Articles on emergency contraception

The Unmet need for Contraception in India!

Dr. Neelam Nath Bhatia, General Physician
26th September Is World Contraceptive Day & India Needs More Awareness.We were 1 billion in 1999 and we are 1.3 billion now in 2016. Why is one billion figure is worth its might- to cause a scare or to remind us about our depleting resources like water, food, and polluted air?Also because Dev Anand made a movie around same time titled 100 Crore to remind us about our might to Fight Corruption!If a qualified doctor happens to work in a one amongst thousands of rural villages right within Delhi/ NCR ,the harsh reality of numbers stares at us. No family has less than 4- 5 children and women are married at less than 18,the official age ,they have kids one after another every year in a row,by the time they are 25 , they are anemic mothers along with malnourished kids hanging around them but not willing to go to school despite education being made free.Still, it is our duty to guide these people, being visited by Government Vans to give them advice for free.Nobody offers them a Cafeteria approach to choose.Every contraceptive does not suit all women. It cannot be robotic.Why I wrote women here? Do men share no responsibility about family planning matters? The harsh reality is Yes.There are Myths associated with Male sterilizations, though medically it is the Safest for man and his family as Abdomen is Not involved. It is No Cut Vasectomy and the man walks out of clinic as if no procedure has been done, ready to go to work the same very day ,including lifting weights etc.Compare this with keyhole surgery of tubal ligation (safest choice for a woman who has completed her family) It looks like 1 stitch operation , but without sounding scary about the surgery, local anesthesia is given and abdomen is bloated up with gas to see tubes through a machine and bands are tied on both tubes one after another. Like any abdominal surgery, there is pain afterward , the woman is advised Not to Lift heavy weights for about 2 weeks lest the bands come out and Operation is a Failure.For temporary contraception, Pills, Condoms ( protection against STDs also ) are suggested but side effects are - Condoms have 20% failure rate,pills have side effects associated with hormones ( more on that later in another article)IUCD-Intrauterine Contraceptive Device is fairly good provided it is inserted to women under hygienic conditions & she does not suffer from heavy periods.I-pill means Only Emergency pill, it is loaded with hormones and can make regular cycle as erratic.Some girls have become habitual of taking it as a routine.Similarly, OCs should Not be given for more than 6 months at a stretch.A recent introduction is an injection for 5 years. This injection is the one being given every 3 months to avoid pregnancy. It is for women who forget to take a pill every day.Injection has hormone Progesterone. The woman is loaded with a dose for 3 months instead of a low dose to be taken daily. These women tend to get an Early Menopause & other conditions related to high doses of hormones. Motivate as many women as possible for safer procedures like Laprascopic Ligation / IUCD after asking them the details about their complex problems.One Happy woman may Not Share her Experience but another unhappy woman with wrongly fitted IUCD in a Van by Inexperienced Nurse/Health Worker is going to badmouth to entire Mohalla about bad effects of IUCD/Ligations.

