TAILIEUCHUNG - Postcoital contraception

Apart from mifepristone (RU486) – a ‘hot potato’ politically, so still unavailable for this use – three methods have now been shown to be effective contraceptives when initiated after unprotected sexual intercourse (UPSI): • • • the insertion of a copper IUD the combined oral emergency contraceptive (COEC) using LNG 500 µg + EE 100 µg repeated in 12 hours the levonorgestrel progestogen-only emergency contraceptive (LNG EC), given as a stat dose of LNG 1500 µg. | Postcoital contraception Apart from mifepristone RU486 - a hot potato politically so still unavailable for this use - three methods have now been shown to be effective contraceptives when initiated after unprotected sexual intercourse UPSI the insertion of a copper IUD the combined oral emergency contraceptive COEC using LNG 500 pg EE 100 pg repeated in 12 hours the levonorgestrel progestogen-only emergency contraceptive LNG EC given as a stat dose of LNG 1500 pg. Marketed in the UK as Levonelle 1500 both on prescription and over-the-counter in pharmacies LNG EC has now superseded COEC in the UK. An important finding for both hormone methods is that delay in treatment increases the failure rate. This essentially means treating as soon as possible. But emergency contraception EC remains a better lay term than morning-after pill since it leaves open the following facts Useful benefit can be obtained long after the morning after -indeed it is licensed for use post-coitally up to 72 hours and is usable even later in selected cases. There is a copper IUD alternative which is not a pill at all. See Table 10. Importantly there is no upper age limit to any of the methods if a sufficient risk of conception is present. 124 Table 10 Emergency contraception choice of methods1 LNG EC LNG mg as stat dose Copper IUD Immediate insertion but sometimes better to delay see text Normal timing after intercourse Efficacy overall within 72 hours Side effects Contraindications WHO 4 Up to 72 hours but also usable up to 120 hours see text About 99 Nausea 23 15 ồ Vomiting 6 ồ Pregnancy ProVen severe acute allergy to a constituent Active acute porphyria with past attack triggered by sex hormones Woman s own ethics prechiding a possible postfertilization mechanism Up to 5 days or 5 days after earliest calculated day of ovulation About Pain bleeding risk of infection Pregnancy As for copper IUDs generally including ethical point if it applies below left aWHO. Lancet 1998 352 .

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