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

Female condoms are generally pouches made of latex and polyurethane, which are used by women during sex in order to prevent pregnancy and thereby reduce the chances of infection by sexually transmitted diseases. Each end of these pouches are made of rings that are flexible. They should be inserted deep inside the vagina before sex is initiated and held in the position by utilizing the rings available at the closed end while the rings which are at the open end remain outside the vagina during sex.

Even though it can be safely used by most people, some women would find female condoms to be an inappropriate form of contraception and would not feel comfortable with their genital areas being touched. Thus, it is very important that the appropriate form of contraception be considered for you and your partner. Condoms should be used correctly. In case of need for extra protection, other options of contraception should be considered.

Pros of female condoms
1. Since the exchange of bodily fluids, such as semen and vaginal fluid is prevented, female condoms aid in offering protection against many sexually transmitted diseases such as HIV.

2. Condoms can prove to be reliable pregnancy averting methods if they are properly and consistently used.

3. Female condoms are only needed during the time of sex. Any form of advance preparation is not required, hence making them suitable for unplanned sex.

4. Prescriptions are not needed

5. The condoms are usually small in size, disposable as well as easy to carry

6. Usually, using condoms does not show any medical side effects.

7. Insertion of female condoms can be done up to a duration of eight hours before sex. The responsibility for utilizing condoms properly should be shared by the woman as well as the partner.

Cons of female condoms
1. Even though condoms are generally very strong, they are prone to splitting or tearing in case of improper use.

2. Availability of female condoms pales in comparison to the male counterparts and they are usually more expensive.

3. The outer ring might produce a cumbersome feeling.

Pros and Cons of Female Condoms

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!! 

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

A birth control pill is commonly referred to as an oral contraceptive pill. A form of hormonal contraception and is a highly effective method of birth control. Only 1% of women experience unintended pregnancy when on the pill.

Birth control pills are of two types i.e combination pills and mini pills. Combination pills contain synthetic forms of the two hormones called oestrogen and progesterone. The mini pill only contains the hormone progesterone and is called progestin.

However, the pill does have some side effects to it. These include the following:

Intermenstrual spotting: Within the first three months of starting the pill, women experience vaginal bleeding between the two period cycles.
Nausea: Although the symptoms subside after some time, some women till experience nausea for a while after taking the pill. If one consumes the pill with food or before going to bed, this can help lower the likelihood of feeling nauseous.
Breast tenderness: The breasts might feel tender and enlarged after taking the pill. However, anyone who finds a lump in the breast or feels continuous pain needs to seek medical help.
Headaches: Migraines and headaches are a very common phenomenon of the birth control pill. Different types and doses of these pills may result in different headache symptoms.
Gaining weight: Experiencing certain fluid retention in the hip or breast area is very common. It also affects the fat cells of the body because of the oestrogen present in the pills.
Mood swings: Those with a history of stress or depression might start to feel the same again. If one has that kind of a history and starts to feel emotional changes, she should consult a doctor immediately.
Missing periods: It is a common side effect that after using the pill, one's period might get skipped. This is influenced by several factors including stress, depression or thyroid dysfunctions.
Decreased libido: The sex drive can be widely affected by the birth control pill. Although many other factors could result in a decreased libido, but if it remains after having the pill and is persistent, one should seek medical help or consult a specialist.
Vaginal discharge: There could be an increase or a decrease in the vaginal lubrication. Some people might experience vaginal discharge since it is very common. Changes in vaginal discharge never turn out to be harmful.
Changes in the vision: Fluid retention due to the birth control pill can result in the swelling of corneas. Because of this, even contact lenses do not fit comfortably. Contact lens wearers should consult an ophthalmologist if their vision or lens tolerance is disturbed.

Although there are certain side effects to taking birth control pills; however, one should not abstain from taking them in the fear that they might cause certain side effects. These pills are a precautionary measure along with other protection methods and should be taken in case someone wants to avoid pregnancy at the time being.

Birth Control Pills - 10 Common Side Effects of Them!

The contraceptive pill, or simply 'the pill', is a type of hormonal contraception taken by women to prevent pregnancy. Now, even though the birth control pill is extremely effective in preventing unplanned pregnancy, it is not without some side effects. The common side effects of birth control pill include:

1. Intermenstrual spotting: Some women experience intermenstrual spotting or bleeding in the time between their menstrual cycles. This is very common in the first three months of you taking the pill. Most of the times, intermenstrual bleeding resolves itself.

2. Nausea: Some women might experience mild nausea when they take the pill for the first time. The nausea will resolve on its own after some time, but if it gets critical or persists, seek medical help. Taking your pill at bedtime or with food can aid in countering the nausea.

3. Breast tenderness: Breasts can become tender or enlarge as a result of birth control pills. Reducing salt and caffeine intake, and wearing a support bra can be beneficial.

4. Headaches: The development of migraines and headaches are the effects of the sex hormones. Different pills with varied doses and types of hormones may lead to different symptoms of headaches. Studies suggest that pills with low hormone doses are usually linked with headaches.

5. Weight gain: There is no logical link between weight fluctuations and contraceptive pills, but fluid retention (specifically in the hip and breast areas) and enlarged fat cells are common side-effects.

6. Mood changes: Women who may have suffered from depression should consult their doctors when taking the pill. A study discovered that taking pills usually leads to the thickening of the cortexes (outermost layers of the brain involved with analysing incoming stimuli and reward response). However, there is more research pending on this issue.

7. Missed periods: Skipping or missing a period is very common when you are on the pill. Factors such as stress, travel, illness and thyroid or hormonal abnormalities can influence this.

8. Decreased libido: The pills contain hormones that can lower your sex drive or libido.

9. Vaginal discharge: Some women experience differences in their vaginal discharge when they are on the pill. Vaginal lubrication can dip, which causes discomfort during sex.

10. Visual changes: Fluid retention is a side-effect of the pill, which even ends up affecting the cornea; they change shape or swell up.

Birth Control Pills - 10 Common Side Effects!

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