I took the emergency concentration pill a second time. Contraindications to taking emergency contraceptive pills. Emergency contraceptive pills

According to international studies, 19% of Russian women have had an abortion. Almost half of them - repeatedly. Moreover, according to surveys, only 1% of women in age group Those aged 16-49 admit that they could have an abortion in the next three years. 54% believe that they would never choose this method. Moreover, now there are means emergency contraception, which can safely prevent unplanned pregnancy when used within the first 72 hours after sexual intercourse. More than half of the women surveyed (57%) would rather take the “pill” next day"than they will go for an abortion.

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 At the same time, many couples (17%) still resort to outdated methods of contraception - calendar method and interrupted sexual intercourse - which lead to pregnancy in 25 and 27% of cases, respectively.

True, even if used in various ways contraception, no one is immune from failure. For example, 35% of women found themselves in a situation where a condom broke or slipped off. But also in emergency situations It is not necessary to think of abortion as the only method of solving the problem.

The need for emergency contraception

Emergency contraceptive pills (ECP) are intended to prevent pregnancy after unprotected or insufficiently protected sexual intercourse. That's why they are sometimes called "morning after pills."

Especially for emergency contraception, the following 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 sexual intercourse. Taking levonorgestrel reduces the possibility of pregnancy by 60-90% (in the case of one unprotected sexual intercourse). Ulipristal and mifepristone are more effective than levonorgestrel.

To take ECP you do not need to undergo an examination or undergo laboratory tests.

Emergency contraceptive pills are indicated for use when:

• no other contraceptive was 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 for more than late stage menstrual cycle than the instructions require.
• During the menstrual cycle, this method was not used correctly.
• We 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 sexual intercourse.

Implants

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

Intrauterine device or system

• The product was involuntarily removed.
• You don't feel the antennae.
• The contraceptive protection expired before sexual intercourse.

Condoms

• The condom has broken, slipped, or been used incorrectly.

Diaphragm or cap

• The product was dislodged or removed before or during sexual intercourse.
• The product was dislodged or removed after sexual intercourse earlier than required by the instructions.

Spermicide

• The spermicidal agent was not administered before sexual intercourse, as required by the instructions.
• The spermicidal tablet or film did not have time to dissolve before sexual intercourse began.

Contraceptive methods based on self-determination of the fertile period

• Were in the fertile period at the time of sexual intercourse.
• Unsure whether you were in your fertile period at the time of intercourse.

Coitus interruptus

• Ejaculation occurred in the vagina or external genitalia.

Contraindications and effects of ECPs on the body

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

1. Are there any contraindications?

The tablets are not dangerous under any known circumstances: even if there are health problems. ECPs are not prescribed to women who are already pregnant - they are no longer effective. However, if it is not clear whether there is a pregnancy or not, ECPs may be used as there are no examples of harm to the developing fetus.

But there are side effects - 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 who 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 likelihood of miscarriage, low birth weight, birth defects fetal development or pregnancy complications. There have been only a few reports of pregnancy occurring after taking ulipristal, but no complications have been observed.

3. Use by teenagers

4. Use during lactation

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

5. Use before sexual intercourse

There is no data on how long the contraceptive effect of ECPs lasts after taking the pill. Supposedly, ECPs taken immediately before sexual intercourse are as effective as ECPs taken immediately afterward. However, if a woman has the opportunity to plan to use a method of contraception before sexual intercourse, then a method other than ECPs, such as condoms or another barrier method of contraception, is recommended.

6. Use after several unprotected sexual intercourses

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

7. Reuse tablets

ECPs are not intended for intentional reuse or use as a regular, systematic method of contraception. Women who do not want to become pregnant in the future are advised to start or continue using contraception on a consistent, long-term basis after taking ECPs. No specific efficacy or safety data frequent use current methods of using fuel and energy complexes. However, at least 10 studies have confirmed that taking multiple doses of levonorgestrel 0.75 mg per cycle does not cause serious adverse effects. side effects. It is unknown whether the effectiveness 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, it is better for her to use the same drug.

