Farmacoriflessioni
La pillola del giorno dopo ovvero il “piano B” della contraccezione
THE DAY-AFTER PILL OR BETTER THE EMERGENCY CONTRACEPTION METHOD
ELENA BARBERO1, LUCA BELLO2, FABRIZIO OLIVERO2, LILIANA MAGLITTO3, LAURA MINIONI3, MARIA ROSA GIOLITO4, RENZO SANDRINI5, ANDREA GUALA6
1SOC Medicina Legale, ASL VCO
2SOC Ostetricia e Ginecologia, Ospedale Castelli, Verbania ASL VCO
3Consultori Familiari, ASL VCO
4Responsabile Coordinamento Regionale dei Consultori Familiari
5Direzione Generale, ASL VCO
6SOC Pediatria, Ospedale Castelli, Verbania ASL VCO - Regione Piemonte
Febbraio 2009 - pagg. 113 -120
Abstract
The term emergency contraception refers to the contraceptive methods that can be used to
prevent pregnancy in case of unprotected sex or if the birth control used fails. The WHO
recommends levonorgestrel in a single dose of 1.5 mg per os. Ideally, “the day after pill”
should be taken as soon as possible after the unprotected intercourse, preferably within 12-
24 hours and not later than 72 hours after the intercourse, but its residual effect can last
for up to 120 hours; it is 88% effective in preventing pregnancy. To prescribe “the day-after
pill” it is not necessary to be a specialist; any practitioner can prescribe it, since the only
indication is the unprotected intercourse. If the doctor refuses to prescribe the medicine
using the conscience clause, he must send the woman to another place where it can be prescribed
(article 22 of the deontological code) and the procedure must be recorded. A specific
law that allows to prescribe the drug to a minor does not exist, but the permission can
be gathered from a series of provisions, resolutions, declarations and law articles that actually
permit to prescribe levonorgestrel to minors. The essential requirement is that the girl is able to give a valid consent, after having been adequately informed.
Suggerite dall'AI
Classificazione MeSH
Bibliografia
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2. Garipoli V, Guala A, Paoletti R, et al. Opinions and attitudes of youngsters about sexually transmitted diseases. Ped Med Chir 2003;25:338-40.
3. De Sanctis V, Tangerini A. Contraccezione e gravidanza. In: De Sanctis V. Problemi ambulatoriali di medicina dell’adolescenza. Pisa: Pacini ed., 1998:157-62.
4. Istituto Superiore di Sanità - Conferenza di consenso - Prevenzione delle complicanze trombotiche associate all’uso di estroprogestinici in età riproduttiva. Roma, 19 settembre 2008.
5. Bastianelli C, Farris M, Benagiano G. Emergency contraception: a review. Eur J Contracept Health Care 2008;13:9-16.
6. Bastianelli C, Farris M, Benagiano G. Reasons for requesting emergency contraception: a survey of 506 Italian women. Eur J Contracept Reprod Health Care 2005;10:157-63.
7. Alan Guttmacher Institute. State policies in brief: access to emergency contraception. www.agi-usa.org/pubs/spib.
8. Piaggio G, von Hertzen H, Grimes DA, Van Look PF. Timing of emergency contraception with levonorgestrel. Lancet 1999;353:721-3.
9. Marions L, Hultenby K, Lindell I, et al. Emergency contraception with mifepristone and levonorgestrel: mechanism of action. Obstet Gynecol 2002;100:65-71.
10. Rodriques I, Grou F, Joly J. Effectiveness of emergency contraceptive pills between 72 and 120 hours after unprotected sexual intercourse. Am J Obstet Gynecol 2001;184:531-7.
11. Meng CX, Andersson KL, Bentin-Ley U, Gemzell-Danielsson K, Lalitkumar PG. Effect of levonorgestrel and mifepristone on endometrial receptivity markers in three-dimensional human endometrial cell culture model. Fertil Steril 2009;91:256-64.
12. Lalitkumar PG, Lalitkumar S, Meng CX, et al. Mifepristone, but not levonorgestrel, inhibits human blastocyst attachment to an in vitro endometrial three-dimensional cell culture model. Hum Reprod 2007;22:3031-7.
13. Muller AL, Llados CM, Croxatto HB. Postoital treatment with levonorgestrel does not disrupt postfertilization events in the rat. Contraception 2003;67:415-9.
14. Ortiz ME, Ortiz ME, Fuentes MA, Parraguez VH, Croxatto HB. Post-coital administration of levonorgestrel does not interfere with post-fertlization events in the new-world monkey Cebus apella. Hum Reprod 2004;19: 1352-6.
15. Durand M, del Carmen Cravioto M, Raymond EG, et al. On the mechanisms of action of short-term levonorgestrel administration in emergency contraception. Contraception 2001;64:227-34.
