EMERGENCY EMERGENCY CONTRACEPTIONCONTRACEPTION

EMERGENCY EMERGENCY CONTRACEPTIONCONTRACEPTION

Béla Veszprémi MD., Béla Veszprémi MD., PhD.PhD.

University of PécsUniversity of Pécs

Faculty of MedicineFaculty of Medicine

Department of ObsteDepartment of Obstettrics and Gynecologyrics and Gynecology

Béla Veszprémi MD., Béla Veszprémi MD., PhD.PhD.

University of PécsUniversity of Pécs

Faculty of MedicineFaculty of Medicine

Department of ObsteDepartment of Obstettrics and Gynecologyrics 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 follicleMaturation of follicle

Inhibit or delay ovulationInhibit or delay ovulation

Inhibit: sperm transportInhibit: sperm transport

fertilisationfertilisation

development and development and

transport of transport of zygote zygote

(Croxatto et al. Contraception 2001)

Inhibition of Inhibition of implantationimplantation

influencing:influencing:

endometrial endometrial receptivityreceptivity

blastocyst blastocyst signalisationsignalisation

corpus luteum corpus luteum function 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 75%• Progesterone only 85%• Mifepristone 85%• IUD 90%

(Curr.Opin.Obstet.Gynecol. 2000.)

Composition of EC pills

(Richter Gedeon Rt.)

Fertilan (Noral,Neogynon)

50 μg ethinyl estradiol250 μg levonorgestrel

Rigesoft 750 μg levonorgestrel

Treatment with EC pills

1st dose: within 48-72 hours after unprotected intercourse

2nd dose: repeat after 12 hoursIf vomitus occurs within two hours after pill intake, repeated dosage is requiredMultiple application in the same cycle is contraindicatedNot teratogenic

Efficacy of EC and time of treatment

Per

cent

age

of e

xpec

ted

preg

nanc

ies

prev

ente

d 100

50

0

0 - 12 13 - 24 25 - 36 61 - 7249 - 6037 - 48

8379

6661

47

95

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.

532

2

44

33

2

31

4 4

24

3

2

6+1

5

2

EC outpatient clinics in Hungary

Telephone-number of EC out-patient clinics in

Hungary

The number of deliveries and

abortions in Hungary

55000

65000

75000

85000

95000

105000

115000

1995 1996 1997 1998 1999 2000 2001 2002

szülésszám abortuszszám

Number of abortions per 100 live births in

Hungary

55

57

59

61

63

65

67

69

71

73

75

1995 1996 1997 1998 1999 2000 2001 2002

100 élveszülésre jutó abortusz

Number of abortions over and under 20 years

0

10000

20000

30000

40000

50000

60000

70000

80000

90000

1995 1996 1997 1998 1999 2000 2001 2002

20 év felett

20 év alatt

The number of pregnancy terminations

(Dept. Of Ob. & Gyn., Univ. of Pécs)

1997 1998 1999 2000 2001 2002

Patient 705 648 639 613 579 584

Under 18

years

57 (8%)

53 (8.1%)

48 (7.5%

)

50 (8.1%)

37 (6.3%

)

27(4.6%)

The number of treated patients in 2002

in Hungary

0

1000

2000

3000

4000

5000

6000

20 év felett

20 év alatt

755755 783783

284284

955955

224224434434

1246124614701470

395395 323323 3323327070

58125812

214214

691691311311

169169426426 411411

főfő

megymegyee

Age distribution of patients at EC clinics

In 2002 in Hungary

5

56

22

11

41 1

0

10

20

30

40

50

60

10-14years

15-19years

20-24years

25-29years

30-34years

35-40years

over 40

pat

ien

ts%

The reason of seeking EC gynecological care

In 2002 in Hungary

38

3

56

3

0

10

20

30

40

50

60

barrier method forgotten pill unprotected miscell.

pat

ien

ts%

Sales of Rigesoft in Hungary

RIGESOFT

01 0002 0003 0004 0005 0006 0007 0008 0009 000

09/

1999

12/1

999

03/2

000

06/2

000

09/2

000

12/2

000

03/2

001

06/2

001

09/2

001

12/2

001

03/2

002

06/2

002

09/2

002

12/2

002

03/2

003

06/2

003

„No women can call herself free who does not

controll her body”

Margaret Sanger 1920