8. Use of ECPs during the infertile period

Research has shown that fertilization through intercourse can only occur 5-7 days before, after or during ovulation. Theoretically, ECPs might not be needed if unprotected intercourse occurs at other times in the cycle, since the likelihood 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 infertile day of the cycle. Therefore, women should not refrain from using ECPs because of the assumption that a particular sexual act occurred during a nonfertile period.

9. Interaction with other drugs

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

Women who use bosentan and medications for treatment increased acidity stomach or stomach ulcers (such as omeprazole) or have taken them in the past month, you should consider inserting a copper-containing intrauterine device. If they choose the ECP levonorgestrel, then they should take double dose. It is better not to use Ulipristal in these cases. Since it is a progesterone receptor modulator, it could theoretically reduce the effectiveness of other hormonal contraceptives containing progestin hormones.

Contraception after taking ECPs

Transition to (resumption of use) regularly taken contraceptives after ECP use

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

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 ECP or the next day. Use the barrier method for 7 days after taking levonorgestrel or for 14 days after taking ulipristal.

Alternative: start using after next menstrual period, but in between use the barrier method.

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

If a woman requests to have a copper-containing IUD installed, and more than 5 days have passed since the use of ECPs, then this will be done after the next menstruation begins.

Sterilization

This procedure should be undertaken after the onset of menstruation following the use of ECPs. Until the final completion of sterilization, the barrier method should be used.

Since it is difficult to determine the risk of pregnancy in each special case, and because mistimed or unwanted pregnancy has serious consequences, a woman who wishes to avoid conception should consider taking ECPs after sexual intercourse during which contraceptive protection was not adequately provided.

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

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

Discussion

Good afternoon A week ago I had unprotected sex with my boyfriend. What pill do you recommend taking to avoid pregnancy?

I don’t support all this honeymoon. It's horrible

Emergency protection is not the best solution. Now there is one great amount There are different, convenient and safe methods of contraception for everyone, so resorting to them is stupid.

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

Killed: Most women would not have an abortion, but “there are now emergency contraception that can safely prevent unplanned pregnancy.” After all, the “next day” pill has an abortifacient effect - in the event of conception, it prevents implantation.

A good article about the abortifacient effect of IUDs and hormonal contraceptives, incl. "next day" tablets [link-1]

This one especially killed me:
3. Use by teenagers
Clinical or programmatic considerations should not limit adolescent access to ECPs; they are safe regardless of age. Teenagers 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"

Take 4 tablets of Femoden (or any other OC, but only if 72 hours have not passed after unprotected intercourse). Contraception for NPC. Hi all! What is NPK? unprotected sexual intercourse? This is what I assumed from the context, but in general the first...

Discussion

My situation is similar, 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 problem with them, the gynecologist picked up a drug, tablets, called Chloe. ugh ugh right now, no problems, the cycle became like a clock, even my breasts began to fucking grow, although I don’t really need it, with my natural not small size. MCH is just happy, the weight hasn’t changed much because of them, well, maybe a little plus, but this is most likely because I’ve finally calmed down. Just like that. I don’t know, it probably helps everyone in their own way.

In such cases, the most sensible thing is to sterilize the “cat”.

Coitus interruptus is the removal of the male penis from the female. I had coils twice, and used suppositories and pills. everything And it is used in the case of any unprotected sexual intercourse, if it is ineffective barrier method(torn...

Discussion

in general, just the opposite: many people douche with soda BEFORE PA, WITH THE PURPOSE to increase the chances of fertilization, because alkali suppresses the acidic environment of the vagina, promoting faster progress larger number sperm)))

Lemon and vinegar are acidic, soda is alkali. Next time, better than a pill Dissolve aspirin (also an acid) in water. But in principle, if you use douching for protection, then you don’t have to poison yourself with acid, just plain water (boiled, of course). Better with chamomile. You just need to do this immediately after PA. The less time passes, the less chance of pregnancy. In combination with interrupted PA and an ovulation calendar, this is quite a protection.
I have ice cubes with chamomile and mint infusion at home. I usually use them for my face, but sometimes I use them for more :)) turn on the kettle before 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 it in advance during the day.
There is little chance of pregnancy. And it’s a shame that I didn’t pass by here earlier. Here we like to call others fools, while bursting hormonal pills like seeds.

