Emergency Contraception

EMERGENCY CONTRACEPTION
SHUMI NEGESSE, MD
ASSISTANT
PROFESSOR, ADAMA HOSPITAL MEDICAL COLLEGE
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
Outline
• Objectives
• Introduction of emergency contraceptives
• Types of emergency contraceptives
• When to prescribe emergency contraceptives
• Side effects of emergency contraceptive pills (ECPs) and management
• Effectiveness of ECPs
• Discussion of future contraception options
• Summary of the presentation
Objectives
1. Define emergency contraceptive

2. List types of emergency contraceptives
3. Identify candidates for emergency contraceptives
4. Discuss mechanisms of action
5. Explain common side effects of emergency contraceptive
pills
Definition
• Use of drugs or a device as an emergency measure to prevent

pregnancy
• ECPs are also called: “Morning After Pill” or post-coital
contraceptives
Pills or Devices for Emergency Contraceptive
• Special ECPs with
• the progestin (levonorgestrel)
• estrogen and levonorgestrel
• Progestin-only pills with levonorgestrel or norgestrel
• Combined oral contraceptives with an estrogen and a progestin
• levonorgestrel
• norgestrel or norethindrone
• Intrauterine contraceptive device (IUCD)
When to take Emergency contraceptives?
As soon as possible after unprotected sex
Any time up to 5 days after unprotected sex

Emergency Contraceptive Pills
• Who is a candidate for ECPs?
• All women can use ECPs safely and effectively
• Unprotected sex
• Condom rupture, slippage
• Missed pills, 3 or more doses
• Sexual assault
No known medical conditions make ECPs unsafe for any woman

Dose(s) of Emergency Contraceptive Pills
• Progesterone 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
Dose(s) of Emergency Contraceptive Pills (cont’d)
• Estrogen progestin dedicated product

• 0.1 mg ethinyl estradiol + 0.5 mg levonorgestrel (follow
with same dose 12 hours later)
• Progestin-only pills with levonorgestrel or norgestrel
• Levonorgestrel pills 1.5 mg in a single dose
• Norgestrel pills 3 mg in a single dose
Dose(s) of Emergency Contraceptive Pills (cont’d)
• Combined oral contraceptives

• 0.1 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)
Effectiveness of ECPs
Facts About ECPs
• Emergency contraceptive pills:

• Do not cause abortion
• Do not cause birth defects if pregnancy occurs
• Are not dangerous to a woman’s health
• Do not promote risky sexual behavior
• Do not make women infertile
Side Effects of ECPs and Management
• Changes in bleeding patterns may include:

• Slight irregular bleeding for 1–2 days after taking ECPs
• Monthly bleeding that starts earlier or later than expected
• Nausea
• Routine use of anti-nausea medications not recommended
• Give anti-nausea medication for clients with
• previous ECPs use
• first dose of a 2-dose regimen
• Vomiting: If within 2 hours after taking ECPs give another dose
Side Effects of ECPs and Management (cont’d)
• No routine return visit is required

• However, a woman should seek follow-up care if:
• She thinks she might be pregnant
• She has no monthly bleeding
• Or her next menses is delayed by more than one week
Planning Future Contraception
• ECPs does not protect from pregnancy

• If she does not want to start a contraceptive method now
• give condoms
• oral contraceptives
• Invite her to come back anytime
• If possible, give her more ECPs (for future use)
Planning Future Contraception (cont’d)
Should women use ECPs as a regular method of contraception?

No
Ø Nearly all other contraceptive methods are more effective in preventing

pregnancy
Ø Women who use ECPs regularly are at high risk to have unintended
pregnancy
IUCD (Copper IUCD)
• Should be inserted within 120 hours

• Highly effective
• Can remain in place for up to 10 years
• Good option for long-term contraception
Some Contraindications for IUCD
• Uterine abnormalities/anomalies
• Acute pelvic inflammatory disease or in the past 3 months
• Pelvic malignancies: Cervical cancer and endometrial cancer
• Undiagnosed abnormal vaginal bleeding
• Allergies to copper
Other Types of Emergency Contraceptive
• Ulipristal acetate
• Highly effective and well-tolerated
• Can be taken up to 5 days after unprotected sex
• Believed to be more effective than levonorgestrel ECPs
• Mifepristone
• Highly effective, with few side-effects
•Both are not included in our guideline
Case Study
• 20 year old female college student

• Unprotected sex 12 hours back
• Last normal menses was 2 weeks back
• Unmarried, with no immediate plan for children
• On antibiotics for pelvic inflammatory disease
Which of the emergency contraceptive do you recommend

based on Ethiopian Ministry of Health family planning guideline?
Case Study (cont’d)
•Levonorgestrel-only dedicated pills
or
•Postpill
Summary
• Levonorgestrel-only dedicated is the most recommended type of

ECPs
• Emergency contraceptives prevent pregnancy when taken up to
5 days after unprotected sex
• Emergency contraceptives do not disrupt an existing pregnancy
• ECPs are safe for all women
• ECPs are not recommended as regular contraceptive methods

Emergency Contraception

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EMERGENCY CONTRACEPTION

1. Define emergency contraceptive

• Use of drugs or a device as an emergency measure to prevent

As soon as possible after unprotected sex

Any time up to 5 days after unprotected sex

No known medical conditions make ECPs unsafe for any woman

• Progesterone only dedicated product(post pill)

• Estrogen progestin dedicated product

• Combined oral contraceptives

• Emergency contraceptive pills:

• Changes in bleeding patterns may include:

• No routine return visit is required

• ECPs does not protect from pregnancy

Should women use ECPs as a regular method of contraception?

Ø Nearly all other contraceptive methods are more effective in preventing

• Should be inserted within 120 hours

• 20 year old female college student

Which of the emergency contraceptive do you recommend

•Levonorgestrel-only dedicated pills

• Levonorgestrel-only dedicated is the most recommended type of

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