Emergency is helpful in preventing pregnancies post unprotected sexual activity. It can be used in case of contraceptive failure, in case of sexual assault, incorrect use of contraceptives and unprotected sex.

Emergency contraception can be done by three methods. These are emergency contraceptive pills, combined oral contraceptive pills and copper intrauterine devices.



The copper IUD is considered to be one of the most effective forms of emergency contraception, when it is inserted within 5 days of unprotected sexual activity.

However, the emergency contraceptive pill regimen as per WHO is:

1 dose of levonorgestrel 1.5 mg, or 1 dose of ulipristal 30 mg, taken within 5 days (120 hours) of unprotected intercourse

The Yuzpe regimen which consists of 2 doses of combined oral contraceptive pills

What is Emergency Contraception?

Emergency contraception is usually referred to as the contraception which is used to prevent a pregnancy within the first 5 days after an unprotected sexual activity. It is used post failures of contraception, coerced unprotected sex, rape or misuse of contraception.

Emergency contraception is only effective in the first few days after an intercourse and before the egg has released from the ovary, and before there is fertilization between the egg and the sperm. The emergency contraception can do no harm to an interrupted pregnancy and a developing embryo.

Who needs emergency contraception?

Any girl or woman who is at her reproductive age might need an emergency contraception in case of an unprotected sexual intercourse.

Uses
1 Breakage , slippage or displacement of barrier methods 
2. Three or more missed OCPills for more than 12 hours 
3. Missed Mini pill for more than 3 hours 
4. Missed Desoestrel pills for more than 12 hours 
5. DMPA injections taken more than 2 weeks late 
6. Miscalculated dates of last period and present ovulation side effects 
These are meant only for emergency contraception and NOT AS A REGULAR CONTRACEPTIVE. It involves pumping of a hormone inside your body at levels which are 5 times higher than normal. hence excessive and unnecessary use may cause irregularity in the period cycles and an adverse effect on the menstrual health over a period of time. Ideally it should be taken under guided medical supervision.


In what situations should emergency contraception be used?

Emergency contraception can be used after a sexual intercourse. These include:

In case of no use of contraceptives

If it is a case of rape or coerced sex, where the woman was not protected

When there is a contraceptive failure, like

breakage

incorrect use or slippage

OCPILLS,

mini pills

DMPA

3 or more missed combined oral contraceptives, progestogen-only pill (minipill) taken more than 3 hours late, desogestrel-containing pill 12 hours or more, norethisterone enanthate (NET-EN) progestogen-only injection taken more than 2 weeks late

Delay in placing or dislodgement or early removal of the skin patch or the hormonal ring

Breaking, dislodgement, tearing or early removal of cervical cap or diaphragm

Failure of withdrawal that is ejaculation the external genitalia or vagina

The spermicide tablet failure

Miscalculating the periods, failure from using a barrier on the fertile days

Expulsion of an intrauterine contraceptive device (IUD)

Methods of Emergency Contraception:

There are three emergency contraception methods:

Copper-bearing intrauterine devices (IUDs)

Emergency contraception pills (ECPs)

Combined oral contraceptive pills or the Yuzpe method



Safety of Emergency Contraception

Birth control is a method by which unwanted pregnancy is prevented. Partners can plan their childbearing in a better way using the increased levels of awareness about birth control.
 
Methods of birth control
1. Intrauterine devices (IDUs): These are most effective methods of birth control. The intrauterine device (IUD) is a long-acting and reversible form of contraception for women. It is of two types: Copper IUD (contains copper) and Hormone-releasing IUDs (progestin hormone is released into the womb slowly). It is a small device that is fitted inside the womb and it provides contraception by preventing fertilization of the egg.

2. Sterilization: This is a process of birth control that renders a woman incapable of conception or a man incapable of sperm delivery. The process is conducted with the consent of the individual and can be done using either surgical or non-surgical methods. In both the cases, tubes carrying sperms (in males) and fallopian tubes (females) are either cut or blocked.

3. Condoms: These are the most commonly used measures for birth control. Male and female condoms act as barriers and prevent the sperm from reaching the uterus.

4. Oral contraceptive pills: These pills are the most popular measures of birth control used by women across the world. This is the most convenient way of postponing pregnancy. However, it is very important that the side effects of the contraceptive pills be noted. The side effects cause changes in the body, such as irregular bleeding, increase in the breast's size increased levels of blood pressure as well as eventual infertility.

5. Contraceptive Injections: In this method, one hormone injection is administered, the effects of which last inside the body for a time period of 8 to 12 weeks i.e. 2-3 months. The contraceptive injection has the similar effects as that of contraceptive pills on birth control. Evidently, the shot is irreversible, which makes the woman infertile for a period of three months. However, similar to the pill, protection from STDs is not offered by contraceptive injections. But these injections can guarantee 99% safety and surety on being used.

