Emergency contraception types. Contraceptive pills after the act: types, dosages, rules for use. How emergency contraceptives work

None of the methods of contraception, with the possible exception of sterilization, is considered to be completely effective. In addition, there are cases of unprotected sex, which can lead to unwanted pregnancies. Therefore, methods emergency contraception – actual topic gynecology. There is even an International Consortium on the application of such methods, whose recommendations are taken into account in our article.

Postcoital contraception can be used by any woman of childbearing age - from the onset of the first menstruation (menarche) to 1 year after last menstrual period(menopause).

Types of emergency contraception

To prevent unplanned pregnancy in urgently in different countries use several methods:

• taking a combination of estrogens and gestagens (Yuzpe method);
• Introduction to medical institution copper-containing intrauterine device;
• use of tablets containing progestogen;
• the use of progesterone antagonists (mifepristone).

In Russia, two are most often used latest method(for other types of contraception, you can read in). However, when asked which emergency contraception is better, scientists from the World Health Organization answer that it is intrauterine contraceptive() installed within the next 5 days. It is most effective in preventing pregnancy. However, this method is expensive, not available to all women, and is not recommended for adolescents and nulliparous women.

As a result of numerous studies by scientists involved in evidence-based medicine, it was concluded that a new generation of emergency contraception is the use of preparations containing 10 mg of mifepristone.

The effect of oral medications

Emergency contraceptive pills have been studied for the past 30 years and have proven to be effective and fairly well tolerated by women. These medicines are used to prevent pregnancy during unprotected sex in the following cases:

• there were no means of planned contraception;
• there was a rupture or displacement of the condom ( one of the means), the vaginal cap, the diaphragm;
• two or more appointments were missed in a row;
• timely injection of long-acting contraceptives was not made;
• interrupted sexual intercourse ended with ejaculation in the vagina or on the skin of the external genital organs;
• the spermicidal tablet used in advance has not completely dissolved;
• error in determining "safe" days for ;
• rape.

In all these cases, you need to take the medication as soon as possible.

Two types of drugs are used:

• drugs based on levonorgestrel (progestin);
• a combination of ethinyl estradiol (an estrogen) and levonorgestrel (a progestin).

Monocomponent means can be taken once after sexual intercourse or in two doses with a break of 12 hours. Combined funds taken twice. This allows to reduce single dose and reduce the likelihood of adverse events. You should take the drug as early as possible, because every hour of delay increases the likelihood of pregnancy. However, the effectiveness is still maintained for 120 hours after intercourse, and not 72 hours, as previously thought.

How pills for emergency contraception work:

• prevent or delay ovulation;
• prevent the fusion of sperm and egg;
• impede implantation of a fertilized egg into the endometrium further development(although this claim has not been proven, and there is evidence that it is false).

The effectiveness of levonorgestrel reaches 90%, combined drugs are less effective. No drug for emergency contraception is not as efficient as modern facilities for permanent protection.

The safety of hormonal drugs

Possible unwanted symptoms:

• nausea and vomiting;
• abdominal pain;
• feeling of weakness;
• headache and dizziness;
• soreness of the mammary glands;
• bleeding from the vagina (not wearing the character of menstruation);
• start date change next menstruation(usually a week earlier or later than expected).

If menstruation after emergency contraception is delayed by more than a week, it is necessary to exclude the onset of pregnancy by buying a test in a pharmacy or by consulting a doctor. Bleeding after ingestion is harmless and will stop on its own. Its probability increases with repeated use of tablets during one cycle. However, if it occurs in combination with a missed period and abdominal pain, it is recommended to consult a doctor. This may be a sign of an ectopic () pregnancy. However, it has been proven that taking postcoital contraceptives does not increase the likelihood of such an event. Women who have had an ectopic pregnancy before may also take these drugs.

To reduce the risk of vomiting, the use of combined drugs, since levonorgestrel very rarely causes such a side effect. If vomiting occurs within two hours after taking the medicine, you need to repeat the dose. In case of intense vomiting, antiemetic drugs (Metoclopramide, Cerucal) can be used.

If you experience a headache or discomfort in mammary glands regular pain medication (paracetamol, etc.) should be used.

Emergency contraceptive pills have no contraindications, as they are considered safe. They are not prescribed for an existing pregnancy, because this makes no sense. However, if pregnancy has not yet been diagnosed, taking levonorgestrel is harmless to developing fetus. Levonorgestrel preparations are not capable of terminating a pregnancy that has already begun, so their action is not similar to medical abortion. Normal pregnancy after emergency contraception may occur in the next cycle.

Serious cases have not yet been reported negative consequences for women's health after prescribing levonorgestrel drugs for postcoital contraception. Therefore, they are allowed to be used even without a doctor's examination, including in many countries of the world they are sold without a prescription.

