Emergency contraceptives. Means and methods of emergency contraception. Types of urgent contraceptives

Mifepristone

The action of drugs from the second group of emergency contraceptive pills (containing mifepristone - Genale, Mifegin, Pencrofton, Miropristone) approximately corresponds to that of tablets, which include levonorgestrel:

• inhibition of ovulation;
• structural changes in the endometrium (mifepristone, the active component of this group of drugs, has antiprogestogenic activity, it blocks receptors in the uterine mucosa that respond to progesterone, the hormone of pregnancy, as a result, the endometrium does not undergo changes necessary for implantation);
• increased contractile activity of the uterus, which contributes to the expulsion of a fertilized egg that has not attached to the uterine mucosa from its cavity.

When is postcoital contraception acceptable?

Life is life, and sometimes it throws up situations that seem hopeless. It is possible to prevent unwanted pregnancy with the help of birth control pills, which should be taken after sexual intercourse.

But it should be borne in mind that it is better never to use them at all, since the indications must be very serious when the risk of an unplanned pregnancy and possibly in the future:

• rape;
• damage or slipping of the condom during intercourse;
• prolapse (expulsion) of the spiral or displacement of the vaginal diaphragm;
• skipping oral combined contraceptives.

How to take pills in case of unprotected sex

To maximize the effectiveness of contraceptives for emergency contraception, you need to know the rules for taking them:

Tablets containing levonorgestrel

Postinor is used no later than 72 hours after intercourse without the use of contraceptives. The first tablet is drunk immediately (the faster, the better), the second after 12 hours (maximum after 16). In case of vomiting, an additional dose of Postinor should be taken. Escapelle or Eskinor F are taken in the amount of one dose (tablet) once within the same 72 hours. Whether birth control pills after intercourse will help depends on the time that has passed between unprotected intimacy and taking the drug:

• If a levonorgestrel-containing drug was taken 24 hours or less after intercourse, protection against unwanted pregnancy is 95%
• When using drugs after 25 - 48 hours, their effectiveness is reduced to 85%
• When taking pills in the period 49 - 72 hours after intimacy, their reliability drops to 58%

Pills that contain estrogen and progestogen

In this case, we are talking about the Yuzpe method, when COCs are used as fire contraception (see). Few women are familiar with this method, but sometimes it acts as a good alternative to the next day's pills (Postinor and Escapel).

• Tablets are taken in 2 stages (from 2 to 4 pieces for each use, depending on the dose of hormones that determine their composition) no later than 72 days.
• The second dose is similar to the use of Postinor, that is, after 12 hours.
• The most commonly used are Rigevidon, Non-ovlon, Silest, Ovidon and others.
• Protection against unwanted pregnancy reaches 75 - 85% (depending on the period of taking the pills after intercourse).

Tablets containing mifepristone

Birth control pills after intercourse, for example, Ginepristone, Mifolian, Genale, Agesta (recently discontinued), are taken no later than 72 hours after "obligation-free" intercourse. You need to drink one tablet only once. Please note: 2 hours before taking the mifepristone-containing tablet and for two hours after taking it, you should fast (do not eat).

Who is not suitable for emergency contraceptive pills?

Why are pills for fire contraception dangerous?

Before you decide to use the birth control pills described above, you should learn about their consequences, which are sometimes irreversible:

• Ectopic pregnancy- The risk of such a formidable disease as an ectopic pregnancy increases several times, as the process of transporting the egg is disrupted (see).
• Bleeding - Failures of the menstrual cycle are quite frequent, which can lead to massive bleeding, and the only way to stop it will be just curettage of the uterine cavity (this moment is fraught with a lot of its complications).
• The threat of infertility in the future- For girls who are in puberty, taking emergency pills will not only disrupt the irregular menstrual cycle, but in some cases will cause infertility in the future.
• thrombus formation- Massive doses of the hormones present in these drugs can provoke thrombosis, which is fraught with stroke (see), pulmonary embolism and even death (especially in women with hemostasis disorders, after 35 years and in smokers).
• Crohn's disease - oral contraceptives and "pills of the next day" increase 3 times.

In addition, you should remember about side effects that do not add charm to the situation:

• mastalgia (painfulness of the mammary glands), their swelling;
• severe nausea and even vomiting;
• significant headaches, migraines;
• pulling or aching pain in the lower abdomen;
• emotional instability;
• allergies in the form of itching and rash.

This video is worth watching for every health-conscious woman before deciding to take any oral contraceptive (even low-dose). This is especially true for young girls who want to have children in the future. Even a healthy woman without obvious contraindications has a risk of developing pulmonary thromboembolism while taking OK (see the video until the end).

Most modern girls and women are quite well versed in matters of and know its basic methods. Among which, by the way, there are frankly outdated and completely irrelevant. For example, the calendar method, when an approximate day is calculated ovulation or the withdrawal method.

In accordance with the scale used to assess the effectiveness of contraceptive methods ( pearl index ), the methods mentioned above are extremely inefficient. The Pearl Index for them is set at 25-40 and 18-27 points, respectively. For comparison, the barrier method of contraception, which uses condoms, and some other methods, gain 2-3 points on this scale.

It is believed that the lower the Pearl index, the higher the protection against unplanned. Perhaps, among all methods of contraception used to prevent pregnancy, the most effective are birth control pills ( , also known as COOK) , as well as some hormonal drugs, for example, injections or intrauterine devices.

Of course, pregnancy pills also have their drawbacks, however, according to experts, the advantages of such contraception more than cover all its negative aspects. Perhaps the main difficulty faced by women using contraceptive pills is the need for a constant, in other words, daily intake of these drugs.

Otherwise, if you skip the next pill, the risk of getting pregnant after intercourse, in which, for example, barrier methods of contraception were not used, increases dramatically. What to do in such a situation and what to drink so as not to get pregnant? There is only one correct answer to these questions - emergency contraceptives .

In medicine, this term is called postcoital , i.e. emergency, fire or emergency contraception. This method is effective after unprotected intercourse. In addition, emergency contraceptives will help to avoid pregnancy when taking contraceptive pills on an ongoing basis in the event that a woman was unable or forgot to take the medicine more than twice in a row.

