Text◆Huang Biwen “Ming Pao”
During the festive season, people are in a state of confusion and ignore protective measures when having sex. After the passion, they worry that they will “hit the target” and seek emergency contraceptive pills afterwards.
The two generations of drugs have different golden periods.
Emergency contraceptive pills are divided into two generations, the first generation is a single hormone (progesterone, levonorges trel), and the second generation is a progesterone receptor agent (ulipristal acetate). The time limits for taking both are respectively 72 and 120 hours after sexual intercourse.
Ng Ka-wing, honorary clinical assistant professor of the Department of Obstetrics and Gynecology, Faculty of Medicine, The Chinese University of Hong Kong, pointed out that the golden time for taking the medicine is closely related to the time when the egg and sperm combine during human conception. During a woman’s ovulation period, her body will release an egg into the fallopian tube, where it will remain for about 12 to 24 hours to prepare for fertilization. Sperm can generally survive for 5 days, and more than 90% of sperm cannot survive thereafter. If the embryo successfully “implants” in the endometrium after fertilization, pregnancy will be successful. The principle of emergency contraceptive pills is to interfere with women’s ovulation cycle and delay ovulation to reduce the chance of the egg and sperm meeting.
In Hong Kong, emergency contraceptive pills are prescribed by doctors, and women over 16 years old can legally obtain them at clinics designated by the Family Planning Association, emergency departments of public hospitals, or private clinics. Wu Jiayong said that even if the two generations of emergency contraceptive pills have the same effect, in terms of medical treatment and drug effectiveness, doctors need to understand five major aspects from the women seeking treatment:
1.What specific day and time did you have sex?
2.Menstrual cycle and ovulation time?
3.Are you breastfeeding?
4.Have you been taking the morning-after pill, forgotten to take it for a few days, and then had sex?
5.Have you ever taken emergency contraceptive pills before having sex? If so, when should it be taken and which generation of drug should it be taken?
She said that since the two generations of emergency contraceptive pills have different golden periods for taking them, it is necessary to ask the client about the exact time of sexual intercourse. If you seek medical advice and medication only 72 hours after sexual intercourse, there is no doubt that you need to choose a second-generation progesterone receptor agent in terms of efficacy.
“In addition, if the patient has ovulated before taking the medicine, the efficacy of the medicine will also be affected, and it may not be successful in preventing pregnancy.
She explained that generally women’s menstrual cycle is calculated on the 28th day, and the ovulation period is the 14th day, and the vaginal discharge will become clear and translucent. However, some women have irregular menstrual cycles, and many are not sure about their ovulation period. Therefore, they need to rely on obstetrics and gynecology examination and doctor’s experience to judge.
You should not breastfeed for 7 days after taking the second-generation medicine
Many breastfeeding women are worried that the medicine will affect the amount of breast milk. Wu Jiayong said that the amount of breast milk is not affected by emergency contraceptive pills, but women should also weigh the frequency and demand of breastfeeding.
She suggested that if you choose the first-generation single hormonal drug, you can pump breast milk in advance before taking the drug and breastfeed after 8 hours; as for the second-generation drug, because it may be secreted into breast milk, you should not breastfeed within 7 days after taking the drug.
She also reminded that in general, if a woman’s menstruation has not resumed within six months after giving birth, and she continues to breastfeed for 24 hours, her body will already have a contraceptive effect. But when menstruation has resumed and breastfeeding is no longer available around the clock, the body no longer has a contraceptive barrier. Appropriate contraceptive methods should be used during sexual intercourse.
Among different contraceptive methods, many people choose to take the morning-after pill, but they often miss taking it for a few days and become ineffective. She reminds women who take morning-after pills that if they choose second-generation progesterone receptors, their contraceptive effectiveness will be affected. It is more suitable to choose first-generation single-hormone emergency contraceptive pills.
The failure rate of IUD emergency contraception is 0.1%
A woman once had unsafe sex within a week after taking a second-generation progesterone receptor agent, and sought medical advice to take emergency contraceptive pills again. She said that taking second-generation progesterone receptor agents in the short term will affect the contraceptive effect, so it is not recommended.
She also reiterated that emergency contraception is by no means a regular medication and is not suitable for long-term use as regular contraception. Repeated use will not only increase the chance of unintended pregnancy, but high doses of hormones may also cause menstrual disorders.
“Since the drug is metabolized by the liver, people with severe liver disease or those who need to take high doses of steroids are not suitable for taking emergency contraceptive pills. In addition, obese women weighing 70 to 85 kilograms can still take the pill, but its effectiveness may be affected. “
Side effects of emergency contraceptive pills generally include fatigue, dizziness, headache, nausea, breast tenderness, etc. The symptoms disappear 1 to 2 days after taking the medicine. If you have irregular bleeding, persistent pain in the lower abdomen, etc., it is recommended to seek medical advice immediately.
If women are not suitable for taking emergency contraceptive pills, they may consider wearing an intrauterine device. She said that within 5 days after having sexual intercourse without contraceptive protection, a doctor can insert a uterine ring into the uterus to achieve the effect of emergency contraception, with a failure rate of about 0.1%.
In addition, the IUD can remain in the uterus for 5 to 10 years and can be regarded as a long-term contraceptive method.
It is very effective in regulating menstrual disorders. Smokers over 35 years old should not take it.
Many women are no stranger to the word “menstrual pain”. Every time menstruation comes, they experience severe pain in the lower abdomen, as well as symptoms such as cold sweats, nausea, diarrhea, and back pain. Some people even experience severe abdominal pain and vomiting that they mistakenly believe to be gastrointestinal problems and require hospitalization.
Wu Jiayong pointed out that the treatment of menstrual cycle disorders can be achieved by taking birth control pills, which are effective. Pre-contraceptive pills are regular and safe contraceptive methods. They are mainly divided into two types: single and mixed hormones. The options include oral pills and injections. The drug mainly inhibits ovarian ovulation. It also inhibits the development of the endometrium, preventing the fertilized egg from implanting and reducing the chance of pregnancy.
Medication can be stopped if the condition is stable
Among them, mixed hormonal drugs have a menstrual effect. She said that she once received a referral from a gastroenterologist to treat a young female student. She had menstrual cramps and severe vomiting during menstruation, which lasted for more than a week each time. She was unable to go to school, affected her studies, and needed to be hospitalized for treatment. At first, the doctor thought it was a stomach problem and arranged for a gastrointestinal examination. Later, it was discovered that the girl had vomiting episodes accompanied by menstrual pain, so she was referred to the obstetrics and gynecology department.
After examination to rule out any uterine polyps, lesions or polycystic ovary syndrome, Wu Jiayong diagnosed that the girl was suffering from premenstrual syndrome (premenstrual syndrome) causing physical discomfort. Later, I tried to use the morning-after pill mixed with hormonal drugs. After a few months, the situation improved significantly. I no longer need to be admitted to the hospital every month. I can continue to go to school. When the situation stabilizes in the future, I will have a better chance to stop taking the medicine.
Not suitable for people over 35 years old
Many women are worried about the side effects of contraceptive pills or increasing the risk of cancer. She said that taking the morning-after pill regularly has a very significant contraceptive effect. Common side effects are mild headache, dizziness or nausea, which disappear within a few weeks. Others may experience mild edema and weight gain.
“As for the risk of cancer, long-term use may slightly increase the risk of breast cancer, but after stopping taking the drug, the related risk will disappear within a few years. At the same time, the drug can reduce the chances of endometrial cancer, ovarian cancer and bowel cancer.”
She believes that women do not need to worry too much about the risks of birth control pills, but women who have smoking habits and are over 35 years old should not take them to avoid increasing the risk of cardiovascular disease.