The use of hormones in special cases

1. Emergency contraception during lactation is considered safe for both mother and child. However, some doctors advise feeding the baby first, then taking the drug, periodically expressing milk for the next 6 hours without using it to feed the baby, and only then resume feeding. It is better if this time is up to 36 hours. If less than 6 months have passed since the birth of the child, breastfeeding and the woman is not menstruating, it is possible that she does not need to be protected, since she has not yet ovulated.
2. If more than 120 hours have passed since sexual intercourse, then the use of drugs for emergency contraception is possible, but its effectiveness has not been studied. In this case, urgent intrauterine contraception becomes preferable.
3. If during the last 120 hours there have been several unprotected contacts, then one pill will eliminate the possibility of pregnancy. However, it should be taken after the first such sexual intercourse.
4. Emergency postcoital contraception can be used as often as necessary, even during the same cycle. Harm from frequent use such drugs have not been proven in large studies, and in any case, the onset of an unwanted pregnancy is much more dangerous. However, it is much more effective and more convenient to take oral contraceptives regularly or use other elective methods.

The most commonly used emergency contraceptives

The most common drugs for postcoital protection

• Postinor;
• Escapelle;
• Eskinor-F.

One tablet contains 750 micrograms or 1500 micrograms of the hormone levonorgestrel, depending on the dosage, you need to take one or two tablets.

Although these drugs are safe once taken, they should be used with caution in the following conditions:

• severe liver disease with its insufficiency (liver cirrhosis, hepatitis);
• Crohn's disease;
• lactose intolerance;
• age up to 16 years.

Combined estrogen-progestin drugs:

• Microgynon;
• Rigevidon;
• Regulon and others.

These are monophasic contraceptives, usually used for planned protection against pregnancy, but in emergency cases they can also be used for postcoital contraception. This method of emergency contraception is recognized as the most dangerous, since estrogens in the preparations have contraindications and quite a few side effects, which are aggravated by the high dosage of hormones: 4 tablets are prescribed twice with a break of 12 hours. The use of these drugs is especially undesirable in the following situations:

• thrombosis of arteries and veins;
• migraine;
• vascular damage in diabetes, atherosclerosis, hypertension;
• severe diseases of the liver and pancreas;
• tumors of the reproductive organs;
• the period after injuries, operations, immobilization.

The main danger is an increase in blood clotting and the threat of blockage of arteries or veins by the resulting blood clots.

Non-hormonal postcoital contraception

emergency non-hormonal contraception carried out with the help of products containing mifepristone. This is a synthetic substance that blocks progesterone receptors in a woman's body. The mechanism of action of the drug includes:

• suppression of ovulation;
• a change in the inner lining of the uterus - the endometrium, which prevents the introduction of a fertilized egg;
• if, nevertheless, the implantation of the egg has occurred, under the action of mifepristone, the contractility of the uterus increases, the fetal egg is rejected.

So, the main difference between mifepristone and levonorgestrel tablets for postcoital contraception is the ability to cause a “mini-abortion”, the death and release of an egg already implanted in the uterine wall. Indications for admission are the same as for hormonal drugs- unprotected intercourse.

Preparations containing mifepristone at a dose of 10 mg:

• Agesta;
• Ginepriston;
• Genale.

Emergency contraception with Genale is possible if you are sure that the woman is not pregnant. In addition, mifepristone should be taken with great caution in such cases:

• liver or kidney failure;
• changes in the blood (anemia, clotting disorders);
• adrenal insufficiency or long-term use prednisolone;
• lactation, after taking the drug, you can not feed the baby breast milk within 2 weeks;
• pregnancy.

Means based on mifepristone can cause undesirable effects:

• bleeding from the vagina, pain in the lower abdomen;
• exacerbation chronic adnexitis, endocervicitis, ;
• dyspeptic disorders and diarrhea;
• dizziness, headache;
• weakness, fever, skin rash and itching.

Mifepristone-based emergency contraceptives cannot be used every month. It is strongly recommended to start using means for planned contraception. If, despite taking the pill, pregnancy still occurs, it is recommended to interrupt it, as there is a risk of damage to the fetus.

Mifepristone is more powerful, but also more dangerous drug to prevent unwanted pregnancy. It is recommended to take it only after consulting a doctor. The drug is dispensed by prescription.

Contraception without pills

Let's say right away that the effectiveness of the methods that will be discussed, is low, and the application is inconvenient. However, women should be aware of such methods.

In the first minute after ejaculation, while spermatozoa have not yet penetrated through the cervical canal into its cavity, douching can be done clean water or with the addition of potassium permanganate, that is, potassium permanganate. Then you should immediately insert a suppository with a spermicidal effect into the vagina.

Of course, the effect of spermicides will be much better if they are used properly - 10-15 minutes before intercourse. Candles such as Pharmatex, Contraceptin T, Patentex oval and others are used.

Contraindications for local contraception:

• inflammation of the mucous membrane of the external genital organs (, colpitis);
• individual intolerance to the drug.

intrauterine contraception

Intrauterine device T Cu 380 A

It is recommended to use copper-containing coils that release this metal into the uterine cavity. Copper has a spermicidal effect, and the presence foreign body in the uterine cavity prevents the implantation of the egg, if fertilization does occur.

