Are U really motivated to use contraceptives.?? Ask yourself & then carefully listen to health Care providers.

Which type of couple U are ?? Ask yourself about your degree of motivation of using contraceptives!!! Use of effective and trustable contraceptive is not Childs play!! Classification of acceptors:

Based on the degree of motivation acceptors are classified as ‘typical users’ and ‘perfect users’. Typical users are women or men of average intelligence and motivation who use the contraceptive method casually.  Does not listen when counseling is on at doctor’s chamber or at Family Planning Clinics. Most of them are illiterate.

For instance in case of oral contraceptives these second type of women(‘typical users’  or use the contraceptive method casually   take the pills regularly at a definite time of this day as per advice communicated to them by physician. These contraceptors one called ‘perfect users’.

So far as IUCD s are concerned the difference between two subsets of acceptors are minimal. ‘Perfect’ and ‘typical users’ are nearly identical. In fact IUCD ‘compliance’ is limited to monthly string checks.

In summary, the IUD is 98-99% effective, which means that of 100 women using the IUD, about 1-2 will become pregnant during the first year of use. By comparison, sixty to eighty women who use no birth control method is likely to become pregnant in one year period, provided couple is healthy.

If the copper IUD is used for twelve year and Mirena LNG-IUS (Skyla/ Emily ) LNG IUS for 7 year period then provide cumulative pregnancy rates will be 1.9 per 100 women for the copper IUD and 1.1 to 1.4 pregnancies per 100 women with the LNG IUS. However, the cumulative 10 year probability of pregnancy after tubal ligation is 1.8 per 100 women, not clinically different.

What in the scientists’ opinion is as ‘reversible sterilization ‘thus modern IUCDs can be considered as ‘reversible sterilization’ – without the risk of anesthesia, surgery, or regret for the woman or her partner?

What are the reasons of surprise pregnancy in spite of regular use of Contraceptives ? Have U ever heard of this. I pray U don't fall in such trap!!occasionally fail?

Why sometimes  “CONTRACEPTIVE FAILS”

Why Contraceptives occasionally fail?

Many a woman become surprisingly pregnant in spite continued use of contraceptives. These pregnancies are designated as ‘contraceptives failures’ or ‘contraceptive accidents’. There are two brad reasons of contraceptive Failures:-

Firstly, method failure:-  In selected case the contraceptive failure is due to real or proven  inefficacy of the method used. These pregnancies are designated as method failure.

Secondly, there another group of clients(contraceptive users)  where such unfortunate event  result from user’s inconsistent use of the choiced contraceptive or use wrong of the method in a way. If accidental pregnancy does occur is such case it is called user failure. Such group of clients (contraceptive acceptors) dedication or -commitment is such that the choiced contraceptive is used strictly as per norms and instruction issued by the concerned authority. They follow whatever the doctor or Health care Providers have ordered or written in the product packet by the manufacturing company.

 Dr(prof. Srimanta Pal). Kolkata, E mail: drsrimantapal@gmail.com

Future Contraception either before or after onset of period: Ongoing contraception: -- Ongoing Contraception:

Choice is theirs!! After proper counseling the couple should be asked to initiate contraceptive immediately on the following day or else they can delay the initiation of regular contraceptive after next period has commenced and they are anxiety free. If a new contraceptive is initiated on the day after ingestion of emergency tablet then such methodology is termed as Quick Start Method.

            By and large, two options are offered to the woman concerned. A) Quick Start Method: Many experts recommended the first as preferable because the method is initiated sooner which may reduce subsequent pregnancy risk. Oral contraceptives, hormonal contraceptive injection, patch, or vaginal ring may be started on the following day the client may begin using the method the day after taking the ECPs. If she is newly starting that particular method: - She should begin with a new pill pack, patch or ring. But if she was previously using the method (e.g. lodgment of the patch or ring):- she may resume using the pill pack, patch. Or ring that she was previously using. In this case, she should be reminded that the patch or ring will not be effective past the original date on which it was scheduled to be removed. All clients starting hormonal methods immediately after using ECPs should use a barrier method if they have intercourse in the next seven days after starting or restarting the method. Clients may have some irregular bleeding until the onset of menses.

1.      Quick-Start of another regular contraceptive is of utmost importance. Future contraception should be discussed and offered along with emergency Pills. Failure to do so will invite the coupe in a similar situation by couple of month depending on the sexual habit of the couple or the female partner. Firstly, the couple should be advised either to refrain from sexual act in that cycles after consumption of EC Pills or should use barrier methods for the rest of the cycle.

Between two methods in timing of initiation of contraceptives :- better advice , according to author will be Quick Start Method which means the female partner should be advised to take either combined oral contraceptive 1 tablet to be taken daily, preferably at bedtime × 21 days / 28 days depending on the pill pack choiced. Or else she can start taking progesterone only pill (Cerazette/Zerogen / Intimacy   ) on daily basis. But pregnancy test has to be done after 7 days have elapsed after the expected day of period. Because occasionally emergency Pill may fail. In that cases if urine test is +ve then she may opt for termination of pregnancy by medical methods along with acceptance of permanent method (Tubectomy). But as quick start method Injectables (Depo- as quick-start method as such agents can rarely induce Teratogenecity if pregnancy is not prevented by the emergency pill.

Contd-From Prof Dr. Srimanta Kumar Pal.

What is Bridging Method AFTER TAKING emergency contraceptives –for the rest part of the cycle?

