Why a prescription for emergency contraception in Ukraine is not a problem. Doctor’s experience
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In recent days, the issue of changes in the rules for dispensing prescription drugs has been heatedly discussed in social networks. Women are outraged by the fact that one of the most popular drugs for emergency contraception, Postinor, will no longer be available to buy in pharmacies. Instead, it seems that you will have to wait in kilometer-long queues for a doctor’s appointment to get a prescription. My view as a practicing gynecologist of this problem: it does not really exist, it is completely artificial. Often, sexual partners forget to take care of their contraception in advance. Also, unfortunately, there are terrible cases of sexual violence. In such cases, so-called “emergency” (or emergency) contraception (EC) drugs come to the rescue. The mechanism of action of such drugs is as follows: they prevent ovulation and fertilization if sexual intercourse occurs in the preovulatory phase, when the probability of fertilization is maximum. EC drugs also affect the endometrium (mucous membrane of the uterus), preventing the implantation of a fertilized egg. In fact, there is a “hormonal attack” on the female body, because the dose of hormones in such drugs is much higher than in combined oral contraceptives (drugs for permanent contraception). Firstly, there will be no problems with obtaining such a prescription – even on the same day when unprotected sexual intercourse took place. In Ukraine, thanks to free access to medical care and a developed network of private and public hospitals, there are no such problems as, for example, in Europe. I say this absolutely responsibly – as a doctor who is on duty in a hospital 24/7, provides emergency gynecological care at any time and has the ability to formulate this prescription. Most of these appeals occur at night, immediately after coitus. By the way, none of the patients has yet had to wait in a “kilometer line”. I will give an example: recently, a patient who has been in Poland for a long time wrote to me in messenger about advice on emergency contraception. I recommended that she first consult a local gynecologist, and then purchase the necessary drug at a pharmacy. But there are two significant nuances. Firstly, access to medicine in EU countries is not as “simple” as here. She was told that the visit to the doctor will have to wait approximately a week or even two, while the means of postcoital contraception should be taken within the first 3-5 days (depending on the active substance of the drug). Secondly, it is impossible to purchase the drug on your own, because since 2017 emergency contraceptive drugs in Poland have been issued only by prescription. By the way, like most other drugs (hormonal, antibacterial, psychotropic, NSAIDs and other prescription drugs). As a result, the patient came to Lviv and consulted a doctor at the first medical institution. On the same day, she bought and took emergency contraception. From April, the procedure for issuing prescriptions in Ukraine will not change significantly, except that additionally, literally in 2 minutes, the doctor will create a paper/electronic prescription for the required drug. Instead, it will significantly reduce the uncontrolled intake of drugs of this group. It is advisable to dispense emergency contraception drugs only with a prescription and after consulting a doctor due to a number of side effects and contraindications for use. The most common side effects are nausea, headache, bleeding, lower abdominal pain, etc. Contraindications to use are individual intolerance to the components of the drug, pregnancy, severe diseases of the liver, gastrointestinal tract, etc. I remember how last year there was a case when the use of “Postinor” without a doctor’s prescription turned out to be ineffective. The woman turned to me already with a delay and a positive pregnancy test, although, according to her, she took the drug according to the instructions – within 24 hours from the moment of sexual intercourse. However, there was one “but” – she has Crohn’s disease (a disease of the gastrointestinal tract, which most often affects the terminal parts of the small intestine). Due to the fact that the patient did not know about the contraindications to taking the drug of this group in such a pathology (Crohn’s disease significantly reduces the effect of the drug), she was forced to terminate the unwanted pregnancy. I must also note that abuse of EC drugs can have serious consequences. Frequent intake of such pills will cause serious disturbances in the menstrual cycle. In addition, there is a high frequency of ovarian cyst formations (more often functional) and hyperplastic processes in the endometrium (polyps and hyperplasia). It is important to emphasize once again that the use of “emergency” contraceptives after an act of intimacy is recommended after consulting a doctor, who will conduct a gynecological examination and select the optimal means of emergency contraception, taking into account the characteristics of your menstrual cycle and state of health. After all, emergency contraception is not limited to the drug “Postinor”. In fact, there are much more of them. Therefore, do not neglect a visit to the doctor and take care of yourself! Roman Ismailov, oncogynecologist of the “Dobrobut” medical network, specially for “UP. Life” Publications in the “View” column are not editorial articles and reflect exclusively the author’s point of view.
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