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Learn about the characteristics, mechanisms, effectiveness, and safety of emergency contraceptive pills to prevent unintended pregnancy. Includes indications, screening, counseling, and ongoing contraception importance.
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Emergency Contraceptive PillsSession I: Characteristics Emergency Contraceptive Pills
Objectives 1. Discuss the consequences of unintended pregnancy. 2. Describe the characteristics of emergency contraceptive pills (ECP) in a manner that clients can understand: a. What ECPs are and how they work (mechanism of action) b. Effectiveness c. Side effects d. Safety e. Who can use emergency contraceptive pills f. ECP regimens g. Key points for providers and clients At the end of this session, participants will be able to:
Objectives (continued) 3. Describe the indications for use of ECPs 4. Demonstrate how to screen clients for ECP use 5. Demonstrate counseling ECP clients including: a. Characteristics of ECPs b. How to address common concerns, rumors and misconceptions about ECPs c. How to use ECPs d. Possible side effects of ECPs and how to manage them e. The importance of on-going contraception after ECP use
What is an unintended pregnancy? Definition: Unintended pregnancy is “a pregnancy that is mistimed, unplanned, or unwanted.” Unintended pregnancy mainly results from the lack of, inconsistent, or incorrect use of effective contraceptive methods. Unintended pregnancy does not mean unwanted births or unloved children.
What are the consequences of unintended pregnancy? The consequences may include: • Health risks to mother. • Unsafe abortion. • Discontinuation of schooling (for adolescents). • Emotional distress. • Economic difficulties. • Disapproval from the community, especially for young, unmarried women. • Possible health risks to infants.
What are ECPs? • ECPs are hormonal methods of contraception that can reduce the risk pregnancy following an unprotected act of sexual intercourse. • There are different types of ECPs. In this training, we will be focusing on the levonorgestrel-only (LNG) and ulipristal acetate (UPA) ECPs.
ECPs: Mechanism of action ECPs interfere with the process of ovulation • ECPs do not inhibit implantation of a fertilized egg. • ECPs do not inhibit implantation of a fertilized egg. • ECPs do not cause abortion of an existing pregnancy • do not cause aboECPsdo not inhibit implantation of a fertilized egg. • ECPs do not cause abortion of an existing pregnancy • rtion of an existing pregnancy
Effectiveness of ECPs • If 100 women each had sex once during the 2nd or 3rd week of the menstrual cycle without using contraception, 8 would likely become pregnant. • If all 100 women used uliprital acetate ECPs, less than one would likely become pregnant. • If all 100 women used progestin (LNG)-only ECPs, one would likely become pregnant. • Effectiveness depends on where a woman is in her menstrual cycle, when she had unprotected sex and when she used ECPs. • Some types of ECP such as ulipristal acetate (UPA) or mifepristone are more effective than LNG-only ECPs and some (regular contraceptives- the Yuzpe regimen) less effective. • Effectiveness may be affected by use of certain medications. • Evidence suggests that ECPs may be less effective in women with higher weight and/or BMI. UPA seems to be more effective in these women than LNG.
Fertilization EC pills have no effect after fertilization, do not cause abortion EC pills work before fertilization Last Day of Menstruation Ovulation Starts Implantation Positive Pregnancy Test First Day of Cycle Day 1
Side effects of ECPs LNG and UPA ECPs are well tolerated and leave the body within a few days. Some women experience mild and short-term side effects. These may include: Changes in bleeding patterns including: • Slight irregular bleeding for 1–2 days after taking ECPs • Monthly bleeding that starts earlier or later than expected In the week after taking ECPs : • Nausea • Abdominal pain • Fatigue • Headaches • Breast tenderness • Dizziness • Vomiting
Safety of ECPs • ECPs have no known serious complications. • ECPs do not cause abortion • They are safe for use by all women including adolescents. • ECPs are not harmful if taken by a woman who is already pregnant. • ECPs have been widely used in various formulations for over 30 years.
No contraindications to the use of ECPs • ECPs have no medical precautions or contraindications. • No pregnancy test or physical examination is needed • ECPs should not be taken if a woman is pregnant because they will not work. However they will not harm an existing pregnancy • ECP effectiveness may be affected by use of certain medications
ECP regimens • UPA should be given as a single, 30 mg dose Two LNG regimens are packaged and labeled specifically for emergency contraception • 1 tablet levonorgestrel (LNG), 1.5 mg or • 2 tablets of 0.75 mg LNG to be taken at the same time.
Other emergency contraceptive options Other types of emergency contraceptives include: • Mifepristone, 10-25 mg in a single dose (not widely available) • Combined hormonal contraceptive pills (both estrogen and progestin- Yuzperegimen) • Copper IUD
Key points for providers and clients ECPs are: • The only currently available contraceptive method that prevents pregnancy after sexual intercourse and before implantation. • Safe for all women—even women who cannot use ongoing hormonal contraceptive methods. • No medical precautions or contraindications. • Few side effects. • Must be taken within 120 hours (5 days) after unprotected sex. • The sooner they are taken, the more effective they appear to be. • Do not affect an existing pregnancy if taken when a woman is already pregnant. • Provide an opportunity for women to start using an ongoing family planning method.