All in all, emergency contraceptive pills use if and only if the main method of protection against unwanted conception has failed. Moreover, it is necessary to have time to take such contraceptive pills after the act within 72 hours. Otherwise, even these emergency contraceptive pills, specially designed for such situations, will not help to avoid unwanted pregnancies.

It is important to emphasize that, in accordance with the recommendations of the World Health Organization (hereinafter referred to as WHO), emergency contraceptives after unprotected intercourse should not be used by women on a regular basis. Since the hormonal compounds that make up such drugs can adversely affect not only reproductive function, but also the entire body as a whole.

Emergency contraceptives are a more benign alternative. surgical termination of pregnancy . But, like all drugs, they should be taken correctly and not abused.

Before we move on to a more detailed discussion of emergency contraceptive pills and talk about how such drugs affect the body, it is worth dwelling on some of the main issues related to the conception process. In order to better understand the mechanism of action on the female body of anti-pregnancy pills in the future.

So, for the onset of pregnancy must occur. This is the fusion of sex cells of partners (male spermatozoa and women's eggs ), resulting in the formation of cells zygotes (a diploid cell capable of "spawning" another cell). By itself, sexual intercourse cannot be associated with the act of fertilization. Since not every contact between a man and a woman is made for the purpose of procreation.

During unprotected intercourse, a man's sperm naturally enters the woman's vagina. It is noteworthy that the environment of the female body is detrimental to spermatozoa. This is due to the high level of acidity in the vagina. Therefore, after ejaculation, the vast majority of spermatozoa die. However, their most mobile part still penetrates into uterus and can lead to fertilization. How long can you get pregnant after unprotected intercourse?

To answer this question, you need to understand that for conception, as they say, “stars must converge”, namely:

• a woman should ovulate during this period, this phenomenon is characterized by the state of egg maturity. If for some reason at break follicle the ovum has not been released fallopian tube or has not reached its maturity, fertilization will not occur;
• male spermatozoa must be strong and mobile enough to overcome the acidic environment of the vagina and penetrate the structure of the egg;
• when the spermatozoon and the egg are connected, the process of division of the fetal egg should start;
• implantation of the fetal egg should occur, in the process of its division into the walls of the uterus.

The entire fertilization process takes about seven days. It is during this period of time that the formation embryo , which with the help chorion (predecessor placenta ) is fixed in the uterus, where it grows and develops over the next nine months. It is important to emphasize that it is not rare that emergency contraceptive pills are not dangerous for conception.

This means that even if you follow all the rules for using emergency contraceptive pills after intercourse (for example, they must be taken after a maximum of 72 hours in order not to become pregnant), fertilization can still occur. Of course, such cases are not the majority, and they are more likely to be exceptions. However, the probability of "flight", as people call an unwanted pregnancy, is always there, even if conventional contraceptives are used.

Pills from unwanted pregnancy after the act are divided into two main categories:

• next day pills , i.e. drugs that are best taken in the next 24 hours after unprotected contact. In fact, a woman has a maximum of 72 hours for pregnancy pills to work and help avoid fertilization;
• COC or (so-called Yuzpe method ).

As for oral contraceptives related to COCs or drugs from the mini-pill series, this is inherently not emergency contraception. After all, birth control pills need to be taken constantly. However, there are varieties of such drugs that can be used as pills so as not to become pregnant after an act that is not protected by any means of contraception.

As a rule, an increased dosage of birth control pills containing hormones or antihormones is used for these purposes. Also, the methods of emergency contraception include the installation within 120 hours after unprotected intercourse intrauterine device .

For pregnancy, emergency contraceptive pills are dangerous because they contain substances in their chemical composition that prevent the onset of fertilization. The main active compounds in pills against pregnancy after an unprotected intercourse can be either, or antihormones .

The first compounds are biologically active substances that belong to proteins or steroids and are produced by organs or tissues of a living organism. Hormones are transported through the bloodstream from organ to organ and are responsible for the physiological activity of the body, for example, for its development and growth, metabolism, and so on.

As the name suggests antihormones These are compounds that act opposite to hormones. They suppress hormonal activity in the body.

It is noteworthy that antihormones, by their nature, having an exogenous or endogenous origin, are often structural analogues of the hormones they suppress.

So, before you ask yourself what kind of emergency contraceptive pill to drink so as not to get pregnant, you should remember that this type of drug may contain:

• , i.e. synthetic progestin (steroid female sex hormone), found in drugs such as: , Tetragynon ;
• mifepristone , i.e. Synthetic antiprogestin (antihormone), found in contraceptives such as: , Renomelan, Agesta, .

Preparations based on levonorgestrel

First, let's talk about how it works. levonorgestrel and preparations containing it. So, abortion pills related to emergency contraception after the first dose:

• immediately affect the chemical composition of mucus endocervix (cervical canal of the cervix) , also increasing its viscosity, thus slowing down the process of sperm penetration into the fallopian tube;
• act on the ovaries, preventing the release of a mature egg from the main follicle (provided that pills are taken before ovulation), suppressing gonadotropic hormones, which ultimately blocks or delays the process of ovulation;
• prevent the implantation of an egg fertilized by a spermatozoon into the uterine walls for the further development of the embryo and the formation of a "children's" place. In order for fertilization to fail, levonorgestrel not only changes the structure of the endometrium, thereby preventing it from entering the secretory phase, without which ovulation does not occur, but also affects uterine (fallopian) tubes. As a result, the number of their contractions is significantly reduced, which leads to the impossibility of getting a fertilized egg into the uterine cavity.

It is important to emphasize that drinking the above drugs, which include levonorgestrel should only be taken after consulting a doctor. In addition, you should definitely read the instructions that come with the tablets. The thing is that these contraceptives contain huge doses of hormones.