6. Natural Family Planning: Even though it is not any external pill or device, Natural Family Planning is also a method of birth control. It relies on the knowledge of timings of the menstrual cycle (periods) so that the couple can avoid sex during the time period when the woman is fertile.

6 Sure Shot Ways of Birth Control

There are two methods by which abortion can be done:

Medical Abortion - Non-surgical abortion in which medicines are used to induce abortion

Surgical Abortion - Use of transcervical procedures for terminating a pregnancy, including vacuum aspiration, and dilatation and evacuation (D and E).

Surgical or Medical Abortion for Unwanted Pregnancy

If pregnancy is lesser than = 7 weeks; medical method with Mifepristone with Misoprostol is favorable as the success rate is as high as 97%.

If pregnancy is between 7-12 weeks; surgical abortion is the only option.

If pregnancy is beyond 12 weeks - 20 weeks, then the woman needs to be hospitalized and will be given either Mifepristone followed by Misoprostol tablet or only Misoprostol tablets and woman will then abort like a miscarriage in the hospital. If any products are remaining, then it will be evacuated surgically.

Surgical abortion is preferred if patient desires concurrent tubal ligation or IUCD (CuT) insertion.

If a woman fulfills the criteria for selecting either method i.e. before 7 weeks, final choice has to be given to the woman.

Summary of choice between Surgical or Medical abortion in India

lesser than = 7 weeks - Medical method or surgical method

7-12 weeks - Surgical abortion

12 - 20 weeks - Medicines with or without surgical procedure in hospital

Advantages of Medical Abortion

Avoid surgery

Controlled by the woman and may take place at home

No need for admission to the hospital

Usually, well tolerated by women, if properly counselled and motivated

No need to take leave from work, as bleeding can be managed with menstrual pads even while in the office or at work.

Disadvantages of medical abortion

Takes time (hours to days) to complete abortion, and the timing may not be predictable. Women experience bleeding and cramping, and potentially some other side-effects (nausea, vomiting, fever, and shivering). May require more clinic visits than surgical abortion.

Advantages of Surgical Abortion

Quick procedure

Complete abortion easily verified by evaluation of aspirated products of conception

Takes place in a hospital so Sterilization or placement of an intrauterine device (IUD) may be performed at the same time as the procedure. It can be performed under local anaesthesia if woman is properly motivated and counselled

Disadvantages of surgical abortion

Requires instrumentation of the uterus

Small risk of uterine or cervical injury

Timing of abortion controlled by the doctor and hospital

Anaesthesia needs to be administered. Most doctors perform this procedure under short general anaesthesia. A woman needs to be in the hospital for at least 6 hours. Effect of sedation will be there throughout the day.

Methods of Abortion for Unwanted Pregnancy

Using contraceptive methods is the easiest method for a couple to avoid pregnancy and enjoy a tension free physical relationship. People have used birth control methods for thousands of years. Today, we have many safe and effective birth control methods available to us.

All of us who need birth control want to find the method that is best for us. If you're trying to choose, learning about each method may help you make your decision. Only you can decide what is best for you. Some contraceptives, such as condoms, will also protect a person from sexually transmitted diseases (STDs).

The methods can be categorised into temporary and permanent methods.

Temporary methods:
1. Withdrawal method: This involves removing the penis from the vagina before ejaculating. Ejaculation should be away from the introitus. However it requires extreme self-control on the part of your man.

2. Barrier methods: These methods prevent sperm from entering the uterus. Barrier methods are removable. Types of barrier methods include:

a. Condom: This is the oldest barrier method. A condom is a thin tube that the man puts over his penis. This keeps the sperm from getting to the egg. Condoms are also called rubbers.
b. Female condom: This is like a condom, but it goes in the woman's vagina.
c. Diaphragm and cervical cap: These are put in the woman's vagina to cover the cervix
d. Contraceptive sponge: This is a sponge that is filled with spermicide and is put in the woman's vagina over the cervix.
Barrier methods can be easy to use and have few side effects.

3. Hormonal methods: These can only be used by women. Hormonal methods cause changes in the woman's reproductive cycle and include Birth Control Pills, Birth Control Patches, Emergency contraception pill, Implants and so on. Unlike barrier methods, hormonal methods do not interfere with sex.

4. Intrauterine methods: In this method an object called an intrauterine device or IUD is put in the woman's uterus. There are two types of IUD: the copper IUD or an IUD with hormones implanted on it. The hormonal IUD has better protection against pregnancy but costs more. You need not do anything once it is inserted. Also it is effective for up to 10 years.

