Briefly about emergency contraception

“Incidents” also happen around sex. .. Whether it’s a missed pill, a broken condom, or “forgetting” about it, the anxiety of getting pregnant after unprotected sex is familiar to many women. Fortunately, the problem has been largely solved with the advent of the so-called emergency contraception.

In our country, it is mainly used in the form of tablets, which are taken after intercourse, although preparations for injection into the uterus are also available. They are more effective than tablets and more effective over a longer period of time – up to five days – but the need for their administration by a specialist has made oral preparations the most widely used for this indication.

Tablets contain progestins or a combination of estrogens and progestins, according to which they are divided into mono- or combined preparations.

In our country, a single-dose preparation containing 1.5 mg of levonorgestrel is freely dispensed in pharmacies. The pills are very effective (but not 100 percent!) for up to 72 hours after sex. It should be noted that it drops rapidly as the interval between intercourse and reception increases, which is why it is necessary to use them as early as possible.

The group of single drugs also includes a drug containing ulipristal, which will soon be registered in the US and the EU. Ulipristal belongs to a new class of compounds called selective progesterone receptor modulators. It provides reliable contraception for up to five days after unprotected intercourse with efficacy comparable to that of levonorgestrel. In the EU, it is only available with a doctor’s prescription.

Combination pills contain high doses of estrogens and progestins. They are taken twice at an interval of 12 hours. The available clinical data show that they are less effective and lead to more frequent and more serious side effects than single drugs, so the latter has gained a much larger market share due to combination drugs.

The question of the benefits and harms of emergency contraception is truly unique in medicine. According to most medical organizations and specialists, including the World Health Organization – WHO, there is no condition under which the potential risks of taking them outweigh the benefits – avoiding unwanted pregnancy. Most clinicians prefer single drugs, especially in the presence of thromboembolic complications or migraine, so they are gradually replacing combination drugs. Moreover, according to the WHO, the US Food and Drug Administration and a number of other influential international health organizations, there are no contraindications for single drugs, so they can be considered first-line drugs when emergency contraception is needed. If there are none, they switch to combined tablets, which can be taken even in the presence of venous thrombosis and breast cancer. This is the only indication for taking estrogen-containing drugs in the presence of these conditions.

Although these products are not subject to contraindications for other hormonal contraceptives, as such they are not without potential drug interactions with hormonal drugs. This includes a decrease in their effectiveness with recent or concomitant use of hepatic enzyme inducers – St. John’s wort, some anticonvulsants, and antibiotics, especially rifampicin and rifabutin. Their intake greatly affects hormonal contraceptives, including for planned contraception. Taking rifampicin or rifabutin for several days makes hormonal contraception unreliable for the next two months. During this period, one should rely exclusively on non-hormonal contraceptives.

Due to the short-term use of emergency contraceptives, they have mostly mild and minor side effects, mainly from the gastrointestinal tract. Basically, it is nausea followed by vomiting. If vomiting occurs within two hours after taking such a drug, it is necessary to take it again, since complete absorption of the active ingredient (s) has not been determined. Next in frequency are abdominal pain, menstrual irregularities, fatigue, headache, and breast tenderness, which are usually transient. If menstruation does not occur within two weeks of ingestion, a pregnancy test is recommended. Preparations containing levonorgestrel should not be taken more than once per monthly cycle due to the risk of hormonal changes. embarrassment.

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