10 Things About Emergency Contraceptives Women Must Know

Dr. Jyotsna Gupta, Gynecologist/Obstetrician
Emergency contraceptive pill is a pill used by a woman after having an unprotected intercourse to prevent her from getting pregnant. It is sometimes called "the morning after pill," "the day after pill," or "morning after contraception or postcoital pill. the term ”morning after pill” is misleading; ECPs may be initiated sooner than the morning after—immediately after unprotected intercourse—or later—for at least 72 hours after unprotected intercourse. ECPs are considered 96-98% effective in preventing pregnancy.The word “Emergency” is important to note. If you are sexually active or planning to be, don't use emergency contraception as your only protection against pregnancy.Many youths in India are using ECPs like I pill & Unwanted 72 without caring about their after effects on the health of the girl.Most youngsters have unprotected sex depending on these emergency contraceptive pills. However, i-pill or any other emergency pill is not a contraceptive pill you can depend on daily. With the fabulous marketing that these pills do, it has succeeded in making it one of India’s most favored ‘emergency contraceptive pills’. In a country like India where people only expect you to have sex after getting married, these advertisements are highly misleading.But before you think of it as a miracle pill, you should know about the dangerous side effects of these emergency contraceptive pills. Given below are 10 facts about the emergency pill that every sexually active woman must know about and ask their partner for a much safer option like condom.The emergency contraceptive pill is not an abortion pill. It stops pregnancy but cannot terminate it. Therefore it is ineffective if a woman is already pregnant.The pill is to be taken soon after unprotected sex. It should be taken preferably within 24 hours and before 72 hours or else the pill may turn useless. Emergency contraceptive pill is about 96-98% effective only if taken in time.It does not offer protection against HIV/AIDS or other sexually transmitted diseases.If you are on long-term medication for any ailment, consult a doctor before taking the emergency contraceptive pill.Nausea, breast tenderness, delayed menstruation, lower abdominal ache, headache, vomiting and irregular menstruation are some of the temporary side-effects of the emergency contraceptive pill. However, these effects subside within a day or two depending on the metabolism of the woman.The emergency contraceptive pill is to be used only as an emergency contraceptive method. It should not be used as a regular contraceptive method and is quite unhealthy if taken more than twice a month.According to researchers, emergency pill can reduce sexual interest; lead to skin allergies and also prepone periods in some women. Other women complain of severe headache which is a result of hormonal imbalance.A woman who has an allergy to Levonorgestrel (contraceptive pills) must consult a doctor before taking the contraceptive pill.The emergency pill is only safe for women between the ages of 25 and 45. It is not the best contraceptive method for teenagers. With the rate of teenage pregnancy growing in India, there is need to educate the youth about the harmful side effects of the i-pill on a developing reproductive system.The emergency contraceptives are hormonal pills and its long time usage can lead to severe menstrual problems or even ovarian damage.

Contraception: The Missed Pill

Dr. Devjani Das (Ganguly), Gynecologist/Obstetrician
In today's busy day and age, ladies want to be in control of their lives. In order to achieve an optimum work-life balance, priorities such as having children, need to be meticulously planned for the right time and when one feels ready to take on the responsibility. Hence contraception plays a very prominent role in the lives of young couples.Many young ladies prefer the combined oral contraceptive pill, i.e. the one that has both oestrogen and progesterone hormones, as their choice of contraception. There are episodes when pills are missed owing to a busy lifestyle or as a result of various other reasons. So what is a "missed pill"?A missed pill is defined as one that is 24 hours late.A pill is "late" if you have forgotten to take it at the usual time.If one combined pill is missed (between 24 and 48 hours of the last pill taken), then the missed pill should be taken as soon as remembered. The rest of the pack should be continued as usual. This means that you may be taking two pills in one day, first the missed pill, and then the usual pill at the usual time of the day that you would have taken.In the event of one missed pill, there is still contraceptive cover, and no emergency contraception is needed, provided there haven't been any other episodes of missed pill in the current pack, or in the last week of the previous pack.If two or more consecutive combined pills have been missed (more than 48 hours late), the last pill missed should be taken immediately, even if it means taking two pills in one day. Any earlier missed pills should be left in the pack. The rest of the pack should be taken as usual and an additional method of contraception (e.g. condom) should be used for the next 7 days. The timing of starting the next pack after missing two or more pills, depends on how many pills are left in the current pack. If seven or more pills are left in the pack after the last missed pill, the pack can be finished in the usual way, with a seven day gap as normal, prior to commencement of the next pack.However, if less than seven pills are left in the current pack after the last missed pill, the pack should be finished, and the next pack should be started the next day, without the seven day gap.There may not be effective contraceptive cover in the case of two or more missed pills in the first week of the current pack of combined pills. If there has been unprotected intercourse within the previous 7 days of the missed pills, in the first week of the pack, emergency contraception is needed, and you will need to see your gynaecologist regarding this.The combined pills are an effective method of contraception, provided they are used correctly and episodes of missed pills are kept to a minimum.