Most known remedies from this group:

• T Cu-380A;
• Multiload Cu-375.

The second model is preferable because its soft shoulders do not injure the uterus from the inside, which reduces the risk of spontaneous removal of the spiral.

Introduction intrauterine contraceptive contraindicated in such cases:

• an existing pregnancy that the woman did not know about;
• tumors and inflammatory processes of the reproductive organs;
• transferred ectopic pregnancy;
• acquired immunodeficiency syndrome;
• individual intolerance;
• promiscuous sex life;
• adolescence (up to 18 years);
• anomalies in the development of the uterus, and other cases when internal form organ is changed.

So, the choice of funds for emergency contraception is quite large. Some of them are more effective, but have more restrictions on their use, others are safe, but often do not have the desired effect. In any case, postcoital contraception is preferable to terminating unwanted pregnancies.

After using any of the methods of emergency prevention of pregnancy, you must consult a doctor and choose an acceptable option for planned protection. Emergency contraception should not be used regularly, including because of its low effectiveness.

Of course, if a woman is responsible for her health, she carefully considers the best way to protect herself from all the troubles associated with the intimate side of relationships. But it is impossible to foresee everything always. Life is multifaceted, and the surprises that it sometimes brings are not always pleasant and predictable.

It happens that
- The condom breaks or slips off;
- Coitus interruptus fails;
– Missing two or more oral contraceptive pills;
– happening unprotected sex interpersonal contact (due to various circumstances).

In all these cases, the risk of becoming pregnant is quite high. However, you should not panic. It is possible to prevent unwanted pregnancy after sexual contact using the so-called emergency or postcoital contraception.

This is a representative of the old generation of hormonal drugs. One tablet contains 0.75 mg of levonorgestrel (a synthetic hormone). It must be applied in two stages. The first tablet of Postinor should be taken within 72 hours after sexual intercourse, and preferably immediately after it. next pill 12 hours after the first. The effectiveness of taking Postinor depends on how long after unprotected act you have taken this remedy:
94% - if the tablet was taken within 24 hours after the act;
86% - if the tablet was taken within 25-48 hours after the act;
57% - if the pill was taken within 49-72 hours after the act.

After taking it is not uncommon side effects:
Feeling nauseous
Vomit
Diarrhea
Dizziness
Feeling broken
Headache
Painful and unpleasant sensations in the area of ​​​​the mammary glands and in the lower abdomen
Temperature rise

Contraindications to taking Postinor are:
Severe illnesses liver (hepatitis (even previously transferred), cirrhosis).
puberty

Postinor can only be used by women with a regular menstrual cycle.

It can be used for a maximum of 96 hours from the moment of possible fertilization. Contains twice as much levonorgestrel (1.5 mg) so only one tablet is required. The risk of pregnancy is on average 1.1%. Contraindications and side effects are the same as Postinor.

Ginepriston or Agesta

However, according to the World Health Organization, the first choice for emergency contraception should be preparations containing the anti-hormone mifepristone. On the this moment available in pharmacies are Ginepriston and Agesta. Their efficiency is 98.8%. One tablet containing 10 mg of mifepristone should be taken no later than 72 hours after unprotected intercourse.

Ginepriston (Agesta) will practically not harm your work. reproductive system, but even after taking it, you may experience the following side effects:
Unpleasant sensations in the lower abdomen
Feeling weak
Headache attacks
Vomiting or nausea
allergic rash
Increase in body temperature
crash menstrual cycle

You can not use Ginepristone (Agesta) for problems with the liver and kidneys, with changes and disorders hormonal background and some other diseases.

Frequent use of Ginepristone (Agesta) reduces the effectiveness of its action.

It is necessary to use drugs intended for postcoital protection against pregnancy strictly in accordance with the instructions. This is done on an empty stomach (at least 2 hours should pass from the moment of the last meal) and do not eat anything for 2 hours after the tablets are drunk.

If emergency contraception causes vomiting within three hours after use, the effectiveness of the drug is sharply reduced. You need to take an extra dose.

Remember that even after you have taken birth control pills emergency action, after some time you need to contact your personal gynecologist:
To check for unwanted infections because these drugs do not protect against sexually transmitted diseases
To make sure that pregnancy still has not occurred (this is especially true when menstruation is delayed more than a week after taking the pills or with suspiciously meager menstrual flow).
So that the doctor, after observing your menstrual cycle for some time, prescribes, if necessary, treatment to stimulate ovarian function.

Emergency (urgent) contraception is not so harmless: they can cause hormonal disbalance and dysfunction of the reproductive system. In addition, their use is less effective than the regular use of conventional birth control pills or the careful use of condoms.

But it is better to use them than to risk: the body will cope with the consequences of taking them pretty soon, and you will have to take care of a child born as a result of an unplanned pregnancy all your life.

What to do if a condom breaks?

So, if you suspect that you might be pregnant, it's best to take the necessary steps.

1. Decide which drug you will use. It is better to opt for Ginepristone or Agesta preparations. By the way, these drugs are cheaper than Postinor.

