Emergency contraception
Download
1 / 47

EMERGENCY CONTRACEPTION - PowerPoint PPT Presentation


  • 333 Views
  • Updated On :

EMERGENCY CONTRACEPTION “Beyond Coca-Cola” - ECPs & IUDs Barb Orcutt, CNM 2/2004 In the US, EC could potentially prevent up to 1.7 million unintended pregnancies and 800,000 abortions each year A PILOT PROJECT - in the state of Washington a pilot project for 16 months

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'EMERGENCY CONTRACEPTION' - oshin


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Emergency contraception l.jpg

EMERGENCY CONTRACEPTION

“Beyond Coca-Cola”

- ECPs & IUDs

Barb Orcutt, CNM 2/2004


Slide2 l.jpg
In the US, EC could potentially prevent up to 1.7 million unintended pregnancies and 800,000 abortions each year


A pilot project l.jpg
A PILOT PROJECT - unintended pregnancies and 800,000 abortions each year

  • in the state of Washington

  • a pilot project for 16 months

  • allowed easier access to EC by providing it directly through 130 participating pharmacies

  • prevented an estimated 700 unintended pregnancies and 350 abortions


Did you know l.jpg
DID YOU KNOW - unintended pregnancies and 800,000 abortions each year

  • 3.04 million unintended pregnancies in 1994

  • 48% of all pregnancies were unintended

  • 47% of unintended pregnancies ended in abortion, 40% in birth, 13% in miscarriage


Slide5 l.jpg



History of ec l.jpg
HISTORY of EC - contraception

  • "First immediately after ejaculation let the two come apart and let the woman arise roughly, squeeze and blow her nose seven times and call out in a loud voice. She should jump violently backwards seven to nine times."

    • Abu Bakr Muhammad ibin Zakariya' al-Razi

      (865 AD-925 AD)


History of ec8 l.jpg
HISTORY of EC - contraception

  • Hormonal methods originated in mid-1920s with discovery that estrogenic ovarian extracts have anti-fertility effect

  • High-dose estrogen (DES or EE) post-coitally as a treatment for rape survivors in the 1960s


History of ec9 l.jpg
HISTORY of EC - contraception

  • How about a post-coital

    Coca-Cola douche!

  • (The New England Journal of Medicine published a study on that one as late as the 1980s.)


Current ec l.jpg
CURRENT EC - contraception

  • Yuzpe’s original article – 1974

  • Dosage was two doses of two Ovral tablets, 12 hours apart

    • within 72 hours of unprotected intercourse

  • Effectiveness believed to be about 95%

  • Problems = nausea, time frame


Other regimens 2 doses 12 hrs apart l.jpg
Other Regimens – contraception2 doses, 12 hrs apart

  • Ogestrel – 2 white pills per dose

  • Levora – 4 white pills per dose

  • LoOvral – 4 white pills per dose

  • Levlen – 4 light orange pills per dose

  • TriLevlen – 4 yellow pills per dose


Copper iuds also are ec first reported in 1976 l.jpg
Copper IUDs also are EC contraception- first reported in 1976

  • Advantages:

    • Decreases risk of pregnancy by 99% if used within 5 days of unprotected intercourse

    • Can be left in place for ongoing effective contraception for up to 10 years

  • Disadvantage

    • Not a good option for women who are at risk for STDs – pre-RX?


Antiprogestins l.jpg
ANTIPROGESTINS contraception

  • Different action from its use in medical abortion, same dose

  • A single 600mg dose of Mifepristone (RU-486) within 72 hrs after unprotected intercourse is highly effective

  • Fewer side-effects than Yuzpe

  • 10mg dose may be equally effective


Plan b l.jpg
PLAN B® - contraception

  • Levonorgestrel 0.75mg per dose (1 pill), x 2 doses, packaged as EC

  • Approved by FDA in 1999, Rx only

  • More effective than Yuzpe regimen of combination OCs

  • Less nausea, fewer side-effects

  • As of April 2003, more than 3 million doses sold


Plan b15 l.jpg
PLAN B® contraception

  • OTC “behind the counter” in 5 states – WA, CA, AK, HI, NM

  • Dec. 2003 – FDA advisory committee endorsed OTC sale

  • Feb. 2004 – strong political pressure to reject OTC sales

    • FDA decision pended until May


How do ecps work l.jpg
How do ECPs work? contraception

  • Emergency contraceptives work before implantation and not after a woman is already pregnant