All About Contraception, a Man or Women Must Know

Dr. Jyotsna Gupta, Gynecologist/Obstetrician
There are different methods of contraception, including:Long-acting reversible contraception, such as an implant, or an intra uterine deviceHormonal contraception such as contraceptive pills – “the pill”, the injection and vaginal ringsbarriers methods, such as condoms and diaphragmsFertility awarenessEmergency contraceptionpermanent contraception, such as vasectomy and tubal ligation.LONG-ACTING REVERSIBLE CONTRACEPTIONLong-acting reversible contraception (LARC) is a contraceptive that lasts for a long time. You don’t need to remember it every day or even every month.an intrauterine device (IUD) that lasts five or more yearsan implant under the skin that lasts either three or five years.These types of contraception last longer so are more effective at preventing pregnancy because you don't have to worry about forgetting pills or a condom breaking or coming off.They are “fit and forget” contraception.HORMONAL CONTRACEPTIVES“The Pill" is one of the most popular contraceptive methods The Pill comes in two forms:combined oral contraceptive pillprogestogen-only contraceptive pillBoth are taken daily and are over 99% effective at preventing pregnancy when taken correctly.BARRIER METHODSBarrier methods stop sperm from entering the vagina. There are three main barrier methods of contraception:male condomsfemale condomsdiaphragms.Condoms protect against sexually transmissible infections (STIs) as well as unwanted pregnancy.A diaphragm (with spermicide) is inserted into a woman’s vagina before intercourse. It must always be used with spermicide.FERTILITY AWARENESSFertility awareness is recognising the signs of fertility in a woman’s menstrual cycle. It can be used to understand your own menstrual cycle, plan a pregnancy or avoid a pregnancy.Knowing when you ovulate (release an egg from your ovary). Avoiding intercourse during ovulation periods and knowing your safe days also helps in avoiding pregnancy.For a regular period of 28 days, it is considered that ovulation takes place in mid of the cycle and day 8th to 19th days are considered fertile days.  If your menstrual cycle is irregular, the success rate of this method decreases drastically.  EMERGENCY CONTRACEPTIONWe have two options for emergency contraception - the emergency contraceptive pill (ECP) or a copper IUD.Emergency contraception can be used to prevent pregnancy after you have had sex when:you haven't used protectionyour normal contraception fails e.g. condom splitsyou have missed more than one contraceptive pillyou have been vomiting or had diarrhoea while on the pillyou have been forced to have sex without contraception.WHAT IS PERMANENT CONTRACEPTION?Permanent contraception is sterilisation that permanently prevents pregnancy. The procedure for men is a vasectomy and for women it is tubal ligation.

Contraception - Common Myths and Misconceptions

Dr. Sujoy Dasgupta, Gynecologist/Obstetrician
Sex is a basic human right. But to have sex safely and without fear of unwanted pregnancy - should be the priority. Many women across the world die every day as a result of unwanted pregnancy, mostly due to unsafe abortion. So, couples can avoid pregnancy and enjoy sex life fully, only if they can follow safe and effective contraceptive advice. Let me clarify some popular myths and misconceptions abut contraception. 1. Contraception is useful for allWhile the ideal contraceptive is necessary but it does not exist. So, what may seem suitable for a couple may not be useful for another couple. We need to assess various points like a number of children they have, wish to have further children and plan to have children, general health of wife and husband (and any diseases they suffer from), the frequency of intercourse, the chance of infection, the age of the partners etc. 2. Regarding barrier methodsMost popular barrier method is a male condom. But the myths are that" condoms reduce sexual pleasure" and" condoms get easily damaged leading to failure.Condoms are especially useful for those who are at risk of infections, who do not have very frequent intercourse and who are not suitable for other methods. Condoms do not decrease sexual pleasure, some of the condoms have medicated products which can increase the duration of intercourse and also act as a lubricant to facilitate intimacy. But men should know how to use it properly. It should be worn on erect penis expelling all the air and projecting the tip beyond the tip of the penis. While withdrawing penis after intercourse, the condom should be held at the base of the penis. Actually, failure/ rupture of condoms occur because of mishandling of condom or not knowing the proper use of it. So, before use, please make sure that you know its correct use. Definitely, some men can feel latex allergy and they have to use a non-latex condom, which is widely available.There are barrier methods for females also- like female condom, diaphragm, and cervical cap etc. But they are not very easy to use and are not so popular.3. Oral Contraceptive Pills (OCP)Myths OCP causes an increase in weight.OCP cause cancers.Facts CP seldom causes gain in weight. The gain in weight is coincidental, that means you have some other reason of gaining weight- like not having exercise, ignoring diet control and some other diseases. OCP rather reduces risk of cancer- especially ovarian cancer (which is very difficult to diagnose and very lethal), cancer of colon, cancer of endometrium (inner lining of uterus). Of course, there is little risk of breast cancer, but the risk is not very high, it can be easily detected by examination by doctor. So, if you take ocp, get rid of all the fears. Just try to have self- breast examination every month. 4. Intrauterine Contraceptive Devices (IUCD)Most popular is copper T. Medicated iucds are also available, that contains hormonal drugs. Copper T does not increase risk of infection, a common misconception lies among woman.5. Emergency contraceptive pills (i pill etc)Often couple uses these pills regularly after intercourse. Remember these pills contain very high content of hormonal drugs, which can lead to serious side effects like hormonal imbalance, irregularities in periods (and thus can prevent you from getting pregnant in future, even when you want pregnancy), ectopic pregnancy (pregnancy outside tubes that are life-threatening) etc. So, use regular contraception if you want to prevent pregnancy. I pill is not meant to be taken for every time.  6. LigationLigation of male (vasectomy) and female (tubectomy) is done as permanent contraception for couples having more than 2 children. Ligation in male does not disturb sexual activity. It is easier than female ligation. Again, female ligation is also a very safe technique. So, please remove all misconceptions and myths about contraception. Have safe sex, enjoy life.

