Situations when emergency contraception is appropriate - details about pills

Situations when emergency contraception is appropriate.

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Emergency contraception can be appropriate:
. in cases where the woman has not used contraception
. in cases where sex has been forced or coerced, or the woman has been raped
. when a woman must deal with a contraceptive mistake, such as a
condom breaking or used incorrectly, an IUCD dislodging, a diaphragm removed too early, or the man failing to withdraw before
ejaculation.

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Emergency contraceptive pills
Emergency contraceptive pills (ECPs) are hormonal methods of
contraception that can be used to prevent pregnancy following unprotected
sexual intercourse. Some women call this method ‘morning-after pills’or ‘post￾coital pills’.
ECPs contain the same concentrated dose of hormones found in daily
contraceptive pills. You will remember from your study session on oral
contraceptives that these comprise combined pills containing oestrogen and
progesterone, and pills containing progesterone only.
The exact mechanism by which emergency contraceptive pills prevent
pregnancy is not completely understood. But the principles behind the
mechanism of action are summarised in Box.  If a woman is already pregnant when she uses ECPs, they will not cause an
abortion, or any disruption to the fertilised egg, once implantation has taken
place. So they do not affect an existing pregnancy.
Women who take ECPs should understand that they could still become
pregnant the next time they have sex, unless they immediately start using
another method of contraception. This is because ECPs delay ovulation in
some women, so they may be at their most fertile soon after taking ECPs. You
should therefore advise women that they use condoms until the beginning of
their next menstrual period. For ongoing protection from pregnancy, they must
start using another contraceptive method at once.

Combined emergency contraceptive pills
Combined emergency contraceptive pills are formulations of oestrogen
(commonly ethinyl estradiol) and progesterone (commonly levonorgestrel or norgestrel).

 There are two common types of combined emergency contraceptives available in Ethiopia, and it is recommended that they be taken
within five days following unprotected sexual intercourse.

1. The Neogynone pill contains 50 mg ethinyl estradiol and 0.5 mg norgestrel. You give two pills as the first dose as soon as convenient within five days (120 hours) after unprotected sexual intercourse. The second dose of the two pills should be after 12 hours. This is a total of four pills within a 12 hour period.
2. The Eugynon pill contains 30 mg ethinyl estradiol and 0.3 mg norgestrel.
   You give four pills as the first dose within five days (120 hours) after
   unprotected sexual intercourse, and another four pills after 12 hours as a
   second dose. This is a total of eight pills within a 12 hour interval.

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Progestin-only pills

The progestin-only or levonorgestrel pill has less effect than the combined
one, but has fewer side-effects. The timing of the pill is the same as above.

•  The Postinor pill contains 0.75 mg levonorgestrel. You give one pill as afirst dose within five days (120 hours) of unprotected sexual intercourse,and the second dose of one pill should be repeated 12 hours after the first dose.
• If the only pill available is Microlut or Norgeston, which only contain 0.03
  mg Levonorgestrel, then give 20 pills for the first and the second dose,
  each dose 12 hours apart, so a total of 40 pills are needed.