Analogs
- Postinor. A drug similar to Escapelle in its mechanism of action and main active ingredient. A distinctive feature is the dosage is twice as low. If you take Postinor, you need to re-use it after a certain period of time;
- Fasile-Va. The drug is similar in composition and mechanism of action to Escapel. The main component is levonorgestrel in a dose of 1.5 mg. A distinctive feature of this drug is the possibility of subsequent administration of an oral contraceptive;
- Evadir. A product containing 75 mg of levonorgestrel. A prerequisite for admission is the presence of a normal previous menstruation.
Unwanted pregnancy remains a serious problem for women. An alternative to terminating pregnancy is to prevent it. To prevent unwanted pregnancy, there are many methods of contraception, including emergency ones.
Emergency contraception was first used as a means of preventing unwanted pregnancies among rape victims in the mid-1960s. Since then, the range of indications for its use has expanded, and emergency contraception is recommended for women who are at risk of pregnancy as a result of unprotected sex (when no contraceptive method was used or when protection has failed, such as when a condom breaks). An emergency contraception method is considered acceptable if it can be used within a few days after unprotected sexual intercourse.
Despite its important role in preventing pregnancy, emergency contraception is not widely used, due to a lack of information about this method among women and sometimes among doctors.
As already stated, emergency contraception should be recommended as an emergency measure to protect against unwanted pregnancy in women who have been raped; if there are doubts about the effectiveness of contraception (displacement of the diaphragm during sexual intercourse, etc.); during expulsion of intrauterine devices (IUD); if you miss taking oral contraceptives; in cases where the planned methods of contraception cannot be used for some reason. Patients who are rarely sexually active and in whom an unwanted pregnancy may occur after sexual intercourse without the use of contraceptives also need to be prescribed postcoital contraception [2, 3].
The mechanism of action of emergency hormonal contraception is to suppress or delay the ovulation process, disrupt the fertilization process, transport the fertilized egg and its implantation.
The risk of pregnancy after unprotected intercourse ranges from 0 to 26% throughout the entire menstrual cycle and from 7 to 30% during the peri- or ovulatory period of the menstrual cycle [7]. Considering that the viability of sperm in a woman’s reproductive tract lasts from 3 to 7 days, and that of an unfertilized egg for 24–72 hours, it is advisable to carry out emergency contraception in the first three days after sexual intercourse [7].
For emergency hormonal contraception, mainly estrogen-gestagen and gestagen-containing drugs are used.
Until recently, one of the common methods of emergency contraception was the use of increased doses of oral contraceptives - the so-called Yuzpe method (named after the Canadian doctor who first used it). The method consists of twice using 200 mcg of ethinyl estradiol and 1 mg of levonorgestrel within 72 hours after sexual intercourse, with a break of 12 hours. The advantage of this method is that for the purpose of emergency contraception, you can use any combined contraceptives, including low-dose ones, while the number of tablets varies depending on their composition and doses of hormones. However, it has been proven that the effectiveness of this method is reduced if unprotected intercourse occurs immediately before ovulation. In addition, the incidence of side effects such as headaches, nausea, vomiting, and menstrual dysfunction occurred in 21.3% of cases, i.e., in almost every fourth patient [1, 3].
Contraindications to the use of the Yuzpe method are determined mainly by the presence of an estrogen component in the tablets. These include a history of thrombolism, severe liver disease, breast and endometrial cancer. Its use is also undesirable for women over 35 years of age, heavy smokers (more than 15 cigarettes per day), as well as women who have been subjected to sexual violence, against which complications often develop.
Currently, one of the most common effective and affordable methods of emergency contraception is the use of gestagens. The most commonly used testosterone derivatives are divided into levonorgestrel and norethisterone derivatives. Their chemical structure is close to natural progesterone. From this group of drugs, the Hungarian drug Postinor is widely known in our country, containing 0.75 mg of levonorgestrel in one tablet, which is recommended for use according to the following scheme: one tablet no later than 72 hours after sexual intercourse, another one 12 hours after the first.
Levonorgestrel is a synthetic compound, structurally similar to norethisterone, binds strongly and selectively to progesterone receptors and exhibits biological activity without any preliminary transformations. This is the most active substance in the series of 19-norsteroids. Levonorgestrel has the longest half-life because it does not have a first-pass effect through the liver, which makes its biological activity maximum.
Levonorgestrel has no estrogenic effect and has a slight androgenic effect on the woman's body. It is characterized by the greatest affinity for progesterone receptors, which explains such a pronounced progestational effect of levonorgestrel, in particular on the endometrium.
Gestagens suppress the mitotic activity of endometrial cells, initiate their early secretory activity, and cause early secretory transformation of the endometrium, which prevents the implantation of a fertilized cell. In addition, gestagens help reduce contractile activity and the threshold of excitability of muscle cells, which explains one of the mechanisms of emergency contraception - disruption of egg transport. Gestagens have an inhibitory effect on the secretion of gonadotropic hormones and, as a result, prevent ovulation.
