วันนี้เรามาคุยเรื่อง emergency contraceptive กันดีกว่า

[SinWiSuth]

ผมดึงเอาข้อมูลส่วนสำคัญจาก THE AMERICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS ที่ตีพิมพ์ใน ACOG Practice Bulletin ปี 2010 มาลงไว้ให้นะครับ
สำหรับคนที่ยังไม่เคยเห็น

The two-dose progestin-only regimen instructs
patients to take one 0.75-mg levonorgestrel pill as soon
as possible after unprotected intercourse and to take the
second 0.75-mg pill 12 hours after the first dose.

However, the two 0.75-mg doses of the levonorgestrel-only
regimen are equally effective if taken 12?24 hours apart,
which may improve adherence.

The single-dose 1.5-mg levonorgestrel-only regimen is as effective as the
two-dose regimen taken 12 hours apart.

[SinWiSuth]

Side Effects

Irregular bleeding??After emergency contracep-
tion use, the menstrual period usually occurs within
1 week before or after the expected time. Some
patients experience irregular bleeding or spotting
in the week or month after treatment; one trial of
the levonorgestrel-only regimen found that 16%
of women reported nonmenstrual bleeding in the
first week after use.If emergency contracep-
tion is taken earlier in the cycle, it is more likely
that a women will experience bleeding before the
expected menses. Irregular bleeding associ-
ated with emergency contraception resolves without
treatment

[SinWiSuth]

Effects on Pregnancy

No studies have specifically investigated adverse effects
of exposure to emergency contraception during early
pregnancy. However, numerous studies of the terato-
genic risk of conception during daily use of oral con-
traceptives (including older, higher-dose preparations)
have found no increase in risk to either the pregnant
woman or the developing fetus.

Existing data indicate that use of emergency contra-
ception does not increase the chance that a subsequent
pregnancy will be ectopic. Emergency contraception,
like all other contraceptives, actually reduces the abso-
lute risk of ectopic pregnancy by preventing pregnancy
overall.

No clinical examination or pregnancy testing is necessary
before provision or prescription of emergency contracep-
tion is provided. Emergency contraception should be
offered or made available any time unprotected or inad-
equately protected intercourse occurs and the patient is
concerned that she is at risk for an unwanted pregnancy.
Emergency contraception should not be withheld or
delayed in order to test for pregnancy, nor should it be
denied because the unprotected coital act may not have
occurred on a fertile day of the menstrual cycle.
ข้อนี้ผมไม่ค่อยเห็นด้วยมาก หากจะใช้ในบ้านเรานะครับ ^ ^

[SinWiSuth]

When should emergency contraception be initiated?

Treatment should be initiated as soon as possible after
unprotected or inadequately protected intercourse to
maximize efficacy, which decreases with time.
However, a few studies have not observed this
time effect with the combined regimen. Because
earlier studies demonstrated that both regimens are effec-
tive when initiated up to 72 hours after intercourse,
product package instructions advise use only within that
time frame. More recent studies have shown that emer-
gency contraception is still moderately effective when
the first dose is taken up to 5 days after intercourse and
may be made available to patients who request it up to 5
days after intercourse . There currently are no
data evaluating the efficacy of emergency contraception
when treatment is initiated more than 120 hours after
intercourse.

[SinWiSuth]

Is emergency contraception safe if used repeatedly?

Data are not available on the safety of current regimens
of emergency contraception if used frequently over a long
period. However, emergency contraception may be used
more than once, even within the same menstrual cycle.
Information about other forms of contraception and counseling
about how to avoid future contraceptive failures
should be made available to women who use emergency
contraception, especially those who use it repeatedly.
Emergency contraception is less effective than most
other available methods for long-term contraception. In
addition, continued use would result in exposure to higher
total levels of hormones than those of either combined
or progestin-only oral contraceptives, and frequent use
also would result in more side effects, including men-
strual irregularities. Therefore, emergency contraception
should not be used as a long-term contraceptive.

[SinWiSuth]

When should regular contraception be initiated or resumed after use of emergency contraception?

Treatment with emergency contraception may not pro-
tect against pregnancy in subsequent coital acts;
in fact, because emergency contraception may work
by delaying ovulation, women who have taken emer-
gency contraception are at risk for becoming pregnant
later in the same menstrual cycle. Women should begin
using barrier contraceptives to prevent pregnancy (eg,
condoms, diaphragms, and spermicides) immediately
after taking emergency contraception. Short-term hor-
monal contraceptives (eg, pills, patches, and rings) may
be started either immediately (with a backup barrier
method) or after the next menstrual period. Long-term
hormonal methods (levonorgestrel intrauterine system,
depot medroxyprogesterone acetate, or progestin contra-
ceptive implant) should be started after the next menstru-
al period, when it is clear that the patient is not pregnant

[SinWiSuth]

สนใจอยากอ่านเต็มๆ ทั้งสิบหน้าดูได้ที่
ACOG Practice Bulletin No. 112: Emergency contraception.
Obstet Gynecol. 2010 May;115(5):1100-9.
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