1747.. ဖိုမ သဘာ၀ အသိ ပညာေပး ( 45 )

ႊအေရးေပၚ ကိုယ္၀န္တားေဆး ( 2 )
Emergency contraceptive pills

EC Methods

Emergency contraceptives available in the United States include emergency contraception pills (ECPs) and the Copper T intrauterine device.^1,2,3

ECPs

Three types of ECPs are available in the United States: combined ECPs containing both estrogen and progestin (Yuzpe method), progestin-only ECPs (Table 1), and an ECP containing ulipristal acetate (UPA)

Emergency contraceptive pills အေရးေပၚတားေဆး ဆိုတာ (၃) မ်ိဳးရွိတယ္။
၁။ Combined ECPs ထဲမွာ Estrogen နဲ႔ Progestin ေတြပါတယ္။
၂။ Progestin တမ်ိဳးထဲပါတယ္။
၃။ Mifepristone ဒါမွမဟုတ္ Ulipristal acetate ပါတဲ့ Antiprogestin ေဆးျဖစ္တယ္။


Combined ECPs contain the hormones estrogen and progestin. The specific agents that have been studied extensively in clinical trials of ECPs are the estrogen ethinyl estradiol and the progestin levonorgestrel or norgestrel. A specially packaged combined ECP (Preven^®) was approved by the Food and Drug Administration (FDA) in 1998 but withdrawn from the market in 2004 based on data showing that progestin-only EC was more effective. Combining estrogen and progestin hormones in this manner is also called the Yuzpe method, after the Canadian physician who first described the regimen.

Progestin-only ECPs have largely replaced the combined ECPs because they are more effective and cause fewer adverse effects. Although ECPs are commonly known as "morning-after pills," the term is misleading; ECPs may be initiated sooner than the name implies or much later than the morning after. Progestin-only ECPs are most effective when taken immediately after unprotected intercourse. Efficacy declines as time elapses between sex and drug administration. Progestin-only ECPs are approved by FDA for use up to 72 hours after intercourse. They are reasonably effective for up to 120 hours and perhaps longer.⁴ However, patients should remember that progestin-only ECPs are more effective the sooner they are taken after unprotected sex.^5-8 While the effectiveness of progestin-only ECPs declines with delay in treatment, the effectiveness of the UPA ECP does not (up to 120 hours).

                    အကာအကြယ္မဲ့ လိင္ဆက္ဆံျပီးေနာက္ ခ်က္ခ်င္းလဲ ေသာက္သင့္သလို ၇၂ နာရီကေန ၁၂ဝ နာရီ အတြင္းမွာလဲ ေသာက္ႏိုင္ပါတယ္။
• ေဟာ္မုန္း ၂ မ်ိဳးတြဲေဆးကို အေမရိကားမွာ Yuzpe လို႔ေခၚတာ မ်ားတယ္။ အဲလို ေဆးမ်ိဳး ဝယ္မရတဲ့ ေနရာေတြမွာ အမ်ားဆံုးသံုးေနၾက ေဟာ္မုန္း ၂မ်ိဳးတြဲ တားေဆးကိုလဲ သံုးႏိုင္ပါတယ္။ တခါထဲ ၄-၅ ျပားေသာက္ျပီး ၁၂ နာရီျခာရင္ ေနာက္ထပ္ ၄-၅ ျပားထပ္ေသာက္ရတယ္။ ၄-၅ ျပားဆိုတာ ေဆးအမ်ိဳးအစား အေပၚမူတည္တယ္။
• Progestin တမ်ိဳးထဲေဆးမွာ Levonorgestrel ပါတယ္။ စေပၚတံုးက 0.75 mg ပါတာကို ၇၂ နာရီအတြင္း သံုးခိုင္းတယ္။ ေနာက္ ၁၂ နာရီအၾကာမွာ 0.75 mg ထပ္ေသာက္ ရတယ္။
• ေလ့လာခ်က္အသစ္ေတြအရ Levonorgestrel 1.5 mg ကို တခါထဲေသာက္တာလဲ အတူူတူ ထိေရာက္တာ သိလာရတယ္။ ေဘးထြက္-ဆိုးက်ိဳးလဲ မထူးဘူး။ အလြန္ဆံုး ေခါင္ကိုက္တာနဲ႔ ရင္သားနာတာသာျဖစ္ေစတယ္။ ဒါ့ေၾကာင့္ ေဆးစ်းကြက္မွာ Levonorgestrel 1.5 mg တလံုးထဲ နဲ႔ Levonorgestrel 0.75 mg ၂လံုးတြဲဆိုျပီး ေရာင္ခ်ေနတယ္။ တလံုးစီကို ၁၂ နာရီ ျခာေသာက္တာနဲ႔ ၂ လံုးတခါထဲေသာက္တာ အတူတူပါဘဲ။
• Mifepristone ေဆးကို ကိုယ္ဝန္ ၃ ေလေအာက္ရွိတာကို ဖ်က္ခ်ေဆး Abortion pill အျဖစ္သံုးတယ္။ အေရးေပၚတားေဆးအေနနဲ႔လဲ သံုးတယ္။ ရာသီလာတာေနာက္က်ႏိုင္တယ္။ ေနရာတိုင္းမွာေတာ့ မဟုတ္ပါ။