In 1998, a randomized controlled trial of levonorgestrel versus the Yuzpe method was conducted under the auspices of WHO. 1998 healthy women with a regular menstrual cycle were examined in 21 centers in different countries: 997 of them were prescribed the Yuzpe method, 1001 - levonorgestrel. The analysis of the study results was carried out based on data from 979 women who used the Yuze method according to the standard method, and 976 who received 0.75 mg of levonorgestrel no later than 72 hours after unprotected intercourse with a repeat dose after 12 hours. The effectiveness of levonorgestrel was higher than that of the Yuzpe method - 98.9 and 96.8%, respectively. In terms of tolerability, levonorgestrel was also superior to the Yuzpe method: nausea was observed in 23.4 and 50.5% of women, respectively, vomiting in 5.6 and 18.8%, dizziness in 11.2 and 16.7%, fatigue in 16 .9 and 28.5% (the differences are statistically significant). Differences in the incidence of other side effects (headache, mastalgia, lower abdominal pain, intermenstrual bleeding) were not statistically significant. Thus, the efficacy of levonorgestrel was higher and the tolerability was better than that of the Yuzpe method.
According to the authors of the study, this is due to the peculiarities of the interaction of estrogens and gestagens, as well as a lower dose of levonorgestrel when using the Yuzpe method. The following conclusion was drawn: the Yuzpe method can be replaced by the use of levonorgestrel, which is more effective and has a lower incidence of side effects. Severe menstrual irregularities with the use of levonorgestrel, which were previously noted in other studies, were not observed in this study [4, 8, 11].
Given the increased interest in emergency contraception methods, which is explained by a number of biological and social factors (early puberty, early onset of sexual activity), the development of effective methods and regimens for taking hormonal drugs has continued in recent years. In mid-1998, a large multicenter, randomized, double-blind study was initiated to compare the efficacy and side effects of 10 mg mifepristone and two regimens of levonorgestrel (0.75 mg twice or 1.5 mg once) for emergency contraception within 120 hours of unprotected use. sexual intercourse. Based on the studies conducted, a new regimen of levonorgestrel was developed - 1.5 mg once [18, 19].
This became the basis for the creation of the drug Escapelle, containing 1.5 mg of levonorgestrel in one tablet, which provides an excellent contraceptive effect and provides greater reliability in preventing pregnancy. Escapelle can be effectively used as a first-choice drug for emergency contraception as an alternative to abortion. Currently, Escapelle has appeared in Russia.
The effectiveness and safety of a single dose of 1.5 mg of levonorgestrel, the dose contained in Escapelle, was confirmed by the results of a WHO study in which more than 4,000 women from 14 countries took part. The Emergency Contraception Consortium recommends this regimen as the first choice [17–19].
If the recommended dosage regimen is followed, levonorgestrel does not significantly affect blood clotting factors, fat and carbohydrate metabolism [16]. When taken orally, it is quickly and completely absorbed from the gastrointestinal tract. The maximum concentration of levonorgestrel in the blood serum after taking 1 tablet of Escapel is achieved after 2 hours. At the recommended dose, levonorgestrel causes inhibition of ovulation if sexual intercourse occurs in the preovulatory phase of menstruation. In addition, the drug-induced regression of endometrial proliferation prevents blastocyst implantation. The effectiveness of contraception decreases as the time elapses between sexual intercourse and taking the drug increases.
If the time of sexual intercourse is unknown or more than 96 hours have passed since unprotected sexual intercourse, the likelihood of pregnancy is high. If menstruation is delayed by more than 7 days, as well as when menstruation that occurs on time is unusual or pregnancy is suspected for some other reason, a gynecological examination should be performed to exclude pregnancy.
If vomiting occurs within 3 hours after taking the Escapel tablet, the effectiveness of the drug is reduced, in which case barrier contraceptives (for example, a condom) should be used until the next menstruation. Repeated use of Escapella tablets during the same menstrual cycle should be avoided to avoid cycle disturbances.
In women with a history of ectopic pregnancy or pelvic inflammatory disease, the use of levonorgestrel may serve as an additional risk factor for ectopic pregnancy. The latter should be excluded if there is pain in the lower abdomen, fainting and the above-mentioned anamnestic data. The use of Escapel, as a rule, does not interfere with the regularity and nature of menstruation. In cases where this drug was used due to an error in regular hormonal contraception and subsequent
There is a 7-day break, there is no menstruation, pregnancy should be excluded. It must be remembered that emergency contraception does not protect against sexually transmitted diseases.
Thus, it should be emphasized that emergency contraception is a one-time measure aimed at preventing unplanned pregnancy. Emergency contraception cannot be recommended for chronic use. However, in certain situations, emergency contraception is the only option to prevent unwanted pregnancy and is an alternative to abortion.
Conclusion
Escapelle is a contraceptive drug taken immediately after sexual intercourse. This medicine is a “fire” contraception measure, so you cannot take it constantly for contraceptive purposes. If your critical days do not come after taking the drug, you need to see a doctor and undergo an ultrasound.
MAKE AN APPOINTMENT
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Abortion and contraception clinic in St. Petersburg - department of the medical gynecological association "Diana"
Make an appointment, tests or ultrasound via the contact form or by calling +8 (812) 62-962-77. We work seven days a week from 09:00 to 21:00.
We are located in the Krasnogvardeisky district, next to the Novocherkasskaya, Ploshchad Alexander Nevsky and Ladozhskaya metro stations.
The cost of a medical abortion in our clinic is 3,300 rubles. The price includes all pills, an examination by a gynecologist and an ultrasound to determine the timing of pregnancy.