After taking them, a hormonal imbalance occurs in the female body, the consequences of which can be unpredictable. Therefore, experts refer to such methods of contraception as "disposable" means, which are highly recommended not to be used more than 4 times a year. In addition, it is strictly forbidden to use such emergency contraceptive drugs more than once per menstrual cycle.

emergency contraceptive pills (they are also called "next day pills" due to the specifics of taking) - this is an effective, but rather controversial method of protection against an unplanned pregnancy. Doctors say that after a single intake of such drugs, serious changes occur in the body, so it takes time to fully restore the functions of the woman's reproductive system.

Mifepristone-based preparations

What can be said about the second group of emergency contraceptive drugs containing an antihormone mifepristone – they work in much the same way as levonorgestrel-containing birth control pills, i.e. also:

• inhibit the process of ovulation;
• change the structure of the endometrium, which leads to the impossibility of fixing a fertilized egg on the uterine walls;
• strengthen uterine contractions, due to such hyperreactivity, the fertilized egg is “expelled” from the uterine cavity.

It is worth noting that to protect against unwanted pregnancy after unprotected intercourse, you can also use non-hormonal drugs e.g. vaginal suppositories containing nonoxynol (Steridil,) or ( , ). The above drugs are not only methods of express contraception, since they have a spermicidal effect, the scope of their application is much wider, due to their anti-inflammatory, antibacterial, antiviral and antifungal abilities.

The above names of pills from pregnancy after an act unprotected by any means of contraception are far from all. Currently, any pharmacy has a good selection of such drugs. You can find out about the names of emergency contraceptive pills directly from the pharmacy pharmacist, but it is better to contact your doctor with these questions. After all, any medicines (and contraceptives are no exception to this rule) have their own contraindications and side effects.

This is especially true for women with GW (breastfeeding) or suffering from certain diseases in which large doses of hormones or antihormones can be fatal. Let there be no unequivocal answer to the question of whether birth control pills related to postcoital contraception are harmful, since what will be good and effective for some may turn into big health problems for others, not a single woman should use this method of solving the problem of unwanted pregnancy without prior medical advice.

Only a specialist will be able, firstly, to choose the right drug, taking into account all the individual characteristics of the patient (an ordinary person can simply get lost in the names of pills that say nothing about the composition, contraindications or side effects after an unprotected act). And, secondly, it is the doctor who will tell you how to take emergency contraceptives correctly so as not to harm your body and achieve the desired result.

There are several basic rules for taking postcoital contraception drugs:

• It is necessary to strictly adhere to the period of use of such drugs. The vast majority of pills should be taken within 72 hours of unprotected intercourse. Many people have a question, how many days are 72 hours? It is well known that in one day or in one day there are 24 hours, therefore, 72 hours are three days or three days. It is believed that the first pill of emergency contraception should be drunk as early as possible, while the second - optimally 12 hours after the first or a maximum of 16 hours. It is important to emphasize that the effectiveness of tablets depends directly on the period of their administration. It is believed that drugs levonorgestrel most effective within 24 hours after intercourse (95% effective). When taken after 48 hours, the effectiveness is reduced to 85%, and after 72 hours - up to 58%. Containing mifepristone tablets are also taken no later than 72 hours from the moment of contact.
• It is important to adhere to the dosage indicated in the instructions for the drugs or prescribed by the doctor. As mentioned above, emergency contraceptive pills are taken twice after a certain period of time, for example, Postinor . However, this rule is not true for all drugs. Eskinor F or Escapelle (contain levonorgestrel ) and Jenale , Ginepriston, (contain mifepristone ) drink one tablet within 72 hours of sexual intercourse.
• It is strictly forbidden to independently adjust the dosage of birth control pills. This can lead to the development of side effects, as well as provoke serious negative consequences ( bleeding, ). It is recommended not to eat a couple of hours before taking emergency contraceptive pills and after that, so that biologically active compounds are better absorbed in the body. If, after taking the drugs, vomiting occurred, then you will have to take the pill again.

Combined oral contraceptives

It is also worth paying attention to the so-called Yuzpe contraceptive method . As mentioned earlier, well-known people can be used as emergency contraceptives. COCs (combined oral contraceptives). This method can be an excellent solution for those who, for whatever reason, are contraindicated in postcoital contraceptive pills.

As emergency contraceptives, you can use COCs such as: , Tetragynon, Ovral, and others. As a rule, these tablets contain hormones - estrogen, levonorgestrel, desogestrel, ethinyl estradiol and progestogen .

According to the instructions, you need to take COC every day, one piece. However, this rule can be broken in an emergency to prevent an unwanted pregnancy. The main thing is not to overdo it, so as not to harm the body. The following COC dosages are considered safe for:

• from 2 to 4-5 tablets (depending on the type of COC) at the first dose, which should take place no later than three days or 72 hours after sexual intercourse;
• the same number of tablets should be drunk 12 hours after the first COC intake.

The effectiveness of this method also depends on the time of taking the drugs. That is, the earlier the woman drank the pills, the greater the likelihood that ovulation will not occur and fertilization will not occur.

Contraindications

We talked about how not to get pregnant after the “no obligation” act. Now it's time to discuss the negative aspects of emergency contraception and determine who should not resort to the help of such an uncompromising method.

There is no benefit from emergency contraceptive pills, apart from, of course, the psycho-emotional calm of a woman - this is a fact. And how much and what harm can they bring?

levonorgestrel drugs:

• at pathology of the biliary tract ;
• with liver diseases, for example, liver failure ;
• in cases where the pregnancy was confirmed by a gynecologist, i.e. the fertilized egg has successfully implanted into the uterine wall;
• when the age of the patient is 16 years or less;
• at lactose intolerance ;
• in case of malabsorption galactose and glucose ;
• with certain diseases of the gastrointestinal tract, for example, Crohn's disease ;
• at ;
• in the presence of tumors sensitive to changes hormonal background ;
• at menstrual disorders ;
• at ;
• in case of malfunction hemostasis systems .

It is forbidden to use containing mifepristone drugs:

• at liver failure ;
• at porphyria ;
• at kidney failure ;
• in case of malfunctions hemostasis systems (blood clotting) ;
• at the reception glucocorticoids , for example, , and so on;
• at the reception anticoagulants ;
• at adrenal insufficiency ;
• with a confirmed pregnancy;
• when breastfeeding; P
• in the presence of certain diseases in the chronic stage;
• at anemia ;
• women over the age of thirty-five;
• with an ectopic pregnancy.