16. Croxatto HB, Brache V, Ravez M, et al. Pituitary- ovarian function following the standard levonorgestrel emergency contraceptive dose or a single 0.75 mg dose given on the days preceding ovulation. Contraception 2004; 70:442-50.
17. Emergency Contraceptive Pills: Medical and service delivery guidelines. Second Edition
2004. International Consortium for Emergency Contraception, Washington DC, USA.
18. von Hertzen H, Piaggio G, Ding J, et al. Low dose mifepristone and two regimens of levonorgestrel for emergency contraception: a WHO multicentre randomized trial. Lancet 2002;360:1803-10.
19. WHO. Medical eligibility criteria for contraceptive use. Geneva, 2004.
20. WHO. Selected practice recommendations for contraceptive use. Geneva, 2005.
21. Faculty of Family Planning and Reproductive Health Care Clinical Effectiveness Unit: FFPRHC Guidance. Drug interactions with hormonal contraception. J Fam Plan Reprod Health Care 2005;29:139-51.
22. Task Force on post-ovulatory methods of fertility regulation. Randomised controlled trial of levonorgestrel versus the Yuzpe regimen of combined oral contraceptives for emergency contraception. Lancet 1998;352: 428-33.
23. Agence Nationale d’Accreditation et d’Évaluation en Santé. Recomandations pour la pratique clinique. Stratégies de choix des méthodes contraceptives chez la femme. Paris: ANAES, 2004.
24. Faculty of Family Planning and Reproductive Health Care Clinical Effectiveness Unit: FFPRHC Guidance, Emergency Contraception. J Fam Plan Reprod Health Care 2006;32: 121-8.
25. Faculty of Family Planning and Reproductive Health Care Clinical Effectiveness Unit: FFPRHC Guidance. Emergency Contraception. J Fam Plan Reprod Health Care 2003;29: 9-16.
26. Faculty of Family Planning and Reproductive Health Care. Royal College of Obstetricians and Gynaecologists. Emergency contraception: recommendations for clinical practice. Br J Fam Plan 2000;26:93-6.
27. International Consortium for Emergency Contraception. Emergency contraceptive pills: medical and service delivery guidelines. 2004.
28. International Planned Parenthood Federation (IPPF). Medical and Service Delivery Guidelines for Sexual and Reproductive Health Services. Third edition 2004.
29. Society of Obstetricians and Gynaecologists of Canada. Canadian contraception consensus. Clinical Practice Guidelines n. 143, 2004.
30. Society of Obstetricians and Gynaecologists of Canada. Emergency contraception. Clinical practice guidelines n. 131, 2003.
31. Assessorato Tutela Salute e Sanità - Regione Piemonte. Raccomandazioni per la contraccezione d’emergenza. 2007; www.regionepiemonte. it.
32. Ministero della Salute. Relazione sullo stato di attuazione della legge sulla tutela sociale della maternità e sull’interruzione volontaria della gravidanza. Roma, Camera dei Deputati, 21 aprile 2008; www.ministerosalute.it.
33. Azienda Sanitaria Locale n. 2 dell’Umbria. La contraccezione. Linea guida per la pratica clinica, 2008; www.ausl2.umbria.it.
34. Arisi E, Michieli R. Contraccezione d’emergenza in Italia - stato dell’arte. Contraccezione Sessualità Salute Riproduttiva 2007;3:36.
35. Arisi E. Consumo e compliance dei contraccettivi ormonali. Riv It Ost Gin 2004;2:638.
2. Garipoli V, Guala A, Paoletti R, et al. Opinions and attitudes of youngsters about sexually transmitted diseases. Ped Med Chir 2003;25:338-40.
3. De Sanctis V, Tangerini A. Contraccezione e gravidanza. In: De Sanctis V. Problemi ambulatoriali di medicina dell’adolescenza. Pisa: Pacini ed., 1998:157-62.
4. Istituto Superiore di Sanità - Conferenza di consenso - Prevenzione delle complicanze trombotiche associate all’uso di estroprogestinici in età riproduttiva. Roma, 19 settembre 2008.
5. Bastianelli C, Farris M, Benagiano G. Emergency contraception: a review. Eur J Contracept Health Care 2008;13:9-16.
6. Bastianelli C, Farris M, Benagiano G. Reasons for requesting emergency contraception: a survey of 506 Italian women. Eur J Contracept Reprod Health Care 2005;10:157-63.
7. Alan Guttmacher Institute. State policies in brief: access to emergency contraception. www.agi-usa.org/pubs/spib.
8. Piaggio G, von Hertzen H, Grimes DA, Van Look PF. Timing of emergency contraception with levonorgestrel. Lancet 1999;353:721-3.
9. Marions L, Hultenby K, Lindell I, et al. Emergency contraception with mifepristone and levonorgestrel: mechanism of action. Obstet Gynecol 2002;100:65-71.
