Acil Kontrasepsiyon
Özet
Acil kontrasepsiyon, korunmasız veya yetersiz cinsel ilişkiden sonra gebeliği önlemek amacıyla uygulanan, düşük yaptırıcı etkisi olmayan bir yöntemdir. Tarihsel süreçte yüksek doz östrojen ve Yuzpe rejimleriyle başlayan süreç; günümüzde oral haplar (Levonorgestrel, Ulipristal asetat, Mifepriston) ve rahim içi araçlar (Bakır RİA, LNG 52 mg RİA) gibi modern seçeneklere evrilmiştir. Bu yöntemler temel olarak LH dalgalanmasını bloke ederek ovulasyonu engeller veya geciktirir; Bakır RİA ise sperm işlevini bozarak döllenmeyi önler. En yüksek etkinlik %0,1 gebelik riski ve BMI'dan bağımsız yapısıyla Bakır RİA'ya aitken, oral yöntemler arasında %1,2-1,8 risk oranıyla reçeteli satılan Ulipristal asetat en etkili seçenektir; oral Levonorgestrel ise reçetesiz erişim kolaylığı sunar. En sık görülen yan etkiler bulantı ve kusma olup, adet düzeninde gecikmeler veya lekelenmeler yaşanabilir. Karaciğer enzim indükleyicileri ve sarı kantaron gibi maddeler oral kontraseptiflerin etkinliğini azaltmaktadır. Adolesanlar ve emziren kadınlar dahil tüm yaş gruplarında güvenle uygulanabilen bu yöntemlerin kasıtlı olarak tekrarlanan kullanımı veya rutin bir doğum kontrol yöntemi olarak tercih edilmesi uygun değildir.
Emergency contraception is a method applied after unprotected or inadequate intercourse to prevent pregnancy and does not have an abortifacient effect. Starting historically with high-dose estrogen and Yuzpe regimens, the process has evolved into modern options such as oral pills (Levonorgestrel, Ulipristal acetate, Mifepristone) and intrauterine devices (Copper IUD, LNG 52 mg IUD). These methods primarily prevent or delay ovulation by blocking the LH surge, while the Copper IUD prevents fertilization by affecting sperm function. The highest efficacy belongs to the Copper IUD with a 0.1% pregnancy risk and a structure independent of BMI, whereas among oral methods, prescription-required Ulipristal acetate is the most effective option with a 1.2-1.8% risk rate; oral Levonorgestrel offers the advantage of over-the-counter accessibility. The most common side effects are nausea and vomiting, and delays in the menstrual period or spotting may occur. Substances such as liver enzyme inducers and St. John's Wort reduce the effectiveness of oral contraceptives. These methods, which can be safely used in all groups including adolescents and breastfeeding women, are not suitable for intentional repeated use or as a routine method of birth control.
Referanslar
World Health Organisation. Fact sheet on the safety of levonorgestrel alone emergency contraceptive pills (LNG ECPs). 2010
International Consortium for Emergency Contraception. Emergency Contraceptive Pills: Medical and Service Delivery Guidelines. Second Edition 2004
Yuzpe AA, Lancee WJ. Ethinylestradiol and dl-norgestrel as a postcoital contraceptive. Fertil Steril. 1977 Sep;28(9):932-6. PMID: 892044
American College of Obstetricians and Gynecologists Committee on Gynecologic Practice, LongActing Reversible Contraception Working Group. ACOG committee opinion no. 450: Increasing use of contraceptive implants and intrauterine devices to reduce unintended pregnancy. Obstet Gynecol. 2009; 114:1434–1438
World Health Organization, Department of Reproductive Health and Research Family and Community Health. Selected Practice Recommendations For Contraceptive Use, 2004
World Health Organization. Medical eligibility criteria for contraceptive use. 4th edition 2010
Piaggio G, Kapp N, von Hertzen H. Effect on pregnancy rates of the delay in the administration of levonorgestrel for emergency contraception: A combined analysis of four WHO trials. Contraception. 2011; 84:35–39.
Brache V, Cochon L, Deniaud M, Croxatto HB. Ulipristal acetate prevents ovulation more effectively than levonorgestrel: analysis of pooled data from three randomized trials of emergency contraception regimens. Contraception 2013; 88:611.
