Dr Ruzigana George OBGyn CHUB OUTLINE Objectives Introduction of Emergency Contraception ECP When to prescribe ECP Side effects of ECP and Management Effectiveness of ECP Choice of future contraception options ID: 998566
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1. Emergency ContraceptionPrepared by Dr Ruzigana GeorgeOB-Gyn CHUB
2. OUTLINEObjectivesIntroduction of Emergency Contraception (ECP)When to prescribe ECPSide effects of ECP and ManagementEffectiveness of ECPChoice of future contraception optionsSummary
3. Objectives1. Define Emergency Contraceptives2. List types of Emergency Contraceptives3. Candidates for Emergency Contraceptives4. Discuss Mechanisms of Action5. Explain common side effects of ECPs
4. DefinitionUse of Drugs/Medications or a device as an emergency measure to prevent pregnancyECPs are called Plan B, Morning After Pill or Post Coital Contraception.
5. Pills or Devices for Emergency ContraceptionSpecial ECPs with : Progestin (Levonorgestrel) Estrogen and LevonorgestrelProgestin Only Pills (Levonorgesrel or Norgestrel)Combined Oral Contraception with Estrogen and ProgestinIntrauterine Contraceptive Device (IUCD)
6. When to Take ECPs?As soon as Possible after unprotected SexAny time up to 5 days after unprotected Sex.
7. Who is a candidate for ECPs?All women can use ECPs safely and effectively Unprotected sexCondom rupture, slippageMissed pills 3 or more doses for combined oral contraceptive pills 1 dose of progestine-only oral contraception pill within 12 hoursSexual Assault
8. Dose(s) of Emergency Contraceptive pillsProgesterone only dedicated product (post pill) • 1.5 mg of levonorgestrel in a single dose or • 0.75 mg levonorgestrel (follow with same dose 12 hours later) • Most recommended ECPs
9. Dose(s) ECPs (cont’d)Estrogen progestin dedicated product0.1 mg ethinyl estradiol + 0.5 mg levonorgestrel (follow with same dose 12 hours later)Progestin-only pills with levonorgestrel or norgestrelLevonorgestrel pills 1.5 mg in a single doseNorgestrel pills 3 mg in a single dose
10. Dose(s) ECPs (cont’d)Combined oral contraceptives0.1 mg ethinyl estradiol + 0.5 mg levonorgestrel (follow with same dose 12 hours later)0.1 mg ethinyl estradiol + 1 mg norgestrel (follow with same dose 12 hours later)0.1 mg ethinyl estradiol + 2 mg norethindrone (follow with same dose 12 hours later)
11. Effectiveness of ECPs
12. Mechanism of Action
13. Side effects ECPsBleeding pattern changes earlier or laterNausea and sometimes vomitingIf any GI Side effects from Emergency Contraceptive use can be offset by Antiemetic medications.
14. Misconceptions about ECPsEmergency contraceptive pills:Do not cause abortionDo not cause birth defects if pregnancy occursAre not dangerous to a woman’s healthDo not promote risky sexual behaviorDo not make women infertile
15. Follow-upNo routine return visit is required. However, a woman should seek follow-up care if:She has missed her Menses by more than one week.She presents with signs/symptoms of pregnancy.
16. Planning for Future ContraceptionECPs does not protect from future pregnancyGive options for all types of contraceptionInvite her to come back anytimeIf possible, give her more ECPs (for future use)
17. Planning for Future ContraceptionShould women use ECPs as a regular method of contraception? No ↑ Nearly all other contraceptive methods are more effective in preventing pregnancy. Women who use ECPs regularly are at high risk to have unintended pregnancy.
18. IUCDShould be inserted within 5 DaysHighly effectiveCan remain in place for up to 10 yearsGood option for long-term contraception
19. Contraindications for IUCDUterine anomaliesAcute pelvic inflammatory disease or in the past 3 monthsPelvic malignancies: Cervical or endometrial cancerUndiagnosed abnormal vaginal bleedingAllergies to copper
20. Other Methods of ECPsUlipristal acetateHighly effective and well-toleratedCan be taken up to 5 days after unprotected sexBelieved to be more effective than levonorgestrel ECPsMifepristoneHighly effective, with few side-effects
21. SummaryEmergency contraceptives/IUCD prevent pregnancy when taken up to 5 days after unprotected sexLevonorgestrel-only dedicated is the most recommended type of ECPsEmergency contraceptives do not disrupt an existing pregnancyECPs are safe for all womenECPs are not recommended as regular contraceptive methodsECPs do not protect against Sexually transmitted Infections (STIs) including HIV.If there is a risk of STI/HIV, the correct and consistent use of condoms is recommended.