Of course, any woman has the right to independently decide which modern methods of contraception or even alternative methods to use to protect against unwanted pregnancy. However, you should always think about what harmful effects can occur for the body when taking certain drugs.

Emergency or "fire" contraceptive pills can be dangerous:

• risk of developing later ectopic pregnancy , which is due to a violation of the process of transporting a fertilized egg to the place of its fixation in the uterus for further development;
• the risk of uterine bleeding , with which even medical workers do not always cope successfully;
• risk infertility , especially for young women whose menstrual cycle has not yet been established;
• development risk Crohn's disease , a chronic inflammatory disease of the gastrointestinal tract, which affects all its departments (from the oral cavity to the rectum);
• increased risk thrombosis , which is provoked by high doses of hormones contained in all tablets of the "next" day without exception, which leads to , and even lethal.

According to women who have experienced the effects of emergency contraceptive pills, the most common side effects of these drugs are:

• nausea;
• allergic reactions as rashes and skin itching;
• puffiness or soreness of the mammary glands (mastalgia);
• lower abdominal pain;
• severe headaches;
• stress ;
• emotional instability.

abortion pills. Price, where to buy, how to use

So-called pharmaceutical board or medicinal often associated with emergency contraception. However, this is far from the same thing. Of course, both drugs help to avoid unwanted pregnancy, only the mechanism of action and the time of taking the so-called abortion pills are different.

Let's talk about the main differences between medical abortion, which, according to many experts, is safer than surgery, for example, vacuum aspiration or scraping. How long can abortion pills be effective in terminating unwanted pregnancies?

So, as we mentioned earlier, after an unprotected act of pregnancy, birth control pills related to emergency contraception can be saved for 72 hours. Medicines for medical abortion are used when pregnancy has already occurred.

So, when can you use abortion pills or for how long. These funds can be taken in early pregnancy (up to 42 days amenorrhea the first day of the last menstrual cycle).

This means that abortion pills have an effect on the course of pregnancy up to the sixth maximum up to the seventh week.

It is worth noting that abortive pills most effectively affect a fetal egg that is still weakly attached to the uterus for up to four weeks.

During this period, the hormonal background of the female body has not yet reached the peak of its changes and you can resort to the help of drugs to terminate an unwanted pregnancy.

It should be noted that abortion pills should not be taken without medical supervision. Although this method of abortion is considered safer than surgery, everything does not always go smoothly and without negative consequences for the female body.

To exclude possible harm to health, it is imperative to consult a gynecologist, and also take this kind of pill only in his presence, so that a qualified specialist can provide quick assistance (for example, if severe bleeding opens) and prevent a severe outcome of medical abortion. Unfortunately, not many people think about how dangerous abortion pills can be.

After all, you can even die from them if complications arise and doctors do not provide urgent medical care to a woman. Therefore, drugs for medical abortion containing mifepristone (a steroid antiprogestogenic substance of synthetic origin), for example, or taken once at a dosage of not more than 200 mg, exclusively under medical supervision.

Mifegin , a drug produced by a French manufacturer, like its domestic counterpart Mifeprex contain the same biologically active substance in their chemical composition mifepristone which blocks the production progesterone by acting on progesterone receptors. In the normal course of pregnancy, such as progesterone , generated corpus luteum of the ovaries , forms endometrium , whose main function is to create the best conditions for the development embryo .

The action of mifepristone-containing drugs gives the opposite effect ( myometrium decreasing, growing prostaglandins ), which ultimately leads to the prevention of unwanted pregnancies. Within a maximum of 48 hours after using abortion pills, the woman should complete a medical abortion and take medicines such as or gemeprost .

These are analogues of prostaglandins, which will stimulate the process of "expulsion" of the fetus from the uterus. It is very important to understand that in order to avoid severe complications, the patient must be under mandatory medical supervision within 2 hours after taking the above drugs.

In order to be completely convinced that an abortion has occurred, a woman needs to undergo an ultrasound scan two days after the procedure, and then re-appear for an appointment with a gynecologist two weeks later. According to experts, the effectiveness of this method reaches 99%. However, in some cases, abortion pills do not help to completely get rid of the fetus, and then the woman has to undergo such unpleasant procedures as:

• abrasion (in common scraping ) is an operation aimed at removing the fetal egg, as well as some pathological formations on the mucous membranes of the uterus;
• vacuum aspiration (in everyday life the name is more common mini abortion ) is a method of abortion in which the fetus is removed from the uterus using a special vacuum suction.

As we said above, medical abortion is considered the most gentle way to terminate an unplanned pregnancy, since there is no mechanical effect on the uterus. As a result, its mucous membranes are not damaged, which eliminates many possible complications. However, this method also has a number of contraindications, in which the use of abortion pills is prohibited:

• inflammatory diseases of the ovaries or uterus;
• ectopic pregnancy ;
• scars on the uterus , due to previously transferred operations;
• some gastrointestinal diseases .

The following complications may occur during medical abortion:

• bleeding in the uterus;
• allergic reactions;
• nausea;
• sharp pains in the abdomen;
• incomplete abortion, those. a situation in which pregnancy progresses because fetal rejection has not occurred;
• jumps in blood pressure;
• vomit.

The price of birth control pills

The price of postcoital contraceptive pills depends on several factors. Firstly, the manufacturer of drugs affects the cost, secondly, the number of tablets in the package, and, thirdly, the region where contraceptives are sold. For example, such popular and widespread tablets as Postinor in Ukraine they cost an average of 200 hryvnias, and in Russia 350 rubles.

How much do abortion pills cost? The price of this type of drugs depends primarily on their manufacturer. In addition, as we mentioned earlier, pharmacological abortion is a medical procedure that should take place exclusively under the supervision of a physician. Therefore, the price of the services of a gynecologist is added to the cost of the abortion pills themselves, who will monitor the patient and be able to help her in a timely manner if something does not go as planned.

