Emergency Contraception

                 This is a contraceptive method which you use before you miss your period, to prevent pregnancy when you have unprotected sex.There are different nomenclature for this such as post coital pill , the morning after pill.They all mean basically the same.
                  These pills does not cause abortion.so if you are already pregnant these can not help .

                History : In older days women tried various harmful methods to prevent pregnancy following unprotected sex , such as They used to take

• Brews and concoctions orally
• Hot or cold vaginal douching with or without astringent
• Herbal drugs.

These methods were not only ineffective but was harm full too.Many oral preparations were toxic and vaginal douching frequently caused burns.

                                             Who can use emergency contraception:

• You miscalculated your safe period . Many a times even when you have sex in your safe period you might not be well protected, as your cycles might vary.
• Ruptured condom
• Forced intercourse as in rape or incest
• For aged couple who meet very infrequently
• Unprepared sex while otherwise you use conventional methods

How does it work :The exact mode of action is not very sure.But it may act through

1. Inhibition or delay of ovulation .as no ovum to meet sperm so no pregnancy
2. Prevention of implantation in an altered endometrium(the mucosal lining of your uterus).
3. Prevention of fertilization due to quick transport of sperm or ova
4. The hormone in morning after pill also thickens the cervical mucus making it impenetrable by sperm

                                                            What are the methods:

There are two methods

• Hormonal
• Mechanical--IUCD(Intra uterine contraceptive device)

Hormonal Emergency Contraceptives:

They are again of two types

• Combine Estrogen and Progesterone Pills eg The usual pills you take for contraception
• Levenorgestrel only pills eg I pill , Unwanted 72

Combine Estrogen and Progesterone Pills

The use of combined Estrogen and Progesterone pills are also known as "yuzpe regimen".

• It should be taken within 72 hours of unprotected intercourse.
• It consists of oral dose of Estrogen 0.1mg with 1 mg of dl-nogestrel repeated after 12 hours of 1st dose , When pills specially packed for emergency contraception are available ( such as Norgynon,Noral,Ovidon etc). 
• Can also take 2 tabs of OCP which contains high doses of 50 microgm EE and 250 microgm levenorgestrel (or 500 micro gm levenorgestrel) such as ovral. 2 tabs within 72 hours preferrably within 12 hour of unprotected sex and 2 tabs after 12 hours.
• When only low dose pills containing 30 microgm of EE and 150 microgm of levenorgestrel(300 microgm dl-norgestrel) such as ovral L are available 4 pills should be taken within 72 hours of unprotected sex and again after 12 hours.

Is there any risk to my baby if i become pregnant even after using these pills

There are potentially two risks

• Development of vaginal adenosis and adenocarcinoma of  children owing to the exposure to the estrogen in the womb.
• Developement of limb defect and cardiovascular defect.

The good news

The chances of occurence  of these disorder are very remote as

• The drug is given for a very short time and that too for a very short time.
• The drug is given before organogenesis starts.
• The blastocyst(very early stage of baby) is resistant to drugs before or soon after implantation.

Levenorgestrel only pills

Levenorgestrel is given in two doses 0.750mg tablets at an interval of 12 hours or more recently as 1.5mg single dose within 72 hour of unprotected intercourse. When these pills are not available you can also take minipill(30microgm).But it is not convenient as it requires you to take 25 pills at the same time.(Overette Method)

Are there any side effects : yes there are few

• Nausea : It can occur in 50% of woman.But thankfully it does not last for more than 24hours.Nausea is less if you take the pills at bed time or with milk or food. you can also try antiemetics.
• Vomiting :  20% of you will have vomiting.If you vomit within 2 hours of taking pills than you must repeat the dose.In case of excessive vomiting you can apply the dose vaginally also. Antiemetics are usually sufficient to stop vomiting.
• Irregular uterine bleeding : Few of you will have spotting after taking pill.57% of you will have your period within 3 days.15% may expect it even earlier.and in some(say around13%)menstruation will be delayed by 7 days.If there is delay of menstruation for more than 7 days you should do a urine pregnancy test .
• Other minor side effects : such as headache, dizziness,fatigue,breast tenderness may be there.Simple medication such as Aspirin or other pain relieving drugs are usually sufficient to relieve headache and breast tenderness. 

Are these effective

• The Yuzpe regimen protects about 75% pregnancies which would otherwise be expected to occur.
• Approximately 8% women can be expected to be pregnant after a single act of unprotected intercourse on a random day of the menstrual cycle.But only 2% become pregnant if they use the yuzpe regimen.
• Prevention of pregnancy rates decreases from 95% where the contraceptive is used within the first 12 hours to 47% where the interval was as long as 61 to 72 hrs.
• If you continue to have intercourse after taking these pills upto your next period there is greater chance of failure.

Which one is better? regular pills or Levenorgetrel pills?

• Failure rate in Yuzpe regimen is 3.2% to 1.1% in levenorgestrel pills
• Side effects are more with regular birth control pills than in levenorgestrel pills.

So if you need emergency contraception levenorgestrel pills are the choice.

When do I report back to my doctor?

• You should report to your doctor after your next period or if you do not get your period even after 7 days of taking these pills whichever is earlier.
• If you have acute pain in your tummy(to rule out ectopic pregnancy).
• You have severe pain in your calf muscle.
• You have difficulty in breathing/pain in your chest.
• Severe headache/numbness/dizziness or weakness.
• Blurred vision,difficulty in speaking
• If you develop Jaundice(yellowish tint in the white of your eye,skin or mucus membrane )
• As these methods are not regular contraceptive measures ,you should talk to your doctor regarding which contraceptive method is  and by better for you in your visit.

Mechanical Emergency Contraception:

IUDs such as cuT or lippes loops can be used upto 5 days of unprotected intercourse.It needs to be introduced into your uterus by an expert.

Who are the ideal candidate ?

• If you want to continue taking it as your regular contraceptive methods.
• If there is any contraindication to the use of hormonal methods.

How does it act?

• By making changes in endometrium thereby making it unsuitable for implantation of the embryo.
• By damaging the blastocyst directly around the time of insertion.

Other drugs tried as emergency contraceptives

• Ulipristal Acetate(ella) : It works up to 120 hours after intercourse.It prevents pregnancy by delaying or inhibiting ovulation and inhibiting follicle rupture.
• Mifepristone(RU486,MT pill,Mifegest) : 10mg dose is effective as emergency contraception up to 5 days following unprotected inter course with fewer side effects .

Must remember:These methods do not protect you from sexually transmitted diseases such as HIV/AIDS.