Permanent methods

Of course, the permanent methods are more effective for preventing pregnancy than the temporary methods. The decision to proceed with a permanent method should only be made if a person is absolutely sure that no more children are desired. The biggest problems after a permanent procedure is regret that it was done.

1. Sterilization: Sterilization is a permanent form of birth control that prevents a woman from getting pregnant. These procedures usually are not reversible.

a. A sterilization implant is a non surgical method for permanently blocking the fallopian tubes. The doctor places a coil in each Fallopian tube through the vagina and uterus block each tube completely. It may take up to 3 months to completely block the tubesb. 

b.Tubal ligation is a surgical procedure in which a doctor cuts the fallopian tubes. This procedure blocks the path between the ovaries and the uterus. The sperm cannot reach the egg to fertilize it and the egg cannot reach the uterus.

c. Vasectomy is a surgical procedure that consists in cutting the tubes that carry sperm. This procedure blocks the path between the testes and the urethra due to which the sperm cannot leave the testes and hence cannot reach the egg. It can take as long as 3 months for the procedure to be fully effective.

Temporary & Permanent Contraceptive Methods For Male & Females

Many studies have shown that excessive caffeine intake affects your chances of conceiving by influencing the ovulation, hormone, and the fallopian tubes but the opinions on this issue are divided. However, research on this topic mostly indicates that, though caffeine can give you a kickstart in the morning, it can have quite a reverse effect on your efforts to conceive.

How intake of excessive caffeine reduces your chances of conceiving?

The fallopian tubes are responsible for carrying the eggs from ovaries to the uterus by rhythmic movements and too much caffeine can affect this movement and cause disruption in the journey of the eggs. Moreover, consuming more caffeine has also been associated with baby's growth restriction, miscarriages, and weight issues. It is preferable to get rid of caffeine altogether from your diet when you are trying to conceive but if you are an avid coffee drinker then you might want to cut back or replace your caffeine intake with milk and syrup which is far more healthy and beneficial.

Which foods and beverages do you need to avoid?

There are so many caffeinated foods and beverages, that it is almost impossible to avoid them. But it is better to take note of them so that you can regulate your caffeine intake. Coffee, tea, soft drinks, energy drinks are obvious sources of caffeine as they are supposed to give you energy. Some herbal teas also contain caffeine. Chocolate, ice creams and candies with coffee flavors, over the counter drugs for allergies, cold and headache also contain caffeine so it is important to read the ingredients list before consuming any of them.

To higher your chances of getting pregnant, it is important to cut back on caffeine. Most doctors are of the opinion that exceeding 50 mg of caffeine intake daily can seriously hamper your chances of conceiving.

How Excessive Caffeine can Stop you from Becoming Pregnant

Though pregnancy is one of the most cherished phases in a woman s life, there are times when it is not desired. This can be due to various reasons ranging from premarital sex to the couple not being ready yet. Whatever the reason, emergency contraceptive measures are available, and I-Pill has become synonymous with that.

Since its introduction, it is widely used to prevent unwanted pregnancies. The easy availability (no prescription required) and low cost have added to its popularity. However, not many realize it has some side-effects and the need to be aware of certain facts when using the I-pill.

It is an emergency contraceptive pill, should be used between 24 to 72 hours after unprotected sex
It is effective in 95% of the women when taking during this time frame
It prevents pregnancy by stopping fertilisation or preventing implantation of the fertilising egg
It stops pregnancy; however, if you conceive before the pill it was taken, it will not have any effect. It is therefore not an abortion pill
So, if you miss the period the next month, test for pregnancy
It does not offer protection against sexually transmitted disease including HIV/AIDS
It is not to be used on a regular basis
If you are on long-term medication, please consult with the doctor before taking the I-pill
It has no long-term consequence. However, there could be some minor symptoms including breast tenderness, nausea, vomiting, headache, and lower abdominal pain (pelvic area),
The next menstrual cycle could be delayed by a couple of days
There could also be spotting before the actual period starts
Women who are allergic to levonorgestrel should not take I-pill.
It can cause skin allergies and reduce libido.
When used repeatedly, it can cause delayed and irregular menstruation
It is ideal for use between the age of 25 and 45. Teenagers should not use it regularly. This needs to be made aware through sex education, as the prevalence of teenage sex and pregnancy is on the rise in India
Repeated usage can cause ovarian damage and severe menstrual issues, so occasional use is the only recommended usage
It is safe to take the pill during lactation. There is no effect on the quality of milk or any other adverse effect on the baby
I-Pill was introduced as an emergency contraceptive method, and not for regular contraceptive purpose. Its correct usage and avoiding complications is largely dependent on sex education which needs to start early and talk about other safe sex measures and avoid using it on a regular basis.


Side-effects of i-Pill Tablets - Every Woman Must Know!! 

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