urgency contraception, sometimes re...

urgency contraception, sometimes referred to as the "morning-after" pill, is birth command that women can use to thwart pregnancy after known or suspected failure of contraception or unprotect intercourse, including sexual assault. Immediate use of an strait contraceptive reduces a woman's risk of pregnancy to 1 to 2 percent The effectiveness hangs on the regimen used and the time between unprotect intercourse and treatment. (1) The mostly common reasons for seeking crisis contraception are failure of a barrier rule of contraception (usually condoms) and failure to use any regularity (2-5) A national survey of women guarded by the Kaiser Family Foundation in 2003 reports that brace thirds of women 18 to 44 years of age are aware of pass contraception; only 6 percent of women reported through all ages having used it. (6) Research analyzing abortion stretchs from 2000, when only 2 percent of women reported till doomsday using emergency contraception, (7) supports estimates that 51000 abortions were debared by emergency contraception use that year, suggesting that increased use of pinch contraception as a back-up order may have accounted for up to 43 percent of the total decline in abortion rates between 1994 and 2000 (8)

Widespread use of push contraception requires familiarity with the rules public awareness of its availability and, in all however the six states (i.e., California, Alaska, Washington, fresh Mexico, Hawaii, and Maine) where it can be obtained without prescription, quick access to a health care professional who can provide a prescription. This article outlines the evidence for the courses safety, efficacy, risks, and benefits of pressing necessity contraception.

Methods

The U subsistence and Drug Administration (FDA) has approved three regularitys of emergency contraception (Table 1) The combination oral-contraceptive means (Yuzpe regimen) uses 0.1 mg of ethinyl estradiol and 10 mg of DL-norgestrel (equivalent to 05 mg of levonorgestrel) in pair doses taken 12 hours apart, starting within 72 hours of unprotect sexual intercourse. (5) The progestin-only course uses 0.75 mg of levonorgestrel in pair doses taken 12 hours apart. The FDA has cleared 13 brands of oral contraceptives for safety and efficacy when used for pass contraception (Table 2).

In 1998 sum of two units prescription formulations specifically intended for conjuncture contraception became available: Preven and Plan B The Preven crisis Contraceptive Kit (Yuzpe regimen) consists of four pills, each containing 025 mg of levonorgestrel and 005 mg of ethinyl estradiol; a urine pregnancy test; and a patient information book

The Plan B option consists of sum of two units tablets, each containing 0.75 mg of levonorgestrel. (9) (This amount differs from the 0075-mg dose of norgestrel in certain progestin-only pills.) Detailed patient and physician labeling accompanies one as well as the other methods. There is a general consensus (1011) that the levonorgestrel extremity contraception should be given in choice to the Yuzpe regimen where available because it is more effective and has fewer side issues In addition, a World Health Organization (WHO) multicenter randomized trial (12) point outs that the levonorgestrel dose does not have to be split further can be taken as a single 15-mg dose. undivided dose simplifies the use of levonorgestrel without causing an increase in side effects

An alternative to the hormonal classifications is insertion of the ParaGard T-380A Intrauterine cauldron Contraceptive up to five days after unprotect intercourse. After insertion for the meaning of emergency contraception, this device can provide reversible contraception for up to 10 years.

Mechanisms of Action

A single mechanism of action has not been identified. (13) Inhibition or delay in ovulation and insufficient corpus luteum function have been reported in a women. (14)

a certain number of studies have reported histologic or biochemical changes within the endometrium that may end in failure of implantation. (1516) Another contemplation suggests that the mechanism of action is interference with tubal transport of semen egg, or embryo. (17) There is no evidence that urgency contraception increases the incidence of ectopic pregnancy; however, no studies specifically focus in succession this issue. Although the predominant fashion of action of combination hormonal contraceptives is most numerous likely ovulation suppression, this efficiency is not total. (18) Breakthrough ovulation is estimated to arise in up to 10 percent of cycles

Other mechanisms of action (changes in cervical mucus and the endometrium) are recognized and included in the prescribing information. Endometrial changes make implantation after fertilization les likely and, depending upon when the hormones are taken, may be the more everyday mechanism. However, how often a post-fertilization force occurs is unknown. (19)

Timing

There is an inverse relationship between prevention of pregnancy and time since unprotect intercourse (Figure 1) (20) This upward gradient between 24 48 and 72 hours is veracious for both hormonal methods, and particularly for the progestin-only manner In almost all studies, the first dose is administered within 72 hours after unprotect intercourse. A fresh multicenter, randomized controlled study lay the foundation of that the sooner the first dose was taken after intercourse, the greater the effectiveness. (21) The failure rate at 72 hours (three days) after hormonal turn of events contraception is approximately 4 percent This rate increases to 10 percent at five days. (2021)