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

In our freedom-loving age, no one would even think of condemning sexual relations outside of marriage. Today this is a common phenomenon. But only every medal has back side, as the saying goes. Chaotic sexual relations can lead to serious consequences, or in a fit of passion you will not be able to use the proven one. Emergency contraception will be optimal solution In current situation.

The concept of "emergency contraception"

Emergency contraception is an excellent backup method if the main one does not work. Just one cherished pill and there is a chance to avoid an abortion or. However, these emergency contraceptive pills should not be taken as everyday contraception, but only in extreme situations. It is advisable not more than four times a year, since these drugs contain large doses of hormones and their mechanism of action is based on the “chaos of menstruation”.

Emergency contraception is an emergency measure that should be used if:

• There were doubts that it worked traditional method contraception, for example, interrupted sexual intercourse;
• Had unprotected sexual contact;
• The condom ruptured or the condom slipped off;
• Contraceptive medications were not taken for two days in a row;
• Rape and other similar cases have been committed.

Emergency contraception methods are used during the first three days after sex. This is taking tablets that contain 1.5 milligrams of levonorgistrel (emergency medicines contain it). birth control pills"Escapelle", "Pastinor") or 30 mg of ulipristal ("Dwella"). The device can also be used as an emergency contraceptive. This should be done on the fifth to seventh day.

How emergency contraception is taken

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

If you have taken emergency contraception, then during subsequent sexual intercourse you will need to continue taking oral contraceptive pills. Emergency contraception does not replace traditional means from pregnancy. Usage this drug does not exclude the possibility of protection against sexually transmitted diseases.

What side effects do emergency contraceptives have?

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

• Nausea;
• The appearance of bleeding between periods;
• Vomit;
• Pain in the area of ​​the mammary glands;
• Headache;
• Formation of blood clots with existing varicose veins;
• Disruptions in the menstrual cycle;
• Dizziness;
• Changes in the abundance of menstruation and their duration.

Most women can use emergency contraception safely. They can be used even while breastfeeding. Emergency contraceptive pills will not harm either the pregnant woman or the fetus. However, if you already know you are pregnant, you should not take them. They will not terminate an existing pregnancy.

Contraindications to taking emergency contraceptive pills

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

Intrauterine device as a means of emergency contraception

An intrauterine device can also act as a means of emergency contraception. It must be implemented no later than 5-7 days after an unprotected sexual contact. This will prevent unwanted pregnancy.

This method is more reliable than emergency contraceptive pills, but its use must be kept in mind individual characteristics every woman. Of no small importance 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 nulliparous girls. In addition, you should not do this if you have a large number of sexual contacts or casual relationships. If you want to insert 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.

During sexual intercourse, something unexpected can happen, it can happen contrary to circumstances, or a woman, while preparing for it, forgets to use contraceptives. All these events require urgent measures, especially if they occurred during the period when the lady entered the ovulation phase. Emergency contraception as a method of protection against unwanted pregnancy It lives up to its name and is used quite often. The main requirement for her is the use of contraceptives no later than three days after sexual contact.

In what cases is EC needed?

Firefighter, as it is also called, contraception must be truly operational. The sooner a contraceptive is used, the higher the likelihood that an unwanted pregnancy can be avoided. In addition, her methods must be used strictly according to the instructions, otherwise the desired effect may not be achieved.

Contraceptives, which are classified as emergency contraception, include critical dose hormones that actively affect a woman’s body. They do not allow the sperm to penetrate into the uterine cavity, and the egg is created unfavourable conditions for attachment to the endometrium.

The great advantage of such products is their availability, no need for a prescription and constant availability in pharmacies.