Primary Eye Care in 7 Emergency Situations

Dr. Manoj Rai Mehta, Ophthalmologist
Many People learn Basic Life Saving skills to save lives and render primary care to the sufferers in emergency situations.  Similarly, there can be "sight saving situations" where timely action can restrict damage and give sufficient time safely to reach a higher centre for further management.1. Sputtering of hot cooking oil into the eyes while frying.Rinse eyes immediately in running cold water or simply dip your head in a bucket full of water to bring down the temperature as soon as possible.  Apply cool patch/ice pack around the lids.  Instil only lubricating drops (if available), gently patch the eyes with a sterile eye pad or clean handkerchief and take the patient to an eye surgeon. 2. Squirting of glue in the eyes.This is not an infrequent occurring with people trying to squeeze tubes that have a blocked nozzle. Immediate action should be to rinse eyes in running water.  Luke warm water around 40 degrees is somewhat more effective.  Put an ointment (lubricant or antibiotic) in the eye, gently cover the eye and take the patient to an eye surgeon.3. Chemical Injury to the eyes (domestic).Diluted Hydrochloric Acid, phenols, diluted caustic soda are some of the common corrosive chemicals found in homes for cleaning purposes.  They are acidic or alkaline in nature. Accidental exposure is not uncommon.  Immediate action is again washing off of the chemical to dilute its damaging effect.  Wash should continue for several minutes before a patient is taken to a medical facility.  lubricating drops, gels, ointments or antibiotic ointment may be applied for relief.Carry the bottle or the container in which the chemical was stored, with a label, in case the exact nature of chemical is not known, it will help the treating doctor in carrying out specific treatment.4. Foreign Body (FB) in the eye (domestic)Foreign bodies of different kinds fall into eyes under various circumstances such as- dusting, blowing dust with a vacuum cleaner, using a screwdriver on rusted components, hammering a nail, splicing cables, cutting wires, gardening or simply going for a ride.  Do not rub the eyes or put pressure as the FB can go deeper into the cornea.  Rinse in running water for a while, cover the eye with a suitable patch and take the patient to a facility.  One can use lubricating drops or antibiotic drops on the way.  No ointment, please.   5.  Soap solution, shampoo, chlorine in water or face creams in the eyesThis is a common issue especially with young children and all it requires is thorough rinsing followed by a lubricating eye drop and some cool compresses.  Creams can be very irritating as they adhere to the cornea and take a while to get washed off.  Chlorine in the swimming pools can also cause a lot of irritation especially on the days when tipping is done.  Preservative free lubricating drops, cold compresses provide relief.    6. Blunt trauma around the eyesAccidental injuries from window panes, friendly boxing or grappling amongst children are also a frequent occurrence.  Apply gentle pressure on the bones to prevent swelling around the eyes and apply a cold patch with pressure.  Take the opinion of a doctor in due course.  At times a blue haematoma may occur after a few days.  Please take an opinion as some blunt traumas around the eyes can lead to retinal oedema (Berlin's Oedema) that needs to be tackled timely to prevent a loss of visual acuity. 7. Penetrating InjuriesPenetrating injuries are seen with pencil tips, pen tips, compass used in geometry, knives, scissors, sewing needles, screwdrivers etc. Do not try to examine the eye forcefully, prise the lids, put pressure on the eye or even touch it. All these actions can result in disastrous outcomes!  Prevent the child from pressing or touching the eye by firmly holding in lap. Patch the eye gently with a clean handkerchief or a sterile pad and reach a facility at the earliest.You may keep a special first aid kit ready with disposable sterile eye pads, clean bandages, one-inch plaster tape, scissors, preservative free lubricating gel drops and gel tubes, antibiotic eye ointment, antibiotic eye drops etc.  A plastic bottle with a bent tube at the opening may be useful for gentle irrigation of the eyes with water.  It is equally important to reduce the risk of injuries at home by keeping potentially harmful chemicals out of reach of children and supervise them when they are using sharp instruments.  Safety always Saves.   