In the life of any woman, an unforeseen situation can arise. And it doesn't matter who is to blame: the man, the condom manufacturers, or the woman herself. There is only one question on the agenda: what to do to avoid an unplanned pregnancy?

Emergency contraception helps prevent pregnancy after unprotected vaginal sex. The sooner action is taken, the greater the chance of preventing pregnancy.

If 1-5 minutes have passed

douching- an old Soviet method: the vagina is washed to remove spermatozoa from it. This method is absolutely ineffective: spermatozoa penetrate the cervix and fallopian tubes in just 90 seconds - you can’t keep up with them, even if you prepared a syringe in advance and poured a spermicidal solution into it.

Risks: the risks are minimal, as is the effectiveness of the method, but if you use too strong a solution of acetic acid or lemon juice instead of ordinary boiled water, the delicate vaginal mucosa will suffer.

Not more than 48 and less than 72 hours

There is still a little time left, you can prevent pregnancy with the help of a “hormonal bomb”. You can take either pure progestin oral contraceptives or a combination drug. In the first case, you need to meet the interval of less than 48 hours. In the second - a little more time - 72 hours. Both types of drugs act in the same way: because of them, the menstrual cycle seems to “turn around” in the opposite direction: ovulation is suppressed. And they have very similar side effects: nausea (46% of women), vomiting (22% of women), dizziness, fatigue, pain in the mammary glands and headaches.

Main condition: it is necessary to follow the schedule of taking (they don’t joke with hormonal drugs), drink the drugs clearly after 12 hours and do not forget about the second dose.

Important! These drugs will not have a harmful effect on the fetus if the pregnancy occurred before the unprotected intercourse occurred.

If less than 48 hours have passed

progestin pills(they are PPSC- pure progestin oral contraceptives) - Postinor or "mini-drank": excluton, microlute, ovret.

Reception scheme: 1 postinor tablet, after 12 hours another one (total 2 tablets)

or: 20 "mini-drank" tablets, after 12 hours another 20 tablets (total 40 tablets).

If less than 72 hours have passed

Combined oral contraceptives(aka COC)

Reception scheme: marvelon, microgenon, miniziston, rigevividon, femoden - 4 tablets 2 times in 12 hours (total 8 tablets). Bisecurin, non-ovlon, ovulen, ovidon, anovlar - 2 tablets 2 times in 12 hours (total 4 tablets).

Advice: nausea and vomiting are frequent companions of this type of emergency contraception! To mitigate these sensations or do without them at all, take the tablets in the evening before bedtime, with meals, or drink them with milk.

Less than 120 hours (5 days)

Intrauterine device (IUD): T-shaped spiral with elements of copper is inserted by a gynecologist.

If more than 72 hours have passed, but less than 5 days, there is a chance to cope with the situation by introducing an intrauterine device, which will not only prevent pregnancy immediately, but will also serve you for some time (the doctor will advise how long to leave the device). It is necessary to contact a gynecologist to determine if you fall into the group of those women who are not recommended this method of contraception: traditionally nulliparous and those who have inflammatory and infectious gynecological diseases. The introduction of a spiral is a signal for the body about the appearance of a foreign body; the uterus will begin to contract, preventing the egg from attaching.

Side effects: cramping pains in the lower abdomen, menstrual flow becomes longer and more abundant, the risk of ectopic pregnancy increases, sometimes spontaneous prolapse of the IUD is possible.

If more than 5 days have passed, you should consult a gynecologist - perhaps they recommend you early medical abortion. The list of side effects and contraindications for the drugs that are used for this is very long, it is better not to act at your own peril and risk alone. Despite the fact that there will be no surgical intervention, a whole range of mandatory medical measures must be taken, especially for women who have a negative Rh factor.

Even if you live sexually from time to time and don’t want to “poison” the body by constantly taking oral contraceptives, and a man is against condoms, because “the sensations are no longer the same,” this is not a reason to hope “at random” and think that everything is somehow somehow manage, and then abuse emergency contraception.

If possible, instead of playing “Russian roulette” with the reproductive system, where the diagnosis of “infertility” or “ovarian dysfunction” is at stake, it is better to consult a gynecologist you trust and choose a non-shock method of contraception that is best for you. .

Of course, it is not pleasant to tell the doctor about your problems, especially if they are associated with violence, it is much easier to run to the pharmacy and buy pills. Remember that all the methods described above do not protect against sexually transmitted diseases. Therefore, no matter how “uncomfortable” and “embarrassing” it is, it is best to consult a specialist anyway!

According to international studies, 19% of Russian women had an abortion. Almost half of them - repeatedly. At the same time, according to surveys, only 1% of women in the age group of 16-49 years admit that they could have an abortion in the next three years. 54% believe they would never choose this method. Moreover, there are now emergency contraceptives that can safely prevent unplanned pregnancy when used in the first 72 hours after intercourse. More than half of the women surveyed (57%) would rather take the “next day pill” than have an abortion.

Modern women use all measures of reproductive planning. At the same time, many couples (17%) still resort to outdated methods of contraception - the calendar method and coitus interruptus - which lead to pregnancy in 25 and 27% of cases, respectively.

True, even with the use of various methods of contraception, no one is immune from failure. For example, 35% of women found themselves in a situation where the condom was torn or moved out. But even in emergency situations, it is not necessary to think of abortion as the only way to solve the problem.

The need for emergency contraception

Emergency contraceptive pills (ECPs) are specifically designed to prevent pregnancy after unprotected or insufficiently protected intercourse. Therefore, sometimes they are called "pills of the next day."

Especially for emergency contraception are used:

• Levonorgestrel. Dose 1.5 mg or 0.75 mg (in this case, take twice with an interval of 12 hours).
• Ulipristal acetate. Dose 30 mg.
• mifepristone. Dose 10-25 mg.

The tablets should be taken within 5 days after intercourse. Taking levonorgestrel reduces the possibility of pregnancy by 60-90% (in the case of one unprotected intercourse). The use of ulipristal and mifepristone is more effective than taking levonorgestrel.

To accept ECPs, you do not need to undergo an examination or take laboratory tests.