2. Go to the pharmacy as soon as possible. Better yet, use the phone and find out what and where is available. In the pharmacy, you can be advised in the old fashioned way by Escapel and Postinor, and for Ginepristone or Agesta, require a doctor's prescription. In any case, it makes sense to go first to the gynecologist. If Ginepriston or Agesta, in principle, is not in the availability zone, then buy Escapel.

3. If you are abroad, there may be similar preparations under other names. For example, instead of Postinor, Plan B, Levonelle, NorLevo and others may meet. And if you are not ready to communicate, for example, in a Turkish pharmacy, then better drug take emergency contraception with you.

4. If you find yourself on a camping trip or in some place where the traces of civilization are barely visible, then it would be nice to take care of emergency contraception in advance. Otherwise, by hook or by crook, you should get regular birth control pills. Of course, they were not originally intended for such purposes, but in case of emergency they can be used, and very successfully. They, like the drugs described above, must be taken the sooner the better (the maximum period is 72 hours). They are used as Postinor in 2 doses (the second dose 12 hours after the first is taken) But the number of tablets in 1 dose, depending on the concentration and composition of hormones, may be different:
- Containing ethinylestradiol (MARVELON, MINISISTON, MICROGENON, FEMODEN, RIGEVIVIDON): dose - 4 tablets;
- Containing ethinylestradiol (NON-OVLON, BISECULIN, OVIDON, OVULEN, ANOVLAR): dose - 2 tablets;
– Mini-pills (MICROLUT, EXCLUTON, OVRET) contain the same active substance, as Postinor, but in very small quantities, so the dose to achieve the effect should be "shock" - 20 tablets.

And now about some psychological aspects for the young and inexperienced.

1. Girls, finding themselves in such a situation, very often begin to worry a lot about their health. Believe me, this situation happens to many, and with some, 5-6 times during an active sexual life. Excessive nervousness will harm you more than any drug.

2. If you're still young and feel the false shame of buying emergency contraception, then visit a pharmacy in another area that you'll probably never visit again.

3. Of course, it is better to ask your partner to buy pills, but, as a rule, young people are also embarrassed to do this. If your man unconditionally agrees to take matters into his own hands, you can be sure that you can count on him in the future. If not, act on your own, and you will sort out your relationship later: now you have a more urgent matter.

4. If you don’t feel moral strength at all, call a friend as a “support group”. Perhaps she will even agree to buy the drug for you, but you should not abuse this: in the end, it is best to solve your problems on your own.

5. Pills emergency assistance» are relatively expensive, but this is not a reason to refuse to buy them. Money can be asked or borrowed
– With your partner (which is quite logical)
- At a friend's
- Mom, after all

For the last two, it is better to come up with a plausible pretext, and not to name true reason However, it depends on the degree of closeness of your relationship.

In spite of big list developed reliable methods of preventing unwanted pregnancies, sometimes due to her recklessness or sexual abuse, a woman has to resort to emergency contraception. One of them includes birth control pills after unprotected intercourse, the components of which are hormone analogs or hormone-like substances. These drugs should be taken with caution as they pose a risk to women's health and may cause problems with future pregnancy.

• tablets containing levonorgestrel (postinor, escapel);
• tablets based on mifepristone (mifepristone, miropristone, ginepristone, mifegin);
• high-dose (ovidon, non-ovlon, anteovin) and low-dose (yarina, regulon, marvelon, microgynon, femoden, zhanin) monophasic combined oral contraceptives(COOK).

Levonorgestrel preparations

The active substance of postinor and escapel tablets, levonorgestrel, belongs to synthetic progestogens. Mechanism contraceptive action implemented through:

• inhibition and suppression of ovulation (release of the egg from the dominant follicle);
• changes in the structure of the inner layer of the uterus, exclusion of the conditions necessary for successful implantation fertilized egg and its further development;
• decrease in peristalsis of the fallopian tubes, slowing down the movement of the egg into the uterus;
• increase in viscosity cervical mucus, creating a mechanical obstacle to the advancement of spermatozoa.

The more time has passed since unprotected intercourse, the less effective levonorgestrel pills are in preventing unwanted conception. If the process of implantation of a fertilized egg has already occurred, then their use does not prevent normal development pregnancy. According to statistics, when taking levonorgestrel within 24 hours after sexual intercourse, the effectiveness is 95%, 24-48 hours - 85%, and after 48-72 hours - only 58%.

Important: To prevent pregnancy after unprotected intercourse, in addition to tablets, intrauterine devices are also used, the installation of which for these purposes is performed for 120 hours after intercourse.

Mifepristone-based preparations

Mifeperiston is a synthetic antiprogestogen steroid structure. Tablets based on it have a complex effect:

• disrupt the functioning of the corpus luteum;
• cause exfoliation of the endometrium;
• block the receptors of the main pregnancy hormone progesterone located in the endometrium, which prevents its normal development after implantation of the egg;
• amplify contractile activity the muscular layer of the uterus, myometrium, by increasing its sensitivity to prostaglandins.