Urgent appointment contraceptive drugs special purpose required if:

• people did not plan sexual contact and were not ready for it;
• the man's condom broke;
• the woman forgot about taking contraceptives daily;
• her IUD or cervical cap fell out;
• the partner was unable to control himself, using the tactic of interrupted sexual intercourse;
• ejaculate by various reasons still got into the woman’s genital tract;
• the numbers in the calendar were mixed up;
• spontaneous peeling off of the contraceptive patch occurred;
• the next injection of the drug was missed;
• rape happened, etc.

All these unpleasant circumstances may well lead to an unwanted pregnancy, and if the partners are not spouses or are not connected by love, then in the event of the birth of a child, an excessive burden will fall on them.

It also happens that a husband and wife are not yet planning to expand their family due to housing or financial circumstances and are preparing for parenthood a little later.

Representatives of the fair sex who have recently become mothers and are in their period breastfeeding, it is advisable to avoid the use of such EC methods. And yet, if they are necessary, they can only be used once. But in this case, you can continue to breastfeed the baby only after a day or another period of time when the drug is completely removed from the body.

Despite the fact that such contraception They are not the method of choice for preventing unwanted pregnancy; they are still preferable to abortion. Therefore, it is better to use them at the right time.

And it’s even better to be careful and not get involved random connections, carefully monitor the phases and intake of daily contraceptives.

In addition, do not forget that most emergency contraception methods are not able to protect against sexually transmitted diseases.

Lack of conception also does not guarantee the occurrence negative reactions body. Therefore, after using such drugs, it is still advisable to donate blood for infections, do a smear for microflora, and also undergo an examination by a gynecologist.

EC methods and methods

Are used various options protection against unwanted pregnancy. The first type of contraceptives contains levonorgestrel. These drugs must be taken once no later than three, maximum four days that have passed since the intimate meeting. It is also possible for a woman to take one tablet twice every twelve hours. This is enough reliable method contraception, suppressing the ovulation phase.

This method of protection from unplanned pregnancy reliable about seventy percent of the time. How faster woman If she takes the necessary emergency contraception, the more confident she is that fertilization will not occur.

These drugs are quite safe, they have minimal negative influences on the body. But they don't pass for permanent use. Excessive passion for them can lead to disruption of the menstrual cycle and changes in hormonal levels.

Second type of contraceptives is an intrauterine device with high content copper It must be urgently implanted no later than five days after sexual intercourse. Installation of an IUD may also become reliable protection from unwanted conception.

Action intrauterine device comes down to chemical contact of ions of the substance with vaginal mucus. They negatively affect both the ejaculate and the egg. This method of protection is almost one hundred percent effective.

After the IUD is installed, a woman can use it for three to five years, depending on the manufacturer’s recommendations. After this, she will decide for herself whether to continue using the IUD or choose another method of contraception.

This in an emergency way cannot be used if pregnancy has already occurred. In addition, individual intolerance to copper must be taken into account.

The third type of contraception is the use of daily combined oral contraceptives containing the hormones estrogen and gestagen. They should be taken according to a certain scheme: take two tablets immediately after sexual contact and two more twelve hours later.

When taking these drugs, you may experience various adverse reactions in the form of nausea or even vomiting. Therefore, if this happens within an hour after taking the contraceptive, then you need to take another pill. It's better to endure it right now discomfort, since they will soon pass and do not create additional stress on the body.

Means and preparations for emergency contraception

You can take a closer look at these effective methods for EC.

Application pharmacological drugs includes pills that dramatically change hormonal background women. For urgent protection against unwanted pregnancy, contraceptives containing Levonorgestrel or Mifepristone are used.

Levonorgestrel-dominant drugs(Postinor, Escapelle or Eskinor F):

• stop the process;
• prevent the appearance of an egg formed from a follicle;
• affect the composition of vaginal and uterine mucus.

These effects make it possible to create unfavorable conditions for the fertilization process.