First Aid for Bleeding

Dr. Yogesh Kumar, Ayurveda
Looking at blood can often lead to squeamishness and nausea in most people who are not used to seeing blood but bleeding is one of the commonest medical emergencies. It is most frequent among children below 15 years and reduces thereafter. Almost 37.9 million visits to the emergency department are for injuries.           Bleeding or haemorrhage is oozing of blood from any body part. An injury to the skin, like a cut, wound or blunt trauma like being hit by a ball can lead to bleeding. In the case of a cut, the bleeding is visible externally as oozing and is termed as external bleeding. In cases of blunt trauma, there might be an injury to deeper tissues and organs leading to internal bleeding. This might be appreciable as a bluish black swelling at the site of injury and is called as a haematoma.  Humans have been blessed by a chemical mechanism wherein once there is an injury the enzymes automatically start making the blood thicker to stop bleeding. This is called as clotting. The thickened blood (clot) seals off the wound and prevents further blood loss. But this mechanism gets affected by various factors including the weather and thus is not completely reliable. Since too much blood loss can lead to shock and fainting, it is necessary that bleeding be stopped at the earliest by all possible measures. Thus, immediate action is a must; a wait and watch policy must not be adopted under any circumstance. Knowing the reasons behind the actions helps understand why it is being performed and helps in customisation in an emergency. Causes of bleeding:•Cuts with sharp or pointed instruments like knives, razors, sharp metal edges, nails, animal bites etc. •Bruises with blunt instruments like heavy objects, hitting a wall/vehicle, falls, etc. •Internal bleeding due to blunt blow causing the haematoma. How to arrest bleeding1. CleanWash your hands before handling the wound, as far as possible. If the wound looks dirty, wash it a little under cold, running water with soap and mild rubbing.2. PressurePress down a clean towel or any cloth directly on the oozing wound and apply firm pressure for 20 minutes to stop the bleed. If no cloth is available, then press the site of bleeding with the palm. Press till bleeding stops. Do not remove the cloth even if it gets soaked and blood oozes through. Add another cloth on top and continue applying pressure.   3. Avoid movementHold the limb/part still to reduce bleeding. Make the person lie down on flat ground. 4. ElevationRaise the injured limb/ part whenever possible. Elevate the lower half of the body slightly above the head to prevent fainting.5. TourniquetIn the case of an injured limb, tie tightly a cloth/wire/tube etc 2-3 inches above the wound, around the limb. This will act as a tourniquet and stop blood flow to the wound. Make sure you untie it within 30 minutes. If bleeding has stopped, remove it. Repeat this after a 5-minute interval if the wound continues to bleeds. Keeping the tourniquet on for too long will cause the limb to start swelling; thus, untying every few minutes is a must.  6. Ice packApply ice on the wound on and off throughout the next 24 to 48 hours. This will reduce the blood flow to the site of injury and slow down the bleed. It will reduce the swelling that forms later.  7. Pain medicationTake a painkiller like paracetamol (acetaminophen) if there is a pain. Do not take aspirin or ibuprofen. They will increase the bleeding.   8. Calling helpCall for help or rush to the nearest doctor or hospital if the bleeding is severe or accompanied by intense pain/swelling. If the victim takes blood-thinning medications, then see a doctor immediately. If the bleeding was due to an animal/human bite or from junked instrument, you might need to get a tetanus shot too.  9. Post-bleeding careOnce the bleeding stops and is followed by a haematoma or bruise the next day, apply hot water packs daily to promote wound healing. If there is a scab, apply the antibiotic treatment and fresh gauze dressing each day.  Recovery Pain, tenderness subsides in 2-3 days while the bruise will take about 2 weeks to clear out.