Emergency contraceptive pills are indicated for use when:

• no other contraceptive has been used;
• the contraceptive was used incorrectly;
• the contraceptive was used correctly, but it immediately became clear that it did not provide the desired effect.

Here are the most common situations in which ECPs may be needed by a woman using standard methods of contraception.

Oral contraceptives, contraceptive patch, vaginal ring

• We began to apply this method at a later stage than the instructions require.
• During the menstrual cycle did not use this method correctly.
• They took medications that could reduce the effectiveness of the method.

Progestin-only injections

• I started using this method at a later stage of the menstrual cycle than the instructions require.
• The contraceptive protection provided by the injection expired before intercourse.

Implants

• The contraceptive protection provided by the implant has expired before intercourse.

intrauterine device or system

• The tool was accidentally deleted.
• You don't feel the mustache.
• The contraceptive protection expired before intercourse.

condoms

• The condom broke, slipped, or was used incorrectly.

Diaphragm or cap

• The remedy was displaced or removed before or during intercourse.
• The tool was displaced or removed after sexual intercourse earlier than required by the instructions.

Spermicide

• Did not introduce a spermicidal agent before intercourse, as required by the instructions.
• The spermicidal tablet or film did not have time to dissolve before the onset of sexual intercourse.

Contraceptive methods based on self-determination of the fertile period

• Were in the fertile period during intercourse.
• Not sure if they were fertile at the time of intercourse.

Coitus interruptus

• Ejaculation occurred in the vagina or on the external genitalia.

Contraindications and the effect of TEC on the body

Women who plan to use ECPs are concerned about a number of issues. Let's take them in order.

1. Are there any contraindications?

Pills are not dangerous under any known circumstances: even if there are health problems. ECPs are not prescribed to women with pregnancy - they are no longer effective. However, if it is not clear whether pregnancy is present or not, ECPs may be used as there are no examples to indicate harm to the developing fetus.

But side effects do exist - these are irregular vaginal bleeding, nausea, headache, abdominal pain, tenderness of the mammary glands, dizziness and fatigue.

2. Effect on pregnancy

Studies of women who become pregnant despite taking levonorgestrel or who use it accidentally after pregnancy show that the hormone does not harm either the pregnant woman or her fetus. In particular, it does not increase the chance of low birth weight, birth defects, or pregnancy complications. There have been only a few reports of pregnancy after taking ulipristal, but no complications have been observed.

3. Use by teenagers

Clinical or programmatic considerations should not limit adolescents' access to ECPs: they are safe regardless of age. Adolescents are able to understand the instructions for using this method of contraception.

4. Use in lactation

If less than six months have passed since the birth, and the woman is breastfeeding only, if there has not yet been menstruation in the postpartum period, then ovulation is unlikely to occur. Then TECs are not needed. However, women who do not meet all three criteria can become pregnant. The use of levonorgestrel during lactation is not contraindicated.

5. Use before intercourse

There is no data on how long the contraceptive effect of ECPs lasts after taking the pills. Presumably, ECPs taken immediately before intercourse are as effective as ECPs taken immediately after. However, if it is possible for a woman to plan to use a contraceptive method before intercourse, then a method other than ECP is recommended, such as condoms or another barrier method of contraception.

6. Use after several unprotected intercourse

Women should try to take ECPs as soon as possible after each unprotected intercourse; it is not recommended to postpone the reception until the end of the last sexual intercourse. However, a woman should not refrain from taking funds simply because she has had several unprotected intercourse. However, she should be aware that the effectiveness of ECPs may be limited if the earliest unprotected intercourse occurred more than 4-5 days ago. She should limit herself to one ECP at a time, regardless of the number of prior unprotected intercourse.

7. Reuse of pills

ECPs are not intended to be intentionally reused or used as a regular, systematic method of contraception. Women who do not want to become pregnant in the future are advised to start or continue using contraception after taking ECPs, which they have been using consistently for a long time. There are no specific data on the effectiveness or safety of the frequent use of current methods of using ECPs. However, at least 10 studies have confirmed that taking multiple doses of levonorgestrel at 0.75 mg per cycle does not cause serious negative side effects. It is not known whether the efficacy of levonorgestrel is reduced by recent or subsequent use of ulipristal, which is a progesterone receptor modulator. Therefore, if a woman who has recently taken levonorgestrel needs emergency contraception again, she is better off using the same remedy.

8. Use of ECPs in the non-fertile period

Studies have shown that fertilization as a result of sexual intercourse can only occur in the range of 5-7 days before, after or during. Theoretically, ECPs might not be needed if unprotected intercourse occurs at a different time in the cycle, since the chance of pregnancy even without ECPs would be zero. However, in practice, it is often impossible to determine whether sexual intercourse occurred on a fertile or non-fertile day of the cycle. Therefore, women should not refrain from using ECPs because of the assumption that a particular sexual act occurred during the non-fertile period.

9. Interaction with other drugs

There are no specific data on the interaction of ECPs with other drugs. However, the effectiveness of taking levonorgestrel may be reduced due to the use of drugs that can reduce the effectiveness of oral contraceptives.

Women who are using bosentan and medicines to treat stomach acid or stomach ulcers (such as omeprazole) or have taken them in the past month should consider inserting a copper-containing intrauterine device. If they opt for levonorgestrel ECPs, then they should take a double dose. Ulipristal in these cases is better not to use. Since it is a progesterone receptor modulator, it could theoretically reduce the effectiveness of other hormonal contraceptives containing progestin hormones.

Contraception after taking ECPs

Switching to (resuming use) regularly taken contraceptives after using ECPs

ECPs do not provide contraception for subsequent sexual intercourse. Therefore, a woman should choose another method of contraception before resuming sexual activity. When should this be done?

Condoms or other barrier methods of contraception

Start using immediately before your next sexual intercourse.

Hormonal methods: oral contraceptives, contraceptive patch, vaginal ring, injections, implants, levonorgestrel-containing intrauterine hormonal system.

Start using immediately - that is, on the day you take your ECP or the next day. Use the barrier method within 7 days of taking levonorgestrel or within 14 days of taking ulipristal.

Alternatively: Start using after your next menstrual period, but use a barrier method in between.

