1. EMERGENCY CONTRACEPTION Béla Veszprémi MD., PhD. University of Pécs Faculty of Medicine Faculty of Medicine Department of Obstetrics and Gynecology Béla Veszprémi MD., PhD. University of Pécs Faculty of Medicine Faculty of Medicine Department of Obstetrics and Gynecology

2. 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.)

3. METHODS OF EMERGENCY CONTRACEPTION High-dose estrogen Ethinyl estradiol with levonorgestrel (Yuzpe regimen) Levonorgestrel alone IUD Mifepristone (Antiprogesterone) GnRh antagonists

4. MECHANISM OF ACTION Maturation of follicle Inhibit or delay ovulation Inhibit: sperm transport fertilisation development and transport of zygote (Croxatto et al. Contraception 2001) Inhibition of implantation influencing: endometrial receptivity blastocyst signalisation corpus luteum function

5. 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.)

6. Efficacy of postcoital contraceptive methods Yuzpe regimen75% Progesterone only85% Mifepristone85% IUD90% ( Curr.Opin.Obstet.Gynecol. 2000.)

7. Composition of EC pills (Richter Gedeon Rt.) Fertilan (Noral,Neogynon) 50 μg et h in y l estradiol 250 μg levonorgestrel Rigesoft 750 μg levonorgestrel

8. Treatment with EC pills 1st dose: within 48-72 hours after unprotected intercourse 2nd dose: repeat after 12 hours If vomitus occurs within two hours after pill intake, repeated dosage is required Multiple application in the same cycle is contraindicated Not teratogenic

9. Efficacy of EC and time of treatment Percentage of expectedpregnancies prevented 100 50 0 0 - 1213 - 2425 - 3661 - 7249 - 6037 - 48 83 79 66 61 47 95 Delay between intercourse and time of treatment with EC

10. 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 9577 24-48 hours8536 48-72 hours5831 WHO 1998.

11. 5 3 2 2 4 4 3 3 2 3 1 4 4 24 3 2 6+1 5 2 EC outpatient clinics in Hungary

12. Telephone-number of EC out-patient clinics in Hungary

13. The number of deliveries and abortions in Hungary

14. Number of abortions per 100 live births in Hungary

15. Number of abortions over and under 20 years

16. The number of pregnancy terminations (Dept. Of Ob. & Gyn., Univ. of Pécs) 199719981999200020012002 Patient705648639613579584 Under 18 years 57 (8%) 53 (8.1%) 48 (7.5% ) 50 (8.1% ) 37 (6.3% ) 27 (4.6%)

17. The number of treated patients in 2002 in Hungary755 783 284 955 224 434 1246 1470 395 323332 70 5812 214 691 311 169 426411 fő megye

18. Age distribution of patients at EC clinics In 2002 in Hungary

19. The reason of seeking EC gynecological care In 2002 in Hungary

20. Sales of Rigesoft in Hungary

21. „No women can call herself free who does not controll her body” Margaret Sanger 1920