In addition, they do not allow the egg to gain a foothold in the endometrium. Fallopian tubes stop actively contracting. Changes and internal structure mucous membrane of the organ, which leads to its rejection. After taking Postinor or Escapella, the uterine bleeding, which does not stop for several days. Sometimes it coincides with the beginning of menstruation.

If a sperm penetrates the uterine cavity and manages to reach the egg, it will still not be able to attach to the endometrium. The embryo will not develop. The cells will die or remain immobilized and come out along with the ensuing bleeding.

Contraceptives containing Mifepristone(Zhenale, Miropriston, Mifegin or Pencrofton) also effectively suspend the ovulation phase, act on the epithelium lining the inner surface of the uterus, do not allow it to interact with the egg, and also create conditions unsuitable for fertilization. The organ itself significantly increases its tone and enhances contractility, which prevents pregnancy from occurring.

Combined contraceptives, taken according to the relevant recommendations (Logest, Marvelon, Mercilon, Microgynon, Miniziston, Novinet, Regulon, Rigevidon or Femoden). They actively influence the general hormonal background of a woman, thereby making the process of fertilization absolutely impossible. These pills are slightly less effective and are approximately eighty percent reliable. In addition, they have a range of plugging actions.

About application high copper intrauterine device has already been described in detail. It should be implemented no later than the fifth day following the sexual contact. Ions chemical substance actively influence the secretion secreted by the female genital organs, preventing possible fertilization. It is better not to use this method of contraception for women who do not yet have children, and especially for those who suffer from any diseases. For healthy women who have given birth, this method of contraception is recommended due to least amount side effects.

Whether the contraceptive worked can be determined by some characteristic features. These include the following important factors:

• menstruation did not appear three days after using EC;
• instead of them, weak ones arose bloody issues;
• breast enlargement began with swelling of the nipples;
• the woman feels sleepy all the time;
• she feels severe weakness etc.

These signs indicate an incipient pregnancy. Therefore, before using any drug, you must carefully read the instructions for use attached to it. Any minor mistake can lead to fertilization occurring.

Folk remedies EC

Many women quite effectively use home methods to prevent unwanted pregnancy. They were used by our distant ancestors when there were no methods of contraception.

Folk remedies are especially indicated in cases where it is not possible to carry out any other procedure to protect against fertilization (the partners are in a distant village or the woman has many contraindications).

Of course, it is advisable to use more reliable methods of protection, but in similar cases you have to get out of this situation on your own.

TO folk methods Emergency contraception most often includes:

• Vaginal microenema with citric acid. The solution is prepared as follows. Cup boiled water mixed with freshly squeezed juice or a teaspoon of the substance. After this, the stream is directed into the vagina and the product should remain there for at least ten minutes. Then you need to wash yourself well so as not to burn the mucous membranes.
• Application of manganese. Should Not a large number of dissolve the powder in a glass of water and douche. The solution must be pink, otherwise severe damage may occur. internal cavity organs. Acidic environment prevents motor activity sperm. In this case, also after the procedure, you need to wash yourself thoroughly with big amount soap, which creates an alkaline environment.
• Peel the lemon fruit, separate one segment and place it in the vagina. A sharply acidic pH will create extremely unfavorable conditions for conception. After using this method, exposure to a large amount of soap is also necessary.
• An Aspirin tablet inserted into a woman’s genital tract works in a similar way, which also creates a sharply acidic environment, neutralizing the activity of sperm.
• Immediately after sexual intercourse, a quarter of a piece should be placed in the vagina laundry soap, after wetting it. It should remain there for about half a minute, then it is removed and thoroughly washed with plenty of water.

It is not recommended to use these methods constantly. They can be used no more than three times a year. But, as a one-time emergency remedy, they are quite reliable. All of them have side effects and negatively affect the mucous membrane of the female genital tract. In addition, they are capable of causing strong allergic reactions.

Contraindications

Emergency contraception, as already mentioned, should only be used in the most extreme cases. But even so, there are a number of contraindications to it.