By the way, before the introduction of implants or a hormonal intrauterine system, it makes sense to conduct a pregnancy test: this way you will exclude the presence of an existing pregnancy.

If a woman has requested to have a copper-containing IUD inserted and more than 5 days have passed since the use of ECP, then this is followed after the next menstruation begins.

Sterilization

This procedure should be undertaken after the onset of menstruation following the use of ECPs. The barrier method should be used until sterilization is complete.

Since it is difficult to determine the risk of pregnancy in each individual case, and since a delayed or unwanted pregnancy is fraught with serious consequences, a woman who wants to avoid should consider taking ECPs after intercourse during which contraceptive protection was not adequately provided.

Remember: if you don't get your period within 3 weeks of taking your ECP, you may be pregnant.

Based on the materials of the Scientific Center for Obstetrics, Gynecology and Perinatology named after academician V.I. Kulakova

Pills after an unprotected intercourse are necessary in several cases: if the condom broke or slipped off, the partners forgot about the means of protection, or rape occurred. These medicines are used to prevent pregnancy and sexually transmitted diseases. These can be emergency contraceptives based on levonorgestrel or mifepristone, antiseptics, antiviral and antibacterial agents, and others.

Show all

emergency contraception

Emergency contraception refers to pills that prevent unwanted pregnancy after unprotected intercourse has already taken place. Synonyms such as "fire" or postcoital contraception are sometimes used. There are several methods to reduce the likelihood of conception in the absence of measures before or during intimacy:

• taking a birth control pill after intercourse or the next day's pill;
• installation of a spiral for 6 days after coitus;
• taking an increased dose of combined oral contraceptives with estrogen and progestogen.

The principle of action of tablets

There are two types of emergency contraceptives. Both refer to preparations containing hormones:

• A group that includes drugs with the active ingredient levonorgestrel (progestogen): Postinor, Escapel.
• Tablets produced on the basis of mifepristone (antigestagens).

In addition, there is the Yuzpe method, based on the intake of increased doses of certain hormones. The effectiveness of protection against unwanted pregnancy in this case reaches 75-80%, depending on the duration of medication.



Levonorgestrel

The mechanism of action of drugs with this active substance consists of several stages:

Action	Description
Delayed ovulation	Levonorgestrel prevents the release of the egg from the dominant follicle, if you drink the drug on the eve of ovulation. In this case, the influence of hormones (follicle-stimulating and luteinizing) is suppressed.
Changes in the composition of cervical mucus	The viscosity of the mucus of the cervical canal increases: it becomes thick, the process of sperm entering the uterus slows down
Reducing the likelihood of implantation of a fertilized egg	Two mechanisms contribute to this. Firstly, the structure of the endometrium changes - the drug causes the reverse development of proliferation processes, excludes its possible transition to the secretory phase, which is necessary for normal ovulation. Thus, there is a mild abortive effect. In addition, the active substance affects the contractility of the fallopian tubes, reducing it, which slows down the delivery of the fetal egg to the uterine cavity in time: if it gets there with a delay, implantation is no longer possible

One tablet of Postinor contains a large dose of hormones, when taken in a woman, a serious hormonal imbalance occurs. The World Health Organization does not recommend the use of such contraceptives. The instructions for the drug indicate that even for a healthy woman, the use of the drug is not allowed more than 4 times a year or once a cycle.

Some women take the drug uncontrollably, which is unacceptable and extremely dangerous. When taking Postinor, ovarian function is impaired. Even with a single use of the drug, a certain time is necessary for their recovery, in each case it is individual.



Mifepristone

Emergency contraceptives of this group are similar in action to the previous ones:

Indications

Indications for the use of emergency contraception should be serious enough - when a woman is sure that in case of pregnancy she will have an abortion. The most common uses for these medications include:

• rape;
• condom damage;
• displacement of the helix or vaginal diaphragm;
• skipping oral combined contraceptives.

Admission rules

To maximize the effectiveness of emergency contraception, you need to follow certain rules of admission.

Instructions for preparations containing levonorgestrel

Postinor is applied no later than 72 hours after:

• The first tablet is drunk immediately.
• The second - after 12 hours, no later than 16.
• If vomiting or severe diarrhea occurs, an additional tablet must be taken within 3 hours.



Escapelle or Eskinor-F are taken in the amount of 1 tablet once within 72 hours. The effectiveness of drugs depends on time:

• If the medication was taken after 2 hours, the effectiveness of protection against unwanted pregnancy is about 95%.
• When used on the second day, it decreases to 75%.
• When taking the drug within 49-72 hours after sexual intimacy, the reliability drops to 58%.

It is necessary to refuse levonorgestrel-containing drugs under the following conditions:

• confirmed pregnancy (if the egg is implanted, it is almost impossible to expel it from the uterus);
• age less than 16 years (when the cycle, ovulation and menstruation have not been established);
• lactose intolerance (tablets include glucose, galactose and lactose, which can cause unpleasant side effects);
• Crohn's disease;
• hormone-dependent tumors;
• ectopic (tubal) pregnancy in history;
• the stage of breastfeeding (or a ban on feeding is carried out during the day after admission);
• violation of menstrual cycles, constant delays, bleeding outside of menstruation or their excessive profusion;
• pathology of the liver and biliary tract, liver failure;
• increase in blood clotting.

Mifepristone-based preparations

Contraceptive pills after coitus, such as Genale, Ginepriston, Mifolian and others, are taken once. The tablet must be taken within 72 hours of exposure. 2 hours before consumption and for 2 hours after, you should refuse to eat.




Mifepristone and preparations based on it are not recommended for drinking under the following conditions:

• lactation (prohibition of feeding for two weeks);
• anemia;
• bleeding disorders or anticoagulant therapy;
• porphyria;
• taking glucocorticoids;
• renal and liver failure;
• severe chronic diseases;
• pregnancy;
• age over 35 years (with caution).

Pills containing estrogen and progestogen

When choosing the Yuzpe method, COCs are taken as emergency contraception - combined oral contraceptives. Few women are familiar with this method, but sometimes it acts as a worthy alternative to other pills. Within 72 hours, take 2 to 4 tablets at a time, depending on the dose of hormones in the composition. Re-admission is carried out after 12-16 hours.

