FAQ Emergency Contraception

Q.1 What is Emergency Contraception?
It is also called post coital or morning after contraception. It means prevention of pregnancy by contraception taken after unprotected intercourse.

Q.2 When should it be taken?
During the periods of Emergency of unprotected sex like condom rupture & diaphragm displacement, pill omission/missed injections/sexual assault/failure to use planned method, unsuccessful withdrawal method or expelled IUCD teenage exposure.

Q.3 What is its mode of action - does it cause abortion?
No it does not cause abortion but prevents unwanted pregnancy by preventing ovulation & fertilization or implantation of pregnancy so it has no ethical / religious implications.

Q.4 When should it be started?
It should be started with in 72 hours or 3-5 days of unprotected coitus. It is ineffective after 5 days.

Q.5 What are the available methods?
There are two methods of emergency contraception - (i) Hormonal or oral pill treatment. (ii) Intrauterine devices like Cu-T, ECPs (Emergency combined pills).

Q.6 How are oral treatment started and what preparations are available?
Oral pills should be started within 72 hours or 3 days of coitus after consulting the doctor.

Various preparations available are combined pills (containing estrogen & progesterone in various doses) like Ovral; Duoluton L, Noral, Ovral (EE 50mcg + LNG 0.25 mg) 2 tablet with in 72 hours & second dose (2tablet) 12 hours later.

POP / mini pills containing only low dose progesterone like, postinar (LNG 0.75 mg) 1 tablets within 72 hours & 2 tablets 12 hours later.

Centchroman (saheli or centro) dose & 2 tablets twice for one day & it should be given within 24 hours.

Q.7 What are side effects & disadvantages of oral treatment?
They are nausea (50-70%), vomiting (20-25%0), abnormal bleeding pattern, breast tenderness, abdominal pain, headache & dizziness.

Q.8 How to decrease its side effects & what is the recommendation if a woman vomits shortly after taking ECPs?
To decrease nausea & vomiting it should be taken with food or an antiemetic drug is given 72- hours before pills.
If vomiting occurs within 24 hours of pills intake additional dose is required.

Q.9 Will severs diarrhoea decrease effectiveness?
Severe diarrhoea can potentially reduce the effectiveness of ECPs.

Q.10 Are there important drug interaction with ECPs?
Yes drugs like anticonvulsant (phenytoin, primidone); Rifampicin (antitubercular) and antifungal (griseofulvin) may reduce its effectiveness. For woman on these drugs doubling the ECPs dose or using an IUCD for emergency contraception is recommended.

Q.11 What is the likelihood of pregnancy after a single act of intercourse?
It is 2-4% at any time of cycle and peaking to 30% on the days of maximum risk.

Q.12 May ECPs be used 4,5 and 6 days after unprotected sex?
It should be used within 72 hours for maximum effectiveness. Its failure rate is more if used after more than 72 hours.

Q.13 How effective is oral treatment?
Pregnancy rates vary form 0.2-2% with centchroman.

Q.14 If woman comes after 3 days what to advise?
She can use IUCD (intrauterine devices like Cu-T, Multi load) for emergency contraception. It can be inserted within 5-7days of expose.

Q.15 What are additional advantages of I VCD over pills?
It can be used as continuing method; it can protect against multiple coital exposures. It can be used when hormones are contraindicated. Its failure rate is (<1%).

Q.16 What are its disadvantages?
It may cause irregular bleeding.
It requires some medical person to insert it.
It cannot be used in-patients with sexual assault / STD.
It may cause pain & infection.

Q.17 Can ECPs be used for regular ongoing contraception?
No it is not recommended as it has higher dose of hormone & it causes more side - effects.

Q.18 Should ECPs use be restricted to the time around expected ovulating?
No it can be used at any time during the menstrual cycle, as it is difficult to know when ovulation occurs in a given cycle.

Q.19 Can smoking women and above 35 years of age be provided Coc for emergency coitus?
Yes they can use Coc's but IUCD may be preferred.

Q.20 How do hormone treatment effects next menstrual cycle?
98% will menstruate by 25 days after use of ECPs and in 90% Women bleeding is normal.

Q.25 What harmful effects on pregnancy occurs if emergency method fail?
There is small risk of ectopic pregnancy with IUCD.
Very remote chances of congenital defects in fetus like limbs or cardiovascular defects with ECPs.

Q.22 What are the absolute contraindications to P.C contraception?
Presentation after 7days.Thrombo-embolism in the past is contraindication to ECP's.

Q.23 What should be done if a woman has already received PC treatment & returns 3-4 days later with condom rupture? Can one use hormone treatment more than once in a given cycle?
Yes since we cannot be sure when ovulation occurs so it can be prescribed again for second or even a third time.

Q.24 When women should be called for follow -up after PC treatment?
Women should come after 3-4 weeks for follows-up visit to rule out pregnancy & get advise for method of contraception.
But if there is pain in abdomen she can be called earlier to rule out ectopic pregnancy.

Q.25 What contraception methods are appropriate for immediate initiation after use of ECPs? When are they appropriate to start?
Barriers and other hormonal methods may be initiated immediately after ECP use oral pills and injectable DMPA may be started after the onset of menses to avoid unnecessary medication if pregnancy occurs due to failure of ECPs.