Transcript EMERGENCY CONTRACEPTION Béla Veszprémi MD., PhD. University of Pécs Faculty of Medicine Department of Obstetrics and Gynecology.

EMERGENCY
CONTRACEPTION
Béla Veszprémi MD., PhD.
University of Pécs
Faculty of Medicine
Department of Obstetrics and Gynecology
Emergency contraception refers to a
particular type of contraception that
is used as an emergency procedure
to prevent pregnancy following
unprotected, possible fertile,
intercourse
(Van Look)
(Br. Med.Bull. 1993.)
METHODS OF EMERGENCY
CONTRACEPTION
• High-dose estrogen
• Ethinyl estradiol with levonorgestrel
(Yuzpe regimen)
• Levonorgestrel alone
• IUD
• Mifepristone (Antiprogesterone)
• GnRh antagonists
MECHANISM OF ACTION
Maturation of follicle
Inhibit or delay ovulation
Inhibit: sperm transport
fertilisation
development and
transport of
zygote
(Croxatto et al.
Contraception 2001)
Inhibition of
implantation
influencing:
endometrial receptivity
blastocyst signalisation
corpus luteum function
Features of EC pills
•
•
•
•
•
•
•
Low toxicity
Overdosage is rare
Non teratogenic
Medical screening is not required
Self administration
Uniform dosage
Drug interaction is not significant
(Grimes et al. Obstet.-Gynecol. 2001.)
Efficacy of postcoital
contraceptive methods
•
•
•
•
Yuzpe regimen
Progesterone only
Mifepristone
IUD
(Curr.Opin.Obstet.Gynecol. 2000.)
75%
85%
85%
90%
Composition of EC pills
(Richter Gedeon Rt.)
Fertilan (Noral,Neogynon)
50 μg ethinyl estradiol
250 μg levonorgestrel
Rigesoft
750 μg levonorgestrel
Treatment with EC pills
1st dose: within 48-72 hours after
unprotected intercourse
2nd dose: repeat after 12 hours
If vomitus occurs within two hours after
pill intake, repeated dosage is required
Multiple application in the same cycle is
contraindicated
Not teratogenic
Percentage of expected
pregnancies prevented
Efficacy of EC and time of
treatment
100
95
83
79
66
61
47
50
0
0 - 12
13 - 24
25 - 36
37 - 48
49 - 60
61 - 72
Delay between intercourse and time of treatment with EC
Percentage of expected pregnancies prevented
in relation to the delay between intercourse and
time of treatment with EC
Time of
treatment
Levonorgestrel %
Yuzpe %
Within 24 hours
95
77
24-48 hours
85
36
48-72 hours
58
31
WHO 1998.
EC outpatient clinics in Hungary
1
3
2
5
4 2
2
3
2
4
4
3
2
4
4
6+1
2
3
3
5
Telephone-number of EC
out-patient clinics in
Hungary
The number of deliveries
and abortions in Hungary
115000
105000
95000
85000
75000
65000
55000
1995
1996
1997
1998
szülésszám
1999
abortuszszám
2000
2001
2002
Number of abortions per
100 live births in Hungary
75
73
71
69
67
65
63
61
59
57
55
1995
1996
1997
1998
1999
100 élveszülésre jutó abortusz
2000
2001
2002
Number of abortions over and
under 20 years
90000
80000
70000
60000
50000
20 év felett
40000
20 év alatt
30000
20000
10000
0
1995 1996 1997 1998 1999 2000 2001 2002
The number of pregnancy
terminations
(Dept. Of Ob. & Gyn., Univ. of Pécs)
Patient
1997
1998
1999
2000
2001
2002
705
648
639
613
579
584
Under
57
18 years (8%)
53
(8.1%)
27
48
50
37
(7.5%) (8.1%) (6.3%) (4.6%)
The number of treated patients in 2002
in Hungary
fő
5812
1470
1246
755 783
955
284
434
224
395 323 332
691
70
214
311
426
169
411
megye
Age distribution of patients at EC clinics
In 2002 in Hungary
56
60
patients%
50
40
30
22
20
10
11
5
4
1
1
35-40
years
over 40
0
10-14
years
15-19
years
20-24
years
25-29
years
30-34
years
The reason of seeking EC gynecological care
In 2002 in Hungary
56
60
patients%
50
40
38
30
20
10
3
3
0
barrier method
forgotten pill
unprotected
miscell.
Sales of Rigesoft in
Hungary
RIGESOFT
9 000
8 000
7 000
6 000
5 000
4 000
3 000
2 000
1 000
0
99 9 99 0 00 0 00 0 00 0 00 0 01 0 01 0 01 0 01 0 02 0 02 0 02 0 02 0 03 0 03
9
/1 2/1 3/2
/2 9/2
/2 3/2 6/2
/2 2/2 3/2
/2 9/2
/2 3/2 6/2
9
6
2
9
6
2
0
1
0
0
0
1
0
0
0
1
0
0
0
1
0
0
„No women can call herself
free who does not controll her
body”
Margaret Sanger 1920