Li HW, Lo SS, Ng EH, Ho PC. Efficacy of ulipristal acetate for emergency contraception and its effect on the subsequent bleeding pattern when administered before or after ovulation. Hum Reprod 2016; 31:1200
Shen J, Che Y, Showell E, Chen K, Cheng L. Interventions for emergency contraception. Cochrane Database Syst Rev. 2017 Aug 2;8(8):CD001324
Von Hertzen H, Piaggio G, Ding J, et al. Low dose mifepristone and two regimens of levonorgestrel for emergency contraception: A WHO multicentre randomised trial. Lancet. 2002; 360:1803–1810.
Yuzpe AA, Smith RP, Rademaker AW. A multicenter clinical investigation employing ethinyl estradiol combined with dl-norgestrel as postcoital contraceptive agent. Fertil Steril. 1982 Apr;37(4):508-13. doi: 10.1016/s0015-0282(16)46157-1. PMID: 7040117
Cleland K, Zhu H, Goldstuck N, et al. The efficacy of intrauterine devices for emergency contraception: A systematic review of 35 years of experience. Human Reproduction. 2012; 27:1994–2000
Turok DK, Gero A, Simmons RG, et al. Levonorgestrel vs. Copper Intrauterine Devices for Emergency Contraception. N Engl J Med 2021; 384:335
SOGC. Canadian Consensus Guideline on Continuous and Extended Hormonal Contraception. JOGC 2007;29(7, Suppl 2):1-33
Marions L, Cekan SZ, Bygdeman M, Gemzell-Danielsson K. Effect of emergency contraception with levonorgestrel or mifepristone on ovarian function. Contraception 2004; 69:373
ACOG practice bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 112, Emergency Contraception. Obstet Gynecol. 2010; 115:1100–1108
Sheffer-Mimouni G, Pauzner D, Maslovitch S, Lessing JB, Gamzu R. Ectopic pregnancies following emergency levonorgestrel contraception. Contraception 2003;67:267-269.
Nielsen C, Miller L: Ectopic gestation following emergency contraceptive pill administration. Contraception 2000;62:275-276
Statement of the American College of Obstetricians and Gynecologists supporting the availability of over-the-counter emergency contraception. Washington,D.C.:American College ofObstetricians and Gynecologists, February 2001.
Faculty of Sexual and Reproductive Health Care. Faculty Statement on Advance Supply of Emergency Contraception via Telephone Consultation with the British Pregnancy Advisory Service. 2011
Speroff L.Darney PD: A Clinical Guide for Contraception. 3rd Edition. Baltimore: Williams & Wilkins, 2001
FIGO Committee Report: Ethical guidelines regarding privacy and confidentiality in reproductive medicine. Testing for genetic predisposition to adult unset disease. Guidelines in emergency contraception. FIGO Committee for the Ethical Aspects of Human Reproduction and Women’s Health. Int J Gynecol Obstet 2002;77:171-175
Cheng L, Che Y, Gülmezoglu AM. Interventions for emergency contraception. Cochrane Database of Systematic Reviews 2012, Issue 8.
Polis CB, Schaffer K, Blanchard K, et al. Advance provision of emergency contraception for pregnancy prevention (full review). Cochrane Db Syst Rev. 2010; 3
Fok WK, Blumenthal PD. Update on emergency contraception. Curr Opin Obstet Gynecol. 2016 Dec;28(6):522-529
(Li HW, Lo SS, Ho PC. Emergency contraception. Best Pract Res Clin Obstet Gynaecol. 2014 Aug;28(6):835-44
Glasier A, Cameron ST, Blithe D, et al. Can we identify women at risk of pregnancy despite using emergency contraception? Data from randomized trials of ulipristal acetate and levonorgestrel. Contraception. 2011; 84:363–367
Trussell J, Ellertson C, Stewart F. The Effectiveness of the Yuzpe Regimen of Emergency Contraception. Family Planning Perspectives. 1996;28(2):58-64.
Trussell J, Cleland K, Bimla Schwarz E. Emergency Contraception. In: Contraceptive Technol ogy, 21, Hatcher RA, Nelson AL, Trussell J, Cwiak C, Cason P, Policar MS, Edelman AB, Aik en AR, Marrazzo JM, Kowal D (Eds), Ayer Company Publishers, Inc., New York, NY 2018. p. 329-365
Upadhya KK, COMMITTEE ON ADOLESCENCE. Emergency Contraception. Pediatrics 2019; 144
U.S. Medical Eligibility Criteria for Contraceptive Use, Morbidity and Mortality Weekly Report 2010