10. Rodriques I, Grou F, Joly J. Effectiveness of emergency contraceptive pills between 72 and 120 hours after unprotected sexual intercourse. Am J Obstet Gynecol 2001;184:531-7.
11. Meng CX, Andersson KL, Bentin-Ley U, Gemzell-Danielsson K, Lalitkumar PG. Effect of levonorgestrel and mifepristone on endometrial receptivity markers in three-dimensional human endometrial cell culture model. Fertil Steril 2009;91:256-64.
12. Lalitkumar PG, Lalitkumar S, Meng CX, et al. Mifepristone, but not levonorgestrel, inhibits human blastocyst attachment to an in vitro endometrial three-dimensional cell culture model. Hum Reprod 2007;22:3031-7.
13. Muller AL, Llados CM, Croxatto HB. Postoital treatment with levonorgestrel does not disrupt postfertilization events in the rat. Contraception 2003;67:415-9.
14. Ortiz ME, Ortiz ME, Fuentes MA, Parraguez VH, Croxatto HB. Post-coital administration of levonorgestrel does not interfere with post-fertlization events in the new-world monkey Cebus apella. Hum Reprod 2004;19: 1352-6.
15. Durand M, del Carmen Cravioto M, Raymond EG, et al. On the mechanisms of action of short-term levonorgestrel administration in emergency contraception. Contraception 2001;64:227-34.
16. Croxatto HB, Brache V, Ravez M, et al. Pituitary- ovarian function following the standard levonorgestrel emergency contraceptive dose or a single 0.75 mg dose given on the days preceding ovulation. Contraception 2004; 70:442-50.
17. Emergency Contraceptive Pills: Medical and service delivery guidelines. Second Edition
2004. International Consortium for Emergency Contraception, Washington DC, USA.
18. von Hertzen H, Piaggio G, Ding J, et al. Low dose mifepristone and two regimens of levonorgestrel for emergency contraception: a WHO multicentre randomized trial. Lancet 2002;360:1803-10.
19. WHO. Medical eligibility criteria for contraceptive use. Geneva, 2004.
20. WHO. Selected practice recommendations for contraceptive use. Geneva, 2005.
21. Faculty of Family Planning and Reproductive Health Care Clinical Effectiveness Unit: FFPRHC Guidance. Drug interactions with hormonal contraception. J Fam Plan Reprod Health Care 2005;29:139-51.
22. Task Force on post-ovulatory methods of fertility regulation. Randomised controlled trial of levonorgestrel versus the Yuzpe regimen of combined oral contraceptives for emergency contraception. Lancet 1998;352: 428-33.
23. Agence Nationale d’Accreditation et d’Évaluation en Santé. Recomandations pour la pratique clinique. Stratégies de choix des méthodes contraceptives chez la femme. Paris: ANAES, 2004.
24. Faculty of Family Planning and Reproductive Health Care Clinical Effectiveness Unit: FFPRHC Guidance, Emergency Contraception. J Fam Plan Reprod Health Care 2006;32: 121-8.
25. Faculty of Family Planning and Reproductive Health Care Clinical Effectiveness Unit: FFPRHC Guidance. Emergency Contraception. J Fam Plan Reprod Health Care 2003;29: 9-16.
26. Faculty of Family Planning and Reproductive Health Care. Royal College of Obstetricians and Gynaecologists. Emergency contraception: recommendations for clinical practice. Br J Fam Plan 2000;26:93-6.
27. International Consortium for Emergency Contraception. Emergency contraceptive pills: medical and service delivery guidelines. 2004.
28. International Planned Parenthood Federation (IPPF). Medical and Service Delivery Guidelines for Sexual and Reproductive Health Services. Third edition 2004.
29. Society of Obstetricians and Gynaecologists of Canada. Canadian contraception consensus. Clinical Practice Guidelines n. 143, 2004.
30. Society of Obstetricians and Gynaecologists of Canada. Emergency contraception. Clinical practice guidelines n. 131, 2003.
31. Assessorato Tutela Salute e Sanità - Regione Piemonte. Raccomandazioni per la contraccezione d’emergenza. 2007; www.regionepiemonte. it.
32. Ministero della Salute. Relazione sullo stato di attuazione della legge sulla tutela sociale della maternità e sull’interruzione volontaria della gravidanza. Roma, Camera dei Deputati, 21 aprile 2008; www.ministerosalute.it.
33. Azienda Sanitaria Locale n. 2 dell’Umbria. La contraccezione. Linea guida per la pratica clinica, 2008; www.ausl2.umbria.it.
34. Arisi E, Michieli R. Contraccezione d’emergenza in Italia - stato dell’arte. Contraccezione Sessualità Salute Riproduttiva 2007;3:36.
35. Arisi E. Consumo e compliance dei contraccettivi ormonali. Riv It Ost Gin 2004;2:638.
Corrispondenza: pediatria.borgosesia@asl11.piemonte.it