Mifepristone and its analogues cause expulsion from the uterine cavity in a woman's body gestational sac and are means medical abortion on the early dates. After receiving it is possible heavy bleeding Therefore, they must be used strictly under the supervision of a doctor. To terminate a pregnancy, mifepristone is used for up to 7-9 weeks.

Combined oral contraceptives

After unprotected intercourse, COCs containing estrogen and progestogen, commonly used for planned contraception, are sometimes used. Their efficiency is 75-80%, which is significantly lower than that of Postinor and Escapelle. In addition, when taking high doses of hormones, the likelihood of severe side effects is significantly increased, which is why many doctors prefer levonorgestrel tablets.

The advantage of this group of contraceptive pills is a wide selection of drugs.

Interesting: The use of COCs to prevent pregnancy after sexual intercourse was named the Yuzpe method in honor of the Canadian physician Albert Yuzpe, who developed this way contraception in 1977

Indications for emergency contraception

Birth control pills for emergency contraception are used to prevent pregnancy after intercourse. The reasons why a woman decides to take such a step are very different:

• doubts about the effectiveness and correctness of the use of contraceptives used;
• rape without the use of contraceptives;
• breaking or slipping of a condom during intercourse;
• bias vaginal diaphragm or cervical cap;
• prolapse of the intrauterine device;
• skipping a COC or delaying its intake by 3-5 hours, and others.

Using birth control pills after intercourse is last resort, they should only be used when possible pregnancy poses a threat to women's health and is accompanied high risks the birth of a handicapped child.

Mode of application

The method of using contraceptive pills depends on the group of drugs and the dosage of the active substance.

Tablets with levonorgestrel are available in dosages of 0.75 mg (Postinor) and 1.5 mg (Escapel). They should be taken regardless of food intake no later than 72 hours after sexual intercourse. Postinor is drunk according to the scheme: the first tablet immediately (the sooner the better) after the act, the second after 12 hours. If vomiting occurs within 3 hours after taking the tablet, an additional one is taken.

Escapel will hold 2 times the large dosage active substance, therefore, it is used once 1 tablet, the second tablet is taken only if vomiting occurs in response to the first one.

Mifepristone preparations are recommended for use in medical institutions under the supervision of a physician. The dosage for medical abortion is 600 mg once. Take the pill orally 1-1.5 hours after light meal, washed down with a glass of water. To enhance the action is sometimes required additional reception prostaglandins (misoprostol, gynoprost). To assess the effectiveness of the drug, after a few days, a woman is given an ultrasound of the pelvic organs and the level of the hormone β-hCG is determined.

COCs to prevent unwanted pregnancy, like Postinor, should be taken within 72 hours after sexual intercourse. The regimen includes taking the tablets twice with an interval of 12 hours, regardless of meals. The dosage per dose is 100 micrograms of estrogen (ethinyl estradiol) and 500 micrograms of progestogen (desogestrel, levonorgestrel). The number of tablets is calculated for each drug individually, depending on the concentration of hormones.

Important: Prescribing emergency contraceptive pills on your own is very dangerous, as the consequences can be unpredictable. Only a doctor will be able to choose the best remedy for solving this problem, taking into account the age of the patient, her state of health and the period after sexual contact.

Negative effects of birth control pills

It is permissible to take birth control pills after an act without using contraceptives only in emergency cases, no more than once a year. They are considered safer for women's health, have fewer complications and are easier rehabilitation period than a full-fledged surgical abortion, however, their use is fraught with side effects, worsening general condition, as well as unfavorable long-term consequences. Contraceptive pills at a certain stage disrupt the normal physiological functioning of the female reproductive system, which in the future can lead to hormonal failure, difficulties in conceiving and bearing a child.

To serious negative consequences, which usually occurs with systematic or too frequent use such birth control pills include:

• high risk ectopic pregnancy;
• uterine bleeding;
• blood smearing between periods;
• infertility (especially when used by young girls);
• increased tendency to thrombosis;
• increased risk of developing Crohn's disease.

After taking the tablets, the following temporary side effects:

• pain and swelling in the mammary glands;
• nausea, vomiting, stool problems;
• headache, dizziness;
• rise in body temperature, chills;
• general weakness;
• exacerbation of chronic inflammatory processes organs of the reproductive system;
• pain in the lower abdomen of a aching or cramping character;
• allergic reactions.

Emotional disturbances are often observed.

Contraindications

Birth control pills after intercourse are serious drugs that can harm the body. Their use is contraindicated in women in case of:

• allergic reactions to any of the components of the tablet;
• severe pathologies liver, kidneys and biliary tract;
• unformed or unstable menstrual cycle;
• breastfeeding;
• history of ectopic pregnancy;
• tendency to thrombosis;
• adrenal insufficiency;
• disorders of the blood coagulation process.

You can not use drugs in the presence of hormonal dependent tumors and inflammatory processes in the organs of the reproductive system.