Ec does not cause abortion l.jpg
EC Does contraceptionNot Cause Abortion -

  • “Pregnancy” is medically defined as the implantation of a fertilized egg in the lining of a woman's uterus


Plan b mechanism of action l.jpg
PLAN B® – contraceptionMECHANISM OF ACTION

  • The exact mechanism of action may vary from woman to woman and may depend on the day of the menstrual cycle on which treatment is started

  • (DO NOT try to calculate by her menstrual cycle how likely it is or isn’t that she might get pregnant – just get it to her as soon as possible no matter where she is in her cycle)


Slide19 l.jpg


If you care about disrupting a fertilized egg l.jpg
IF YOU CARE ABOUT DISRUPTING A FERTILIZED EGG -- believed to act principally by interfering with the process of ovulation

  • the sooner ECPs are taken, the more likely they are to alter ovulation, and less likely to inhibit implantation after fertilization

  • PROVIDE ECP IN ADVANCE!


Effectiveness l.jpg
EFFECTIVENESS believed to act principally by interfering with the process of ovulation

  • Recent studies indicate that BOTH types of pills (combination OCPs as well as Plan B) are effective when the first dose is started up to 5 days (120 hours) after unprotected intercourse


Effectiveness22 l.jpg
EFFECTIVENESS believed to act principally by interfering with the process of ovulation

  • However, a recent large study by the World Health Organization found effectiveness declined significantly with increasing delay between unprotected intercourse and the initiation of treatment


Effectiveness plan b information l.jpg
EFFECTIVENESS – believed to act principally by interfering with the process of ovulationPLAN B® INFORMATION

  • Early treatment is significantly more effective. For emergency contraception generally, each 12 hours of delay in the start of treatment reduces efficacy by 50%


Effectiveness plan b information24 l.jpg
EFFECTIVENESS – believed to act principally by interfering with the process of ovulationPLAN B® INFORMATION

  • Plan B® prevents 95% of expected pregnancies when taken in the first 24 hours after a single act of unprotected intercourse, reducing the crude pregnancy rate from about 8% with no treatment, down to 0.4%


Effectiveness plan b information25 l.jpg
EFFECTIVENESS – believed to act principally by interfering with the process of ovulationPLAN B® INFORMATION

  • If treatment is delayed 25-48 hours, efficacy declines to 85%, and if treatment is delayed beyond 48 hours, efficacy declines to 61%


Slide26 l.jpg


Effectiveness27 l.jpg
EFFECTIVENESS?? differences in success rates for women taking EC within either 72 hours or 120 hours of intercourse were not statistically significant

  • Clinical trials demonstrated a higher pregnancy rate in Chinese populations with both Plan B® and the combination Yuzpe regimen

  • It is unknown as to exactly what the effectiveness may be in our patient populations


Dosage adjustments l.jpg
Dosage Adjustments differences in success rates for women taking EC within either 72 hours or 120 hours of intercourse were not statistically significant

  • Recent studies indicate that BOTH doses of PLAN B can be taken at the same time with no decrease in efficacy

  • At least consider the timing of the second dose – earlier than 12 hours is OK


Dosage adjustments29 l.jpg
Dosage Adjustments differences in success rates for women taking EC within either 72 hours or 120 hours of intercourse were not statistically significant

  • Efficacy of emergency contraceptive pills may be reduced in women also taking Dilantin or other enzyme inducers

  • No official recommendations exist for this situation

  • Informal - patients should double the amount of hormone in the first of the two ECP doses


Dosage adjustments30 l.jpg
Dosage Adjustments differences in success rates for women taking EC within either 72 hours or 120 hours of intercourse were not statistically significant