The most common ones include:

• liver failure;
• cirrhosis;
• malignant neoplasms;
• tendency to bleeding;
• increased coagulability blood;
• varicose veins veins;
• mastitis;
• myoma;
• early adolescence;
• pregnancy;
• breast-feeding;
• allergy;
• inflammatory processes;
• individual intolerance to substances included in contraceptives, etc.

These diseases do not allow you to quickly remove drugs from a woman’s body and provoke an exacerbation in her chronic diseases and increase the symptoms of inflammation.

In addition, even healthy women should not use EC constantly, much less take it into service as a daily contraceptive. This method can cause a number of complications in the body. Even its one-time use is permissible only in cases of extreme necessity, and for regular use it doesn't fit at all.

Side effects

However, even women who use emergency contraception only occasionally may experience a number of negative responses from the body. Among them, the most common is a disruption of the menstrual cycle, the appearance of bleeding in the middle, a significant delay or too much early start next menstruation. The process itself may also undergo strong changes. The discharge can become extremely scanty or excessively abundant, disappear completely within three days or drag on for ten days.

The duration of the menstrual cycle also changes in any direction, and there is also a loss of its regularity.

EC, as already mentioned, should only be used in the most extreme cases. And women must not forget that sperm are capable of long time remain in the genital tract, therefore, after the expiration of these contraceptives, nothing will interfere with the possibility of fertilization.

Besides, great value has a time factor. The faster it was applied certain drug, the more reliable the result.

Despite the presence of a large number of side effects, women actively use emergency contraception. It is better to choose such contraceptives in advance in consultation with a gynecologist and have them in the house only for extreme case. Sometimes it becomes the only means of protection against unwanted pregnancy. Therefore, representatives of the fair sex take this risk in order to avoid even more severe consequences in the form of an abortion.

After using emergency contraception, a woman needs to think about her choice permanent method protection that more reliably protects against the possibility of unforeseen conception, and also has a minimum of contraindications and side effects.

From the book “Thousands... of questions and answers on gynecology” (2008)

What is urgent (emergency) contraception?
Emergency contraception (EC) is used to prevent unwanted pregnancy in cases where, for some reason, other methods of birth control have not been used and there is high probability conception. Other names for this contraception: emergency, immediate, urgent, extreme, fire, postcoital. This contraception can prevent 75 to 90% of pregnancies. Unfortunately, most female population reproductive age even in developed countries does not know about this type of contraception, and therefore about 50% of all pregnancies that occur are not planned. 75-80% of these pregnancies are terminated through abortion. This is the only method of contraception used in cases of mental and physical trauma (rape, forced sexual intercourse) to prevent unwanted pregnancy.

What are the indications for using EC?
Emergency contraception should be carried out following cases:
. Lack and non-use of other contraceptive methods
. Violations of the integrity of the male condom
. Displacement of diaphragm or cap
. Missing 2 or more COC tablets
. Ejaculation on external genitalia
. Errors in the use of biological methods of contraception (often with irregular cycles)
. Sexual violence if the woman does not use other methods of contraception.

What types of emergency contraception are there?
IN modern medicine There is emergency hormonal contraception using hormonal drugs and emergency mechanical contraception with insertion intrauterine device.

When should emergency contraception be used to be effective?
Hormonal contraception must be carried out within 72 hours after unprotected sexual intercourse. Mechanical contraception can be carried out within 7 days after sexual intercourse.

What types of hormonal drugs are used for emergency contraception?
For emergency hormonal contraception are offered the following means:
. Estrogens (due to severe side effects, estrogens were no longer used
for emergency contraception in many countries).
. Combined estrogen-progestin drugs.
. Gestagens.
. Antigonadotropins.
. Antiprogestins.