Video: Doctors on emergency contraception

According to international studies, 19% of Russian women had an abortion. Almost half of them - repeatedly. At the same time, according to surveys, only 1% of women in age group 16-49 years old admit that they could go for an abortion in the next three years. 54% believe they would never choose this method. Moreover, there are now emergency contraceptives that can safely prevent unplanned pregnancy when used in the first 72 hours after intercourse. More than half of the women surveyed (57%) are more likely to take a “pill next day than go for an abortion.

Modern women use all measures of reproductive planning. At the same time, many couples (17%) still resort to outdated methods of protection - calendar method and coitus interruptus - which lead to pregnancy in 25 and 27% of cases, respectively.

Indeed, even when using various ways contraception, no one is immune from failure. For example, 35% of women found themselves in a situation where the condom was torn or moved out. But also in emergency situations you don't have to think about abortion the only method problem solving.

The need for emergency contraception

Emergency contraceptive pills (ECPs) are specifically designed to prevent pregnancy after unprotected or insufficiently protected intercourse. Therefore, sometimes they are called "pills of the next day."

Especially for emergency contraception are used:

• Levonorgestrel. Dose 1.5 mg or 0.75 mg (in this case, take twice with an interval of 12 hours).
• Ulipristal acetate. Dose 30 mg.
• mifepristone. Dose 10-25 mg.

The tablets should be taken within 5 days after intercourse. Taking levonorgestrel reduces the possibility of pregnancy by 60-90% (in the case of one unprotected intercourse). The use of ulipristal and mifepristone is more effective than taking levonorgestrel.

To accept ECPs, you do not need to undergo an examination or take laboratory tests.

Emergency contraceptive pills are indicated for use when:

• no other contraceptive has been used;
• the contraceptive was used incorrectly;
• the contraceptive was used correctly, but it immediately became clear that it did not provide the desired effect.

Here are the most common situations in which ECPs may be needed by a woman using standard methods contraception.

Oral contraceptives, contraceptive patch, vaginal ring

• We started using this method at a later stage of the menstrual cycle than the instructions require.
• During the menstrual cycle did not use this method correctly.
• They took medications that could reduce the effectiveness of the method.

Progestin-only injections

• I started using this method at a later stage of the menstrual cycle than the instructions require.
• The contraceptive protection provided by the injection expired before intercourse.

Implants

• The contraceptive protection provided by the implant has expired before intercourse.

intrauterine device or system

• The tool was accidentally deleted.
• You don't feel the mustache.
• The contraceptive protection expired before intercourse.

condoms

• The condom broke, slipped, or was used incorrectly.

Diaphragm or cap

• The remedy was displaced or removed before or during intercourse.
• The tool was displaced or removed after sexual intercourse earlier than required by the instructions.

Spermicide

• Did not introduce a spermicidal agent before intercourse, as required by the instructions.
• The spermicidal tablet or film did not have time to dissolve before the onset of sexual intercourse.

Contraceptive methods based on self-determination of the fertile period

• Were in the fertile period during intercourse.
• Not sure if they were fertile at the time of intercourse.

Coitus interruptus

• Ejaculation occurred in the vagina or on the external genitalia.

Contraindications and the effect of TEC on the body

Women who plan to use ECPs are concerned about a number of issues. Let's take them in order.

1. Are there any contraindications?

Pills are not dangerous under any known circumstances: even if there are health problems. ECPs are not prescribed to women with pregnancy - they are no longer effective. However, if it is not clear whether pregnancy is present or not, ECPs may be used as there are no examples to indicate harm to the developing fetus.

But there are side effects - these are irregular vaginal bleeding, nausea, headache, pain in abdominal cavity, breast tenderness, dizziness and fatigue.

2. Effect on pregnancy

Studies of women who became pregnant despite taking levonorgestrel or used it accidentally after pregnancy show that this hormonal agent does not harm either the pregnant woman or her fetus. In particular, it does not increase the chance of miscarriage, low birth weight, birth defects fetal development or pregnancy complications. There have been only a few reports of pregnancy after taking ulipristal, but no complications have been observed.

3. Use by teenagers

4. Use in lactation

If less than six months have passed since the birth, and the woman is breastfeeding only, if there has not yet been menstruation in the postpartum period, then ovulation is unlikely to occur. Then TECs are not needed. However, women who do not meet all three criteria can become pregnant. The use of levonorgestrel during lactation is not contraindicated.

5. Use before intercourse

There is no data on how long the contraceptive effect of ECPs lasts after taking the pills. Presumably, ECPs taken immediately before intercourse are as effective as ECPs taken immediately after. However, if it is possible for a woman to plan to use a contraceptive method before intercourse, then a method other than ECP is recommended, such as condoms or another barrier method of contraception.

6. Use after several unprotected intercourse

Women should try to take ECPs as soon as possible after each unprotected intercourse; it is not recommended to postpone the reception until the end of the last sexual intercourse. However, a woman should not refrain from taking funds simply because she has had several unprotected intercourse. However, she should be aware that the effectiveness of ECPs may be limited if the earliest unprotected intercourse occurred more than 4-5 days ago. She should limit herself to one ECP at a time, regardless of the number of prior unprotected intercourse.