3 Simple Ways to to Avoid Unwanted Pregnancy

Dr. Himani Gupta, Gynecologist/Obstetrician
1. Use protection - Prevention is always better than cureIndian social scenario is changing - Pre- marital, extramarital and living in relationships are on a riseAt times these relationships are casual and will lead to unwanted pregnancyAt the end of it, it is the female's body which will bear the brunt of physical discomfort of abortionThere are many myths in people's minds regarding use of regular contraceptive methods like oral contraceptive pills, condoms or Copper - TWhether a couple is married or unmarried when these regular contraceptive methods are used, unwanted pregnancy can be avoidedA consultation with the Gynaecologist for check up and to understand their correct use is a must and will allay your anxieties and concernsA word of caution here about Emergency Contraceptive Pill It is clear that these pills are for emergency situationsCouples in steady relationship should adopt regular contraceptive methodThese emergency pills have very high content of hormonesUsing them can make your next menses irregular, delayed and heavyThey should be taken ONLY on advice of a Gynaecologist2. Be alert - For early diagnosis of unwanted pregnancyAs soon as you have missed your periods, check yourself for pregnancyEasiest method is to do a urine pregnancy test done at home in a kit easily available at ChemistThe instructions to do the tests are also clearly written on packet Advanced tests for diagnosis of pregnancy can be done on your Gynaecologist 's advice like a test in blood known as Serum Beta HCG and sonography3. Timely treatment - See a Gynaecologist at earliestWhen we talk about unwanted pregnancy, it is clear that couple wants terminationGovernment of India has made guidelines to offer safe abortion to all who seek it, regardless of marital statusThere are two ways of undergoing abortion:A. Surgical D&C - This is traditional way and will require a day's time hospitalization.- If done in Govt approved MTP (Medical Termination of Pregnancy) center, it is safe B. Abortion by pills- If clinical situation is of early pregnancy and within the limit set by Govt of India, oral abortion pills  can be taken on advice of a Gynaecologist- There are no risks of anesthesia and surgical instrumentation in this method and no hospitalization is required

Missed Periods-Is It Because of PCOS or Unwanted Pregnancy

Dr. Himani Gupta, Gynecologist/Obstetrician
For most women , getting her menses (period ) on time in regularity and flow is a very important matter. This holds true regardless of marital status. Whether she is married or unmarried, she does not want to miss her chums.Many times the management of missed periods rely on correct diagnosis.Two most important reasons for delay in getting periods are PCOS (Polycystic Ovarian Syndrome-A hormonal imbalance disorder) and Unwanted pregnancyDifferentiating correctly between theses two will make timely treatment available in both the cases.Problem of irregular menses and PCOS is rampant these days. Changing lifestyle, dietary patterns are environmental factors responsible for it.Education and career demands on women will make them move out of their family domain and stay on their own managing everything about themselves. This will add further to their stress levels. Relationship status in new social paradigm is ever changing.Knowingly or unknowingly this is another stress factor.It becomes imperative to them that periods (menses)  come on time.If they put missed periods on PCOS,  at times their self-diagnosis is incorrect.On the face of unprotected sex and having taken an emergency contraceptive pill ( Over The Counter emergency unwanted pregnancy protection tablet)  sometimes they find themselves facing an unwanted pregnancy.Away from home and family and at times short of money too, they may look for quick fixes with local doc/ family doctors instead of qualified Gynaecologist. This will further complicate the clinical pictureThe first step towards resolving the issue is to seek the consultation of an expert Gynaecologist in your area. For those who are in a relationship , a pregnancy test should be done. Depending on the test results the treatment is offered.If the pregnancy test is positive, and the woman wants to discontinue, it is best to do so at the earliest as newer methods of abortion like abortion tablets work well in those pregnancies which are of shorter duration. In early cases, the complications rate is also less.If a pregnancy test is negative, hormonal tests and sonography are advised to arrive at a correct diagnosis.In either case scenario, your Gynaecologist will help you in getting the correct treatment.