Dr. Álvaro Monterrosa Castro, MD
TO Despite the availability of highly effective contraceptive methods, many pregnancies are unwanted. These pregnancies carry a higher risk of morbidity and mortality. Especially due to abortion performed in unsafe conditions (196).
The concept of emergency contraception, long known as post-coital contraception. It refers to the use of some methods that women can resort to to prevent pregnancy when they have already had unprotected intercourse. (196,197,198,199).
Emergency contraception is given before pregnancy occurs, therefore it is not abortive. Indicating when unexpected sexual relations occur. When the condom breaks or slips during intercourse. When you are a user of oral contraceptives but have forgotten to take more than two pills. Or in cases of sexual assault (196,197,200).
The application of an intra-uterine device has been recommended in the hours following intercourse. (196,200).
The most commonly used methods are: administration of only progestogens (minipills) at high doses. And the administration of high concentrations of steroid hormones, including oral contraceptives, incorrectly called “morning after pill”.
It has been evaluated for years and has recently become popular. The administration of combined oral contraceptives according to the regimen known as the Yuzpe method. Safe and highly effective contraceptive measure (197,200,201).
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Yuzpe’s method is: administer 2 macrodose oral contraceptive tablets.
That includes 50 ug of Ethinyl-estradiol and 250 ug Levonorgestrel (Noral ®, Neogynon ®). In the first 72 hours after unprotected intercourse and repeat 12 hours later.
If macrodose tablets are not available. 4 microdose tablets may be administered including 30 ug of Ethinyl-Estradiol and 150 ug of Levonorgestrel (Nordette ®, Microgynon ®). In the first 72 hours after unprotected intercourse and take another 4 pills 12 hours later (197,202,202). Recently, the use of oral contraceptives that include Gestodene, Desogestrel or Norgestimate has been included in the scheme. (203).
If the woman vomits before three hours have passed. From the moment she took the first or second pill. She can take an antiemetic, such as Metoclopramide. And thirty minutes later take the supposedly vomited tablets again.
Always in the first and second intake, the pills must be the same brand. Taking a greater number of tablets than indicated is useless and may increase adverse effects. (197, 200, 203, 204). For the rest of the cycle, a barrier method should be used when having new intercourse.
Menstruation usually occurs on or before the expected date. If menstrual delay occurs, the existence of pregnancy should be diagnosed. The woman must receive sufficient instructions and motivation so that with the arrival of her menstrual period she begins a regular family planning method. Emergency contraception should not be a regular planning method and should be administered by medical prescription (200).
The Yuzpe method has a failure rate of up to 2% if the woman has used it correctly.
Which represents a considerable decrease in the risk of pregnancy, compared to not using emergency contraception. (197,200,203).
Depending on when the woman uses the pills as emergency contraception during the menstrual cycle. The combination may prevent ovulation, fertilization or implantation (205). It is believed that it basically modifies the endometrial lining, preventing implantation (190,203). The Yuzpe method is not abortive and is not effective when the implantation process has begun. (200).
46% of women present nausea, 22% vomiting, 23% dizziness and 20% breast tension. They may frequently experience headache. These effects generally take no more than 24 hours. (206).
Yuzpe’s method is safe. Even in women who cannot regularly take oral contraceptives. Although the concentration is high, the administration time being short, they can be used without fear even in women with cardiovascular pathology.
The World Health Organization asserts that the only contraindication to using pills in the emergency contraception scheme is the existence of pregnancy (203). If the method fails, a deleterious effect of these hormones on the embryo has not been proven. (139).
Emergency contraception should be part of the normal education program for Doctors, Nurses and Health service providers. (203). In Italy in 1995, the Bellagio consensus on emergency contraception was developed. Where it was stated that women around the world should have access to this safe and effective method. To prevent unwanted pregnancy and avoid the need for unsafe abortion (199,203).
Studies are being done to make emergency contraception more accessible and useful.
Vaginal administration of oral contraceptive pills is being tested. This route apparently has the same effectiveness in preventing pregnancy. Although the incidence of nausea and vomiting is not reduced, it is not necessary to repeat the post-emesis dose. Studies are being carried out with other progestogens trying to extend the 72-hour limit and the administration of a single dose is being tested. (203).
In most countries doses are taken from a package of oral contraceptives for monthly use. In Western Europe, specific commercial presentations for emergency contraception are beginning to be available. This is how the product is available Tetragynon ® containing 4 macrodose tablets of Ethinyl-estradiol and Levonorgestrel. To be issued under absolute medical prescription (62,203).
Dr. Álvaro Monterrosa Castro, MD