What is the Yuzpe method?
This method was developed by Canadian physician Albert Yuzpe, who was the first to use combined oral contraceptives for the purpose of emergency contraception. The method consists of twice prescribing 200 mcg ethinyl estradiol (EE) and 1 mg levonorgestrel within 72 hours after sexual intercourse, 12 hours apart. In the USA and Canada, such a postcoital drug is marketed under the name "Ovral" (Priven), and consists of 4 tablets, each of which contains 50 mcg of ethyl estradiol and 0.50 mg of norgestrel. For the purpose of EC, you can use almost any commercially available COC, including low-dose ones, and the number of tablets will vary depending on their composition and dosage. For example, many doctors recommend taking 3 tablets of Silesta (Rigevidon, Miniziston), and 12 hours after the first dose - 3 more tablets; or 4 tablets of Marvelon (Trifasil, Triquilar) and 4 more tablets - 12 hours later. The effectiveness of the Yuzpa method of emergency contraception is 73-75% if taken within 72 hours after sexual intercourse, and about 60% if taken within 120 hours after coitus. The drug "Ovidon", containing 50 mcg of ethinyl estradiol and 250 mcg of levonorgestrel in each tablet, is recommended for twice taking 2 tablets with a break of 12 hours. The effectiveness of this method was 94%.

What progestin drugs are used for EC?
For the purpose of EC, testosterone derivatives are most often used, which are divided into levonorgestrel and porethisterone derivatives. By chemical structure they are close to natural progesterone, and therefore are capable of blocking ovulation in large doses and preventing pregnancy. The most popular drug is Postinor, one tablet of which contains 0.75 mg of levonorgestrel. To prevent pregnancy, it is recommended to take one tablet within 48 hours, but no later than 72 hours after sexual intercourse, and another tablet should be taken after 12 hours. The effectiveness of this method is 95% if used in the first 72 hours after sexual intercourse. Other drugs that are used for EC include Microlut, Microval, Micro-30, Norgeston, Neogest, Ovret, the dose of which depends on the type of drug.

What other drugs can be used for EC?
Danazol is a drug that suppresses the production of gonadotropins (LH and FSH) by the pituitary gland; it is recommended to take 600 mg twice at 12-hour intervals within 72 hours after unprotected sexual intercourse. It can be used by women with contraindications to the use of COCs. A synthetic antiprogestin known as "RU-486" is a steroidal derivative of norethisterone, Mifepristone (Mifegin), better known as a production agent. medical abortion on early stages, can also be used for the purpose of EC, at a dose of 600 mg once within 72 hours or 200 mg from the 23rd to the 27th day of the menstrual cycle. According to some reports, RU-486 can be used even within 5 weeks after unprotected sexual intercourse.

What are the contraindications for hormonal EC?
There are no absolute contraindications, other than existing pregnancy, for the use of hormonal EC. According to WHO data, science does not know any medical condition, except for allergies to drug components, which is a contraindication for the use of hormonal EC. There is only a theoretical risk of developing serious complications in women for whom COCs or progestin contraceptives are contraindicated. However, many studies have shown that, in practice, the level of complications in these categories of women is not increased after using EC.

What side effects occur after using emergency contraception?
The most common side effects that occur after using hormonal EC are:
. Nausea (23‑50%)
. Vomiting (6‑19%)
. Dizziness (11-17%)
. General weakness (17‑29 %)

What is mechanical EC?
Inserting a copper-containing intrauterine device (IUD) within 5-7 days after sexual intercourse prevents pregnancy, even if conception has occurred. According to many studies, the effectiveness of this method emergency contraception is 98.7%, which is higher than the effectiveness of hormonal EC. The IUD is usually left in the uterine cavity until the next menstruation begins or, at the woman’s request, for a longer period.

What are the contraindications for using an IUD for EC?
Before inserting an IUD, it is necessary to conduct a pregnancy test (hCG determination in urine or blood) to exclude pregnancy. In women with previous acute inflammation appendages several days or weeks before using EC, insertion of an IUD is undesirable. The presence of an acute vaginal or cervical infection is also a contraindication for EC using this method. Many practitioners, during the process of inserting an IUD, take secretions for testing to rule out gonorrhea and chlamydia, and prescribe antibiotics (doxycycline or azithromycin) and metronidazole to prevent sexually transmitted diseases.

What are the side effects of using an IUD?
The most common complaints are complaints of pain in the lower abdomen, bleeding, and exacerbation of inflammation of the appendages. IN in rare cases insertion of an IUD may be accompanied by uterine perforation.

When should a woman taking hormonal EC start her period?
According to WHO, 15% of women start their periods prematurely, 57% of women start their periods within 3 days of their expected period, and 28% of women experience a delay of 3 days or more.

Main operating principle emergency contraception(it is also called postcoital) - in disruption of the process of ovulation, fertilization or movement of the egg, as well as its implantation and further development embryo. This can be achieved different ways, both quite effective and not very effective. Moreover, we should not forget that the more effective a method of postcoital contraception can be, the more it can harm health.

Method one: immediately take a shower

The simplest, cheapest, practically harmless and ineffective way is douching, for example spermicide, boiled water with addition lemon juice or very weak solution vinegar. Yes, in acidic environment sperm must die. But since some of them only need one and a half minutes to get to the cervix and fallopian tubes, then the effectiveness of this “folk” method of protection is questionable. According to statistics, in approximately 60% of cases, such “emergency contraception” ends in pregnancy.

Method two: install a spiral

Intrauterine device (IUD) usually administered within 5 days after unprotected sex, and this method is quite effective (about 99%), but it is not suitable for everyone. And it’s difficult to call this method of preventing pregnancy “emergency” contraception. It is advisable to insert the IUD at the beginning of the menstrual cycle, when the cervix is ​​softened and there is the least risk of injury. An ultrasound and tests are required in advance; the IUD is also not recommended for those who have not given birth, those who have a large number of sexual contacts, infections or inflammatory processes of the pelvic organs.

Method three: POC

The method is effective, popular and far from safe for women's health, as it seems to some. Action progestin-only oral contraceptives(they are gestagens, ChPOK, ChPK), containing a very large amount levonorgestrel (postinor, escapelle) based on the so-called blockade of ovulation (slowing down or preventing the release of the egg) in the first phase of the cycle and blocking fertilization or implantation of the egg in the second, as well as preventing the penetration of sperm into the uterine cavity (due to the fact that hormones cause thickening of the mucus in cervical canal). The sooner the pills are taken, the better. It is recommended to take such contraceptives in the first 24-72 hours after sexual intercourse. It is believed that in the first day the effectiveness of such emergency contraception is up to 95-97%. A larger dose has a similar effect. progestin COCs (mini-pills).

The main danger of such post-coital contraception is that it greatly affects hormonal levels. It is no coincidence that it is considered undesirable to resort to this method more than once or twice a year. And, even more so, POCs cannot replace planned contraception.

Larisa Ivanova

gynecologist, Central Clinical Hospital No. 13, Moscow, doctor highest category, Ph.D.

Such pills do not provide a 100% guarantee against pregnancy. Such drugs contain a large dose of hormones, which, roughly speaking, are aimed at causing premature menstruation. They often cause severe bleeding and cycle disorders, ovarian dysfunction, normal operation which then takes a very long time to recover.

Method four: according to Yuzpe

Yuzpe method, proposed more than 30 years ago by a Canadian doctor Albert Yuzpe based on reception loading dose combined estrogen-progestogen drugs (COCs), approximately 3-6 times greater than the amount of hormones that enters the body during routine contraception. You should also take the pills no later than 72 hours after unprotected sex. Except strong influence During the menstrual cycle, a global single dose of hormones often causes side effects such as nausea, vomiting, headache, and dizziness. Doctors estimate the effectiveness of emergency contraception using the Yuzpe method at 75-90%, and even less on days close to ovulation.

Method four: progesterone steroid

Pills are again used as emergency contraception, but only based on a steroid mifepristone– an antagonist of the pregnancy hormone progesterone. Same active substance, by the way, is also the basis of drugs for medicinal abortion ( medical abortion). The effectiveness of similar emergency contraceptives (eg gynepristone) is assessed by doctors as quite high, according to some data up to 97-98%. However, they also have quite a lot of contraindications and side effects (including disruption of the ovaries and menstrual cycle).