ella^® (one 30 mg tablet), approved by FDA August 13, 2010, marketed in Europe as ellaOne since October 2009.

 

• အခုေနာက္ပိုင္း Antiprogestin ဒုတိယမ်ိဳးဆက္ ျဖစ္တဲ့ Ulipristal acetate (30 mg single dose) ေဆးေပၚလာတယ္။ Ella လို႔ေခၚတယ္။

The progestin-only products currently approved by FDA for use in the United States contain levonorgestrel. Two progestin-only products are currently available in the United States:

• Next Choice^® (two 0.75-mg tablets), approved by FDA in June 2009, is the branded generic of its two-tablet predecessor, Plan B^® (first approved by FDA in July 1999).
• Plan B One-Step^® (single 1.5-mg tablet), approved by FDA in July 2009.

The original treatment schedule was one 0.75-mg dose within 72 hours after unprotected intercourse and a second 0.75-mg dose 12 hours later. The 72-hour marker is listed on the label for both of the currently marketed progestin-only ECPs. However, subsequent studies have shown that a single dose of 1.5 mg is as effective as two 0.75-mg doses 12 hours apart.^5,6 A single 1.5-mg dose is now considered the evidence-based standard, and it can be effective up to 120 hours after unprotected intercourse. Also, this dosing regimen is easier for women and enhances adherence.
Recently, a second-generation anti-progestin, UPA, was FDA approved for use as EC in the US:

• ella^® (one 30 mg tablet), approved by FDA August 13, 2010, marketed in Europe as ellaOne since October 2009.

A single 30 mg dose can be effective up to 120 hours after unprotected intercourse.
When ECPs specifically indicated for EC are not available, certain other oral contraceptives can be used in specified combinations for EC. The regimen is one dose followed by a second dose 12 hours later, where each dose consists of up to six tablets depending on the brand. Currently, 19 brands of combined oral contraceptives are approved in the United States for use as EC (Table 1).

Table 1: Oral Contraceptives approved for EC in the United States 9
					Levonorgestrel per Dose (mg)b
အေရးေပၚတားေဆးမ်ားအမွတ္တံဆိပ္   ကုမၼဏီ   အေရအတြက္္     စသည္တို့ ေအာက္တြင္ေဖၚျပထားသာ္
Table 1: Oral Contraceptives approved for EC in the United States 9 Branda Manufacturer Pills per Dose Ethinyl Estradiol per Dose (mcg) Levonorgestrel per Dose (mg)b Dedicated emergency contraception (take one dose) Plan B One-StepTM Teva 1 white pill 0 1.5 Next Choice® Watson 2 peach pills 0 1.5 ella® Watson 1 white pill 0 0c Combined progestin and estrogen pills (take two does 12 hours apart) d AvianeTM Teva 5 orange pills 100 0.50 CryselleTM Teva 4 white pills 120 0.60 EnpresseTM Teva 4 orange pills 120 0.50 JolessaTM Teva 4 pink pills 120 0.60 Lessina® Teva 