7. Reuse of pills

ECPs are not intended to be intentionally reused or used as regular, systematic method contraception. Women who do not want to become pregnant in the future are advised to start or continue using contraception after taking ECPs, which they have been using consistently for a long time. There are no specific data on the effectiveness or safety of the frequent use of current methods of using ECPs. However, at least 10 studies have confirmed that taking multiple doses of levonorgestrel at 0.75 mg per cycle does not cause serious negative side effects. It is not known whether the efficacy of levonorgestrel is reduced by recent or subsequent use of ulipristal, which is a progesterone receptor modulator. Therefore, if a woman who has recently taken levonorgestrel needs emergency contraception again, she is better off using the same remedy.

8. Use of ECPs in the non-fertile period

Studies have shown that fertilization as a result of sexual intercourse can only occur in the range of 5-7 days before, after or during ovulation. Theoretically, ECPs might not be needed if unprotected intercourse occurs at a different time in the cycle, since the chance of pregnancy even without ECPs would be zero. However, in practice, it is often impossible to determine whether sexual intercourse occurred on a fertile or non-fertile day of the cycle. Therefore, women should not refrain from using ECPs because of the assumption that a particular sexual act occurred during the non-fertile period.

9. Interaction with other drugs

There are no specific data on the interaction of ECPs with other drugs. However, the effectiveness of levonorgestrel may be reduced due to the use medicines, which may reduce the effectiveness of oral contraceptives.

Women who use bosentan and medicines to treat hyperacidity stomach or stomach ulcers (eg, omeprazole) or have taken them in the past month, you should consider inserting a copper-containing intrauterine device. If they opt for levonorgestrel ECPs, then they should take a double dose. Ulipristal in these cases is better not to use. Since it is a progesterone receptor modulator, it could theoretically reduce the effectiveness of other hormonal contraceptives containing the hormones progestins.

Contraception after taking ECPs

Switching to (resuming use) regularly taken contraceptives after using ECPs

ECPs do not provide contraception for subsequent sexual intercourse. Therefore, a woman should choose another method of contraception before resuming sexual life. When should this be done?

Condoms or other barrier methods of contraception

Start using immediately before your next sexual intercourse.

Hormonal methods: oral contraceptives, contraceptive patch, vaginal ring, injections, implants, levonorgestrel-containing intrauterine hormonal system.

Start using immediately - that is, on the day you take your ECP or the next day. Use the barrier method within 7 days of taking levonorgestrel or within 14 days of taking ulipristal.

Alternatively: start using after the following menstrual period, but use the barrier method in between.

By the way, before the introduction of implants or hormonal intrauterine system it makes sense to conduct a pregnancy test: this way you exclude the presence of an existing pregnancy.

If a woman has requested to have a copper-containing IUD inserted and more than 5 days have passed since the use of ECP, then this is followed after the next menstruation begins.

Sterilization

This procedure should be undertaken after the onset of menstruation following the use of ECPs. The barrier method should be used until sterilization is complete.

Since it is difficult to determine the risk of pregnancy in each individual case, and because untimely or unwanted pregnancy is fraught with serious consequences, a woman who wants to avoid conception should consider taking ECPs after intercourse during which contraceptive protection has not been adequately provided.

Remember: if you don't get your period within 3 weeks of taking your ECP, you may be pregnant.

Based on materials Science Center obstetrics, gynecology and perinatology named after academician V.I. Kulakova

Discussion

Good afternoon! I had unprotected sex with my boyfriend a week ago. What pill would you recommend to take to avoid pregnancy?

I do not support all these medoty. This is terrible

Emergency protection - not the most best way out. Now there is great amount various, convenient for everyone and safe, methods of contraception, that resorting to them is stupid.

I do not trust such methods of contraception, I think strongly negative impact on the body.

Killed: Most women wouldn't go for an abortion, but "there are now emergency contraceptives that can safely prevent an unplanned pregnancy." After all, the "next day" pill has an abortive effect - in case of conception, it prevents implantation.

A good article about the abortive effect of spirals and hormonal contraceptives incl. pills "next day" [link-1]

This one especially killed me:
3. Use by teenagers
Clinical or programmatic considerations should not limit adolescents' access to ECPs: they are safe regardless of age. Adolescents are able to understand instructions for use this method contraception.

02/03/2014 14:22:15, for life

Comment on the article "Contraceptive pills: 9 questions about emergency contraception"

You drink 4 Femodena tablets (or any other OK, but only if 72 hours have not passed since unprotected intercourse). Contraception in NPC. Hi all! What is NPC? unprotected sex? This is what I assumed from the context, but in general the first ...

Discussion

I have a similar situation, it’s too early to get married and it’s not time to become a mother either. The spirals didn’t fit, there was even a flight with them, the gynecologist picked up a drug, pills, they are called Chloe. Ugh, ugh, right now, no problems, the cycle has become like clockwork, even my breasts have begun to pancake grow, although I don’t really need it, with my natural not small size. MCH only rejoices, the weight has not changed much from them, Well, maybe a little plus, But this is most likely from the fact that I finally calmed down. That's it. I don't know, maybe it helps to each his own.