The most commonly used agents are Rigevidon, Non-ovlon, Ovidon, Silest.

Side effects

Before using birth control pills, you need to familiarize yourself with the list of possible undesirable effects:

Pathology	Description
Ectopic pregnancy	The risk of this condition increases several times, as the egg transport process is disrupted
Bleeding	Frequent disruptions of the menstrual cycle can provoke massive bleeding, which can only be eliminated by scraping the uterine cavity
Risk of infertility in the future	In girls in puberty, pills can disrupt irregular menstrual cycles and cause infertility
thrombus formation	High doses of drugs can provoke the formation of blood clots, which can lead to stroke, pulmonary embolism and even death, especially in women with impaired hemostasis, smokers and after 35 years
Crohn's disease	The risk of this pathology when taking oral contraceptives or means of "fire" contraception increases by 3 times

You should also be aware of the side effects that are caused by taking such drugs:

• mastalgia (swelling and soreness of the mammary glands);
• severe headaches, migraine;
• emotional instability;
• allergic reaction;
• severe nausea and vomiting;
• drawing pains in the lower abdomen.

STD prevention

The main sexual infections are divided into bacterial and viral. Bacterial infection after unprotected sex can be prevented if treatment is started on time, viral infection cannot be stopped.

Bacterial STDs include:

Viral infections include:

• hepatitis B and C;

With unprotected intercourse, you can also become infected with non-venereal skin diseases (lice, scabies, molluscum contagiosum).

Necessary actions

The measures to be taken to avoid infection depend on the elapsed time:

• In the first 2 hours, emergency preventive measures are used. In the period from 2 to 4 hours, their effectiveness will be lower. After 4 hours, such measures do not make sense.
• In the next 72 hours, prophylaxis with medicines is carried out.
• After 3 days, any manipulations will be not only ineffective, but also harmful. Medicines will "blur" the picture of the disease, cause resistance to antibiotics and transfer the infection into a latent form.

In the absence of symptoms, tests for major bacterial infections are taken after 14 days. After 1.5 months - for syphilis, after another month and a half - for HIV, hepatitis and herpes.

If symptoms appear and a certain infection is suspected, it is not recommended to select drugs on your own. First, you need to get the results of the tests, pass the culture to determine the sensitivity to antibiotics (subject to a bacterial infection), or immediately consult a doctor.

Emergency prevention

It is carried out independently or by contacting the point of individual prevention of STDs. Such points work around the clock, you can find out their location in the city skin and venereal dispensary. Most often they are organized near the station, hotels, large car parks, recreation areas and markets.

The prevention point is a cabinet with an examination chair and a separate toilet. First of all:

• It is necessary to wash your hands with soap, empty your bladder, rinse your genitals with warm water.
• Next, the doctor wipes the intimate areas with sterile gauze wipes, treats with a cotton ball with an antiseptic solution.
• Douching of the vagina and urethra is performed. The vagina is washed with 150-200 ml of an antiseptic solution (Chlorhexidine or Miramistin is used). 1 ml is poured into the urethra, 2 ml for a man. An alternative to drugs are potassium permanganate (for douching the vagina) and silver nitrate (for the urethra).
• After treatment of the genital organs, it is necessary to refrain from urinating for two to three hours.

If in the next 2 hours it is not possible to visit the prophylactic office, the procedure is carried out at home. Action algorithm:

• Urinating immediately after intercourse - this will help flush out pathogenic bacteria from the urethra.
• Rinse the external genitalia, treat with antiseptic solutions that contain chlorhexidine, miramistin or povidone-iodine.
• Inject the medicine into the urethra (1-2 ml) and into the vagina (10 ml). It is effective to use antiseptics in the form of vaginal suppositories and tablets.

Optimal an option is to treat the genitals and urethra with an antiseptic in the first minutes, and then contact a preventive center.

Medical prevention

It is too often impossible to use such prevention of sexually transmitted diseases: the drugs used are harmful to the body and can provoke the insensitivity of other bacteria to antibiotics. It is allowed to use this technique if the risk of infection is high - provided that the time for preventive measures is missed:

• If syphilis is suspected, a single injection of benzathine benzylpenicillin into the gluteal muscle is effective.
• With gonorrhea - a single dose of 400 mg of Cefixime.
• With chlamydia - 1000 mg of Azithromycin.
• Against Trichomonas - 2 mg of Tinidazole orally once.

If there are several infections and it is not known exactly which sexually transmitted diseases the partner has, combinations of drugs can be taken. The most commonly used medication is Safocid. It is active against the most common sexually transmitted diseases (gonorrhea, trichomoniasis, chlamydia) and fungal diseases. The composition includes 4 tablets that are drunk at a time: Fluconazole, Seknidazole (2 pcs.) And Azithromycin.



Antibiotics should be used with caution, especially in the presence of allergies or bronchial asthma. An effective addition to antibiotic therapy is the use of antiviral and immunostimulating drugs, a list of which is presented in the table:

Name	Description	A photo
Viferon	It is used in the form of suppositories for rectal administration. Increases local immunity, reduces the risk of infection with herpes and hepatitis B and C
Genferon	Available in the form of suppositories for vaginal and rectal administration. The composition of the drug includes taurine, which enhances the effect of interferon, and benzocaine (gives an analgesic effect)
Vagiferon	Sold in the form of vaginal suppositories. The composition contains: interferon, metronidazole (an antibacterial drug with a wide spectrum of action) and fluconazole - an antifungal agent
Interferon inducers	Produced in the form of tablets, they stimulate the production of their own interferon
epigen intimate	Release form - spray, has an immunostimulating, antiviral, antipruritic, regenerating and anti-inflammatory effect

Topical preparations are best used in the first hour. If more than two hours have passed since sex, it is recommended to use antiviral pills.

Prevention of infection is quite difficult. Antiviral drug prophylaxis only slightly reduces the likelihood of infection with herpes and hepatitis and is an addition to the main prophylaxis with antibacterial drugs.