What is post-coital (morning-after or emergency) contraception?
Post-coital contraception (sometimes called emergency contraception) is a method used after unprotected intercourse with the aim of preventing pregnancy. It takes about five days from ovulation (egg release) to implantation (embedding of the early embryo into the lining of the uterus). Post-coital contraception is essentially preventing implantation rather than fertilisation. This method of contraception may not be acceptable to all cultures.
Vaginal douching has been used for centuries although it is quite ineffective, as sperm will reach the protection of the cervical mucus within 90 seconds of ejaculation. Effective post-coital contraception was introduced as recently as the early 1960's when diethylstilboestrol was first prescribed. This oestrogens, however, could have adverse effects on the fetus if the pregnancy continued. Diethylstilboestrol has been replaced by ethinyloestradiol, which is the oestrogen used in most combined pills; it has a proven safe track record.
Postcoital contraception methods.
There are three methods.
- The Yuzpe method using combined oral contraceptive pills (morning after pill),
- Levonorgestrel (progestogen-only pill).
- Insertion of an IUCD.
Related Medical Abstracts - Click on the paper title:-
How do postcoital methods of contraception work?
They may:
- delay or prevent ovulation.
- reduce the chance of fertilisation.
- prevent implantation in the unlikely event that fertilisation occurs.
What is the Yuzpe method of post-coital contraception?
This is named after the Canadian gynaecologist who first described it. Four tablets of PC4 (post-coital 4 tablets) are prescribed. Each tablet contains ethinyloestradiol 50mg and 250mg levonorgestrel (or Ovran see
Table 16.1). Two tablets are taken immediately and the other two tablets 12 hours later. Nausea occurs in about 25% of cases. There may be a little bleeding two or three days after the treatment. Usually, your doctor will wish to review the situation just after your next period is due.
The term morning after pill is inappropriate and misleading as it suggests that the method must be initiated within a few hours of unprotected intercourse. The treatment should be commenced within 72 hours of a single episode of unprotected intercourse. It is less effective if taken later. Sadly many unwanted pregnancies have occurred because the women concerned had assumed that they were too late to use a morning after pill.
What is the Levonorgestrel method of Postcoital contraception?
The levonorgestrel method requires one 0.75mg tablet (Levonelle-2) to be taken as soon as possible and within 72 hours of unprotected intercourse and a further tablet to be taken 12 hours later. This method is an alternative for women who cannot be given oestrogen (Q15.8). An additional tablet should be taken if vomiting occurs within 2 hours of taking either tablet.
What is the postcoital IUCD?
An IUCD can be inserted at the time of consultation with the doctor provided that this is not more than five days later than the predicted time of ovulation. More than one episode of unprotected intercourse is not a contraindication.
How effective is postcoital contraception?
The Yuzpe method has a reported success of 98% (two pregnancies per hundred women). The reported success for the levonorgestrel method is 97% (three pregnancies per hundred women). It may be tried more than 12 hours after intercourse but failure is more likely and data is not available.
The IUCD method of post-coital contraception is more than 99% successful (less than one pregnancy per hundred women). An additional advantage is that long-term contraception is provided. From a legal point of view, an IUCD should be introduced not later than 5 days after ovulation (day 19 of a 28 day cycle) as implantation could have taken place after that time and the device would be causing pregnancy termination (abortion).
Advance provision of emergency contraception
did not reduce pregnancy rates when compared to
conventional provision.0701
Advance provision does not negatively impact
sexual and reproductive health behaviors and
outcomes. Women should have easy access to
emergency contraception, because it can decrease
the chance of pregnancy. However, the
interventions tested thus far have not reduced
overall pregnancy rates in the populations
studied.
Are there any risks if pregnancy continues
after emergency contraception?
It is possible for the pregnancy to implant in the Fallopian tubes (ectopic pregnancy-
Q12.23) so you should see your doctor quickly if pain develops in the pelvic area.
If the pregnancy is in the uterus and allowed to continue to term there is inevitably concern that the fetus may have been damaged. Early reports do not suggest a significant increased risk. Certainly there is no support for the concept that pregnancy should be terminated because of failed post-coital contraception.
There are risks associated with insertion of an IUCD (Q17.14) or taking the pill (Q15.6) but these are not specific to the post-coital situation.
Support Groups
Members of a support group, provide each other with various types of help and information for a particular shared difficulty.
The support may take the form of providing relevant information,
- relating personal experiences,
- listening to others' experiences,
- providing sympathetic understanding and
- establishing social networks.
A support group may also provide ancillary support, such as serving as a voice for the public or engaging in advocacy.
Support groups maintain interpersonal contact among their members in a variety of ways.
Support groups also maintain contact through printed information rich newsletters, telephone chains, internet forums, and mailing lists.
Support groups offer companionship and information for people coping with diseases or disabilities. Support groups may not be appropriate for everyone, and some find that a support group actually adds to their stress rather than relieving it.
Evaluation of the quality of Web sites is discussed in (internet information).
You may find that several general women's health sites may help you (internet information).
The following are more specialised Web sites on topics found in this Chapter
:-
This page was updated 7th May 2008
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