  • If taking St. John's Wort –

  • ECPs may not work quite as well as they would otherwise

  • - but might still work well enough

  • Some advise to increase the number of pills in each dose by 50%


Dosage adjustments31 l.jpg
Dosage Adjustments differences in success rates for women taking EC within either 72 hours or 120 hours of intercourse were not statistically significant

  • If doubling or increasing doses, consider ordering Meclizine

    • 25-50 mg before the first dose of ECPs


Contraindications l.jpg
CONTRAINDICATIONS differences in success rates for women taking EC within either 72 hours or 120 hours of intercourse were not statistically significant

  • The only absolute contraindication is PREGNANCY

  • Plan B® will have no effect

  • No evidence that there is any harm to a fetus


Contraindications33 l.jpg
CONTRAINDICATIONS differences in success rates for women taking EC within either 72 hours or 120 hours of intercourse were not statistically significant

  • Women with undiagnosed abnormal genital bleeding probably should not use emergency contraception


Contraindications34 l.jpg
CONTRAINDICATIONS differences in success rates for women taking EC within either 72 hours or 120 hours of intercourse were not statistically significant

  • Women should not use Plan B® if they might be hypersensitive to any component of the product

  • Women who should not use OCPs as a regular method are generally safe using occasional EC




Why don t they l.jpg
Why don’t they? abandon other more reliable BCMs

  • ANY other BCM is more effective than ECPs!

  • ECPs are more expensive than most other BCMs!

  • ECPs contain a higher dose of hormones than ongoing BCPs

  • Nausea & cycle irregularity might deter routine use


Offer another method l.jpg
OFFER ANOTHER METHOD! abandon other more reliable BCMs

  • Given that EC is less effective than ANY other ongoing contraception, offer another method while you’re counseling your patient

  • Condoms and other barrier methods can be provided immediately


Offer another method39 l.jpg
OFFER ANOTHER METHOD! abandon other more reliable BCMs

  • Oral contraceptives and IUDs may be initiated immediately following Plan B® treatment or after the next menses

  • If waiting until the next menses, impress upon the woman that she should have no unprotected intercourse while waiting!


Offer another method40 l.jpg
OFFER ANOTHER METHOD! abandon other more reliable BCMs

  • If oral contraceptives are initiated before the next menses, a follow-up pregnancy test is recommended, since the OCPs will change the bleeding pattern and make it difficult to tell if a woman is pregnant or not


Plan b41 l.jpg
PLAN B® abandon other more reliable BCMs

  • About 58 percent of users will have their next menses on time or a few days early or late

  • If no menses by 3 weeks, should get a pregnancy test


Will men be less likely to use condoms l.jpg
Will men be less likely to use condoms? abandon other more reliable BCMs

  • ECPs don’t protect against STDs

  • Condom use is critical for those at risk of STD

  • Men & women may feel more comfortable using condoms if they know EC is available if a condom slips or breaks

  • PLAN B has a note in the instructions about STD screening


What we know l.jpg
What we abandon other more reliable BCMsknow -

  • A Kaiser study found that 100% of obstetrician/gynecologists believe that ECPs are safe and effective


What we do l.jpg
What we abandon other more reliable BCMsdo -

  • - only 10% of OB/Gyns routinely discuss EC with patients

  • - only 24% prescribe ECPs more than 5 x a year


Acog feb 2002 l.jpg
ACOG – Feb. 2002 abandon other more reliable BCMs

  • “Clinicians should proactively talk to their patients of reproductive age about ECPs and offer advance prescriptions for ECPs during routine gynecologic office visits….”

  • Remind women to check expiration dates if bought ahead


Resources faqs l.jpg
RESOURCES & FAQs abandon other more reliable BCMs

  • www.uptodateonline.com

  • http://www.plannedparenthood.org/library/BIRTHCONTROL

  • www.NOT-2-LATE.com

  • www.backupyourbirthcontrol.org

  • 1-888-NOT2LATE


Slide47 l.jpg

Thanks for your attention – HAPPY TRAILS! abandon other more reliable BCMs


ad