In such cases, the most sensible thing is the sterilization of the "cat".

Interruption of sexual intercourse is the removal of the male penis from the female. I had 2 spirals, and used candles, and pills. all And it applies in case of any unprotected sexual intercourse, with inefficiency barrier method(torn...

Discussion

in general, just the opposite: many douche with soda BEFORE PA, IN ORDER TO increase the chances of fertilization, tk. alkali suppresses the acidic environment of the vagina, promoting faster progression more sperm)))

Lemon and vinegar are acid, soda is alkali. Next time, better pill aspirin (also acid) dissolve in water. But in principle, if you use douching for protection, then it is not necessary to poison yourself with acid, plain water (boiled, of course) is enough. Better with chamomile. Just do it right after the PA. The less time passes, the less chance of pregnancy. In combination with an interrupted PA and an ovulation calendar, it is quite a protection.
I have ice cubes with chamomile and mint decoction at home. Usually I use them for my face, but sometimes not only :)) turn on the kettle in front of the PA and throw a few ice cubes into a glass with hot water before douching is not difficult. You can also buy chamomile in bags and brew in advance during the day.
Little chance of pregnancy. And I'm sorry I didn't pass by earlier. Here they like to call other fools names, while bursting hormonal pills like seeds.

Emergency contraception: when to start after unprotected intercourse. Girls, how long is the recovery of the cycle after a year of taking pills (to Diana)? the fact is that physically M. during the reception is not. In fact, if a woman is after 22-23 years old for ...

In our freedom-loving age, no one will even think of condemning sexual intercourse outside of marriage. Today this is a common occurrence. But only each medal has back side, as the saying goes. Chaotic sexual relations can lead to grave consequences, or in a fit of passion it will not be possible to use the proven one. Emergency contraception will be the best solution in this situation.

The concept of "emergency contraception"

Emergency contraception is an excellent backup method in case the main one fails. Just one cherished pill and there is a chance to avoid an abortion or. However, such emergency contraceptive pills should not be taken as a daily contraceptive, but only in extreme situations. Preferably no more than four times a year, as these preparations contain large doses hormones and their mechanism of action is based on the "chaos of menstruation".

Emergency contraception is urgent measures to be used if:

• Doubt it worked traditional method contraception, for example, coitus interruptus;
• There was unprotected sexual contact;
• There was a rupture of the condom or the condom slipped;
• Were not accepted contraceptives for two days in a row;
• Committed rape and other similar cases.

Emergency contraceptive methods are used during the first three days after sex. This is taking pills that contain 1.5 milligrams of levonorgistrel (it contains emergency contraceptive pills "Escapel", "Pastinor") or 30 mg of ulipristal ("Dwell"). Also, as an emergency contraceptive, you can use the installation. This should be done on the fifth or seventh day.

How are emergency contraceptives taken?

One pill of emergency contraception in the first three days will help to avoid unplanned conception. "Escapel" can be used for four days, "Advella" - 120 hours.

If you have been taking an emergency contraceptive, then you should either continue taking oral contraceptive pills during subsequent sexual intercourse. The emergency contraceptive is not a substitute for traditional means from pregnancy. Usage this drug does not exclude the possibility of protection against sexually transmitted diseases.

What are the side effects of emergency contraceptives?

When using emergency contraceptives, the following side effects may occur:

• Nausea;
• Appearance spotting between periods;
• Vomit;
• Soreness in the area of ​​​​the mammary glands;
• Headache;
• The formation of blood clots with existing varicose veins;
• Disruptions in the menstrual cycle;
• Dizziness;
• Change in the abundance of menstruation and their duration.

Most ladies can use safely emergency contraceptives. They can be used even when breastfeeding. Emergency birth control pills will not harm either the pregnant woman or the fetus. However, if you already know about the presence of pregnancy, then you can not take them. They will not terminate an existing pregnancy.

Contraindications for taking emergency contraceptive pills

• Severe migraines;
• Age over thirty-five years;
• Advanced pathologies of the liver;
• Predisposition to uterine bleeding;
• Tendency to thromboembolism;
• Long history of smoking.

Intrauterine device as a means of emergency contraception

Can also act as an emergency contraceptive intrauterine device. It must be introduced no later than 5-7 days after unprotected sexual contact. This will prevent unwanted pregnancy.

This method is more reliable than emergency contraceptive pills, but its use must be considered individual characteristics every woman. Equally important is her desire to use this method of contraception for further protection from pregnancy, and possible contraindications.

It is not recommended to use a spiral for nulliparous girls. In addition, you should not do this when in large numbers sexual contact and random connections. If there is a desire to introduce a spiral, but in the past there were inflammatory diseases genital organs, then you need to start taking antibiotics 5 days before its introduction and continue their use for 5 days after that.