irreversible:
- ectopic pregnancy;
- bleeding;
- infertility;
- thrombus formation;
- Crohn's disease.
These drugs have many side effects:
- soreness of the mammary glands;
- nausea, vomiting;
- severe headaches;
- pain in the lower abdomen;
- increased emotionality;
- allergic reactions.
Modern medicine helps a woman plan a pregnancy. In case of unforeseen situations, you should not trust advice; only a specialist will suggest the most effective and maximum safe way prevent unwanted pregnancy.
- Emergency contraception can prevent pregnancy in 95% or more of cases when used within five days of intercourse.
- Emergency contraception can be used in the following situations: unprotected sexual intercourse, doubts about the effectiveness of the contraceptives used, incorrect use of contraceptives, sexual violence, if contraceptives were not used.
- Emergency contraception methods include the use of copper intrauterine devices (IUDs) and emergency contraceptive pills (ECPs).
- Copper IUDs are the most effective form of emergency contraception available.
- The WHO recommended emergency contraceptive pills are ulipristal acetate, levonorgestrel, and combined oral contraceptives (COCs) containing ethinyl estradiol and levonorgestrel.
What is emergency contraception?
Emergency contraception refers to contraceptive methods that can be used to prevent pregnancy after sexual intercourse. Such methods are recommended to be used within five days after sexual intercourse, but their effectiveness is higher the earlier they are used.Mechanism of action
Emergency contraceptive pills prevent pregnancy by preventing or delaying ovulation and do not cause abortion. Copper-containing IUDs prevent fertilization by causing chemical changes in the sperm and egg before they touch. Emergency contraception cannot terminate an existing pregnancy or harm the developing embryo.
Who can use emergency contraception?
Any woman or girl of reproductive age may need emergency contraception to avoid unwanted pregnancy. There are no absolute medical contraindications for the use of emergency contraception. There are also no age restrictions for its use. Emergency use of a copper-containing IUD is subject to the same acceptance criteria as permanent use.
In what cases can emergency contraception be used?
Emergency contraception can be used in some cases after sexual intercourse. These include:
- cases where no contraceptives were used;
- cases of sexual violence where the woman was not protected by an effective contraceptive method;
- cases when there is reason to believe that the contraceptives used are ineffective due to their unsuccessful or incorrect use, including for the following reasons:
- Condom rupture, slippage, or misuse;
- missing three or more combined oral contraceptive pills larger number once in a row;
- taking a progestogen-only pill (minipill) more than three hours after your usual dosing time, or more than 27 hours after your previous pill intake;
- taking a tablet containing desogestrel (0.75 mg) more than 12 hours after the usual time of administration, or more than 36 hours after taking the last tablet;
- a progestogen-only norethisterone enanthate (NET-EN) injection with a delay of more than two weeks;
- a progestogen-only depot medroxyprogesterone acetate (DMPA) injection more than four weeks late;
- introduction of a combined injectable contraceptive (CIC) more than seven days late;
- displacement, breakage, rupture, or premature removal of the diaphragm or cervical cap;
- a failed attempt to interrupt sexual intercourse (for example, ejaculation in the vagina or on the external genitalia);
- incomplete dissolution of the spermicidal tablet or film before sexual intercourse;
- when using methods based on fertility tracking: errors in calculating the abstinence period, failed abstinence or unsuccessful use of the barrier method on fertile days of the cycle;
- expulsion of an intrauterine contraceptive device (IUD) or hormonal contraceptive implant.
A woman may be provided with a supply of ECPs in advance so that she has them with her in case of need and can take them as soon as possible after unprotected intercourse.
- Code of practice for the use of contraception - in English
Transition to permanent contraception
After using ECPs, a woman or girl can return to or start using a permanent method of contraception. If a copper-containing IUD is used for emergency contraception, then additional contraceptive protection is not required.
After taking levonorgestrel-containing ECPs (LNG) or combined oral contraceptive pills (COCs), women or girls can resume their current method of contraception or start using a method, including a copper-containing IUD.
After using ECPs with ulipristal acetate (UPA), women or girls can continue or start using any progestogen-containing product (combined hormonal contraception or progestogen-only contraceptives) on the sixth day after taking UPA. They can immediately receive an IUD with LNG if it can be established that they are not pregnant. They can immediately receive a copper-containing IUD.
Emergency contraception methods
There are four methods of emergency contraception:
- FEC containing UPA;
- ECPs containing LNG;
- combined oral contraceptive pills;
- copper-containing intrauterine devices.
Emergency contraceptive pills (ECPs) and combined oral contraceptive pills (COCs)
- ECP with UPA, taken in a single dose of 30 mg;
- ECP with LNG, taken as a single dose of 1.5 mg or, as alternative option, LNG is taken in two doses of 0.75 mg each, 12 hours apart.
- COCs are taken in two doses: one dose of 100 mcg ethinyl estradiol plus 0.50 mg LNG, then 12 hours later a second dose of 100 mcg ethinyl estradiol plus 0.50 mg LNG (Yuzpe method).
Efficiency
A meta-analysis of two studies found that among women using ECPs with UPA, the pregnancy rate was 1.2 percent. Studies have found that in the case of TKA with LNG, the pregnancy rate is from 1.2 to 2.1 percent (1) (2) .
Ideally, ECPs with UPA, ECPs with LNG or COCs should be taken as soon as possible after unprotected intercourse, no later than 120 hours. ECPs with UPA, unlike other ECPs, are more effective in the range from 72 to 120 hours after unprotected sexual intercourse.
Safety
Side effects of ECP use are similar to those caused by oral contraceptive pills and include nausea and vomiting, minor, irregular vaginal bleeding, and fatigue. Side effects occur infrequently, are mild and usually resolve without any additional drug treatment.
If vomiting occurs within two hours after taking a dose of the drug, the dose should be repeated. ECPs with LNG or UPA are preferable to COCs because they cause less nausea and vomiting. Intentional use of antiemetics before taking ECPs is not recommended.
The drugs used for emergency contraception do not harm future fertility. After taking ECPs, there is no delay in the restoration of fertility.
There are no medical contraindications regarding who can use ECPs.
However, some women use ECPs intermittently or as their primary method of contraception for the reasons mentioned above. In such cases, they should be further counseled about what other more permanent contraceptive options may be more suitable and effective for them.
Frequent and intermittent use of ECPs may cause harm to women with conditions classified in categories 2, 3, or 4 of the medical eligibility criteria for use of combined hormonal contraceptives and progesterone-only contraceptives. Frequent use of emergency contraception may increase side effects such as menstrual irregularities, although occasional use does not pose any health risks.
Emergency contraceptive pills have been found to be less effective for obese women (with a body mass index over 30 kg/m2), although there are no safety concerns. Obese women should not be denied access to emergency contraception when they need it.
When counseling on the use of emergency contraceptive pills, it is necessary to talk about options for using permanent contraceptive methods, and in case of their alleged ineffectiveness, explain the correct procedure for emergency actions.
WHO recommends a copper IUD as an emergency contraceptive, to be inserted within five days after unprotected intercourse. This method is especially suitable for women who want to start using a highly effective and long-term reversible method of contraception.
Efficiency
When inserted within 120 hours of unprotected sex, a copper-containing IUD is more than 99 percent effective in preventing pregnancy. This is the most effective form of emergency contraception available. After its insertion, a woman can continue to use a copper-containing IUD as a permanent method of contraception or switch to another contraceptive method at her discretion.
Safety
Medical eligibility criteria
For emergency use of a copper-containing IUD, the same criteria apply as for permanent use. Women with medical conditions that fall within category 3 or 4 of the medical eligibility criteria for copper-containing IUDs (such as untreated pelvic inflammatory disease of infectious origin, puerperal sepsis, unexplained vaginal bleeding, cervical cancer, or severe thrombocytopenia) should not use them. for emergency purposes. In addition, a copper IUD should not be inserted for emergency contraception after sexual assault because the woman may be at significant risk for sexually transmitted infections such as chlamydia and gonorrhea. A copper-containing IUD should not be used for emergency contraception when a woman is already pregnant.
As noted in Medical eligibility criteria for the use of contraceptive methods IUD insertion may further increase the risk of PID among women at increased risk of sexually transmitted infections (STIs), although limited evidence suggests that the risk is low. Current algorithms for identifying increased risk of STIs have insufficient predictive value. The risk of STIs varies depending on individual behavior and the local prevalence of these infections. Thus, although many women at increased risk of STIs general case Although an IUD may be inserted, some women who are at high risk of having an STI should not have an IUD inserted until appropriate testing and treatment has been performed.
- Medical eligibility criteria for the use of contraceptive methods - in English
WHO recommendations for the provision of emergency contraception
All women and girls at risk of unwanted pregnancy have the right to access emergency contraception methods, and these methods should be routinely included in all national family planning programmes. In addition, emergency contraception should be included in health services for populations most at risk of unprotected sex, including services and care for women and girls who have survived sexual violence and living in humanitarian emergencies.
- Ensuring human rights in contraception programs: analyzing existing quantitative indicators from a human rights perspective - in English
WHO reaffirms its commitment to carefully review emerging evidence through its Continuous Evidence Identification (CIRE) System and to regularly update its recommendations accordingly.
- (1) Can we identify women at risk of pregnancy despite using emergency contraception? Data from randomized trials of ulipristal acetate and levonorgestrel.
Glasier A, Cameron ST, Blithe D, Scherrer B, Mathe H, Levy D, et al. Contraception. 2011 Oct;84(4):363-7. doi: 10.1016/j.contraception.2011.02.009. Epub 2011 Apr 2. - (2) Effect of BMI and body weight on pregnancy rates with LNG as emergency contraception: analysis of four WHO HRP studies.
Festin MP, Peregoudov A, Seuc A, Kiarie J, Temmerman M. Contraception. 2017 Jan;95(1):50-54. doi: 10.1016/j.contraception.2016.08.001. Epub 2016 Aug 12. -
Institute of Health. Johns Hopkins Bloomberg/Center for Information Programs and World Health Organization
