The Importance of

Emergency Contraception:By - Dr. Ashwini Bhalerao Gandhi ,

- Consultant Gynecologist
P.D. Hinduja National Hospital & Medical
Research
Centre ,Mahim, Mumbai.
- Chairperson of Adolescent Health
Committee of The Federation of Obst. &
Gynec Societies of India (2004-2008).
- Ex Associate Professor, T.N. Medical

Historical aspects of Post coital

contraception
1. A foetus-preventing tampon of Ajowan seeds and
rock salt ground in oil.
(Sacred Vedas of the Hindus)
2. Grease, matet herb, sweet ale - cook them. To be
swallowed for four mornings.
(The Berlin Medical Papyrus; Circa 1, 300 B.C.)
3. Colocynth pulp, bryony, iron scoria, sulphur,
scammony & cabbage seed; Grind these up
thoroughly and mix with tar - Insert one after
intercourse.
(Al-Razi, 924 A.D.)

In India 78% of conceptions occurring annually

are unplanned;
25% are unwanted;
6.7 million abortions induced every year
A ratio of 10-11 illegal abortions for each
legal abortion.
(National Family Health Survey, 1995)
Contraceptive prevalence rate only 41%.

Reasons 1. Lack of awareness regarding F.P. methods

2. Lack of willingness to use the methods
3. Lacunae in service delivery system
4. Overall weakness in the social, economical
and health status of women.

Indications for Emergency

Contraception
Defn - Used after unprotected intercourse to
prevent pregnancy.
When ? 1. Not using any contraceptive
2. Sexual assault, rape, coercion
3. Recent use of suspected
teratogens cytotoxic drugs, live vaccines.
4. Sex against will, failure to plan ahead
5. Contraceptive accidents

Contraceptive accidents
Failed coitus interruptus
Ejaculation on external genitalia
Miscalculation of rhythm method
Condom rupture, dislodgment or misuse
Diaphragm / Cap inserted incorrectly,
dislodged, found to be torn or removed too
early.
Complete or partial expulsion of IUD.
Mid-cycle IUD removal due to side effects
Missed combined pills
Missed progestin - only pill.

Types of EC
1. Estrogens - 50mg of DES was first tried on a
rape victim (1960).
DES - 25 to 50mg/day for 4-5 days
EE - 2 - 5mg/day for 3-5 days
CE - 30 - 50mg/day for 2-5 days
Side effects - Nausea, vomiting, headache,
dizziness,
breast tenderness, irregular bleeding.

Types of EC - contd
2. Yuzpe method - Canadian Physician tried single dose of
100ugm of estrogen and 1 mg of dl-norgestrel (1970).
2 tabs of EE 50 ugm + LNG 250 ugm stat, to be
repeated after 12 hours.
4 tabs of EE 30 ugm + NG 300 ugm stat,to be
repeated after 12 hrs.
(PC 4, Tetragynon, Fertilan)

Types of EC - contd
3. Only Progestins - Levonorgestrel (0.75 mg) or
Norgestrel (1.5 gm) stat and repeat after 12 hrs.
LNG - Ecee 2 (German Remedies)
Pill 72 (Cipla Ltd)
Norlevo (Win-Medicare)
This method is most commonly used all over the world
today.
Mechanisms of Action 1. Inhibit / Delay ovulation
2. Effect on tubal transport
3. Hamper development of fertilized ovum
4. Prevent implantation in endometrium by making it out of
phase by hormonal imbalance
5. Does not interrupt an established pregnancy

Types of EC - contd
4. Anti Progestogen Mifepristone - 600mg single
dose of RU - 486 - MA - Competes with
progesterone for receptor binding, alters ovarian
follicular maturation, effect on ovulation /
fertilisation / tubal transport / implantation.
5. Danazol - 2 or 3 doses of 400 mg each at 12 hr
interval. MA - Anti-implantation agent.
6. Centchroman - Anti-implantation agent
7. Copper IUD - Inserted within 5 days
MA - prevent fertilization, implantation,
blastotoxic / embryotoxic.
In case of method failure - MTP recommended.

Management of a Request for EC

1. History - LMP, Duration of cycle, timings of all
unprotected acts in relation to the current cycle;
medical history; FP.
2. Examination - BP, PS-PV not mandatory (Risk of
pregnancy 20 to 30% in midcycle, under 1.0% at other
times.)
3. Contraindications for E+P - Current focal migraine,
current hepato-cellular jaundice, past H/o thrombotic
disease.
C.I. For IUD - Nulliparity, PID
4. Antiemetic 1 hr before the dose
5. Barrier method / abstinence till next period.

Counselling

Supportive non-judgemental way

Assess necessity
Explain proper use
Discuss side-effects, effectiveness
Need for ongoing contraception
First contact point for Reproductive Health
Follow - up
Within 3-4 weeks of Rx
Delay in menses of more than 1 week
Lower abdominal pain
Heavy bleeding
Next period scanty

When to start Regular

Contraception ?
Barrier methods - Immediately
IUD- Immediately
OCS - First day of next period
Injectables - within 7 days of next period
Sterilisation - After next period
Effectiveness
EC not used - 8% lead to pregnancy
Progetin only - 1% lead to pregnancy
E+P used - 2% lead to pregnancy
Most effective when taken early

Frequently Asked Questions

ECPS are not abortion pills, not an
abortifacient agent.
Dose should be repeated if vomiting occurs
within 1 hour.
Can be used at any time during menstrual
cycle.
Not a regular method of FP
Do not prevent STDS.

Frequently Asked Questions - Contd

Double ECP doses when on
anticonvulsants & antibiotics
Will not cause menses to start
immediately - may start 2 to 3 days early
or late.
Will not provide protection for the rest of
the cycle.
Will not harm a pregnancy

Legal, Ethical & Regulatory

Aspects of EC
Grossly underutilized method especially in
developing countries.
No legal risk in prescribing
Infact legal risks incurred if the client not
told about EC.
Will it promote irresponsible, promiscuous
life-style specially in adolescents ?
Can be provided even in countries where
abortion is illegal.

Legal, Ethical & Regulatory

Aspects of EC - contd
Should be available over-the-counter
(No counselling, no follow-up)?
Desirable to hold a dialogue between
medical community, drug regulatory
bodies, youth & women activist groups.

The Worlds Best

Contraceptive Secret !!

Thanks to all contributors.

Dr Adarsh Bhargava.
Dr Ashwini Bhalerao.
Dr Alka Kriplani.
Dr. Kalpana Apte.
Dr Mala Arora.
Dr.Meenakshi Bharath.
Dr. Mandakini Parihar.
Dr.Nozer Sheriar.
Dr.Parikshit Tank.
Dr. Roza Olyai.
Dr.Sasikala Kola.