1.     What is Bridging Method? Contraception for rest of the cycle?: By bridging method we mean the contraceptive coverage till menstruation resumes after unprotected sex and ingestion of emergency pill. Many times unprotected sex does occur in the first half of menstrual cycle i.e.  Well before the expected time of ovulation. If unprotected sex do occur in the rest part of the cycle -in that case emergency drug may not prevent ovulation and if unprotected coitus occurs again in the same cycle after release of egg (Ovulation) then pregnancy can occur in spite of taking emergency drugs. With this idea in mind Bridging Contraceptives were recommended for the rest of the cycle. And any combined oral Pills (except those containg Cyproterone acetate or Drospirenone) may be recommended for this purpose at least for that cycle. However, ether she can continue the packet of pills with urine for pregnancy test done 7-10 days after the expected period or else she can stop the pill taking after 10-12 days. The fact all ECP do not offer 100% efficacy should be made aware to the couple. Therefore it is possible that pregnancy can ensue in the rest Part of the cycle.(contd-Dr S K Pal).

What are the secrets of success to achieve near 100% pregnancy prevention after having sex without any contraceptive coverage ??

Tip 4. Use condom for the rest of that cycle days -in which cycle your partner took tablets for prevention of unwanted pregnancy: - EC will not prevent pregnancy that may follow unprotected coitus after taking the tablets.  

Tip 5. If some tablet is vomited out –take an anti-vomiting drug first and after one hour of taking anti-vomiting drug take another contraceptive tablets.

Tip 6. Purchase one such emergency packet early. Husband may refuse to use or deny using condom someday. My dear daughter, it (condom use by husband) depends on his sweet will. It is you should get duly protected for your own health. It costs about Rs. 100/- per packet, if one opts for conventional / traditional emergency tablet (like Preventol, Pill 072, Unwanted -72, I pill, Ecee, etc) which are available in Indian market since 1995.

Tip 7. May use antibiotics for prevention of sexually transmitted diseases if the male partner is unknown to you (nonregular partner).There is no harm in taking such post-exposure prophylactic drugs to prevent any possible sexually transmitted disease. Such advices are available free of cost at STI clinic of Govt. Hospitals.

Tip 8. Covert use of contraceptives: - U can take such tablets occasionally even if your husband objects and you consider that further pregnancy will jeopardize your health. These tablets can be taken without the knowledge of family members.

Tip 9.  Sudden arrival of husband from his place of posting :- You are not on regular contraceptive coverage as your husband is employed outside the state. Your husband is employed outside the state and a message in mobile comes stating that he is coming by 12 hours times there is a sudden vacation in his office for 2-3 days :- Use such tablet prior to his arrival(Precoital Pill).

Tip 10. No or minimal side effects of emergency contraceptive pills:-Don’t get scared of side effects which U might have heard from your friends. Do not believe on rumors on different contraceptives including Emergency Pills. Use your own judgment.

How best to avoid mistimed pregnancy or unwanted pregnancy after an act / acts of unprotected sex??

How best to avoid mistimed pregnancy or unwanted pregnancy after an act / acts of unprotected sex?? Follow the followings instructions  from Dr. S K Pal(senior gynecologist) for near 100% efficacy in  emergency pregnancy prevention in emergent situation. What are then the  Tips ?

 Tip-No. 1. Sooner the emergency tablet are taken more is the efficacy. Is most effective when used within 12 hours of unprotected intercourse or contraceptive accident..

Tip No. 2. Don’t get worried if there is delay in initiation of next periods:--Changes in menstrual bleeding patterns are common following use of high dose progesterone only pills (I-Pill, Pill-72, Unwanted-72).  Therefore, women who use this method should be counseled to expect such changes. They may experience spotting a few days after taking the pills or they may find that their taking the pills or they may find that their next menstrual period is earlier, later, lighter, or heavier than usual. Delay in menstruation for more than 7 days is of clinical concern; the possibility of pregnancy should be considered. In case of high dose progesterone only pills (I-Pill, Unwanted-72) as many as 87% of women had their next menstrual period at the expected time or within 7 days of the expected time . Whereas 13% have a delay exceeding 7 days. Doctors or Health Care Providers should make her aware that menstrual bleeding after intake of emergency pills may be 7 days earlier or seven days later than the expected date the women concerned should be briefed ahead about such delay to avoid her anxiety. Emergency copper containing IUD insertion, which must be done by a health care provider, can be effective within five days of unprotected intercourse. Someone have noticed that such device do work even if such device placed as late as 7 days after unprotected sex. Copper IUD is the most effective post coital contraceptive.

Tip No, 3. Periods follows after intake of EC tablets will usually be scanty-No worry:-So far as amount of bleeding that follows after ingestion of ECP most women experienced vaginal bleeding that was similar to their normal menses, but 11% to 14% bled more than usual .( Advices of Dr. Prof. Srimanta Pal) -contd.

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Can every woman take such highly effective Contraindications of ullipristal? Is there any contraindications of this new but highly effective after sex pills??

There are some special times when such strong pills should not be consumes. Such situations are:-

1 Not to be consumed during breast feeding 2 ) Severe asthma  3) Hepatic or renal impairment  4) Hereditary metabolic disorders like a) Galactose intolerance b) Lapp Lactase deficiency & glucose-Galactose malabsorption.5) women taking anti-convulsing  drugs ( phenytoin, rifampicin, Phenobarbital and carbamazepine) .Because all these drugs cause increased synthesis of hepatic enzymes. Therefore many drugs including combined oral contraceptives and ullipristal are very quickly destroyed without exerting its contraceptive efficacy.

Can this drug(Ulipristal) be used for other diseses too ? What are the other uses of the drug -Ullipristal? Ullipristal drug at the dose of 5 mg tablet per day can reduce the size of one very common type of fibroid tumour (one benign type of tumour named as myoma of uterus) to about 50% by 3 months of use. This tab is now available in our country too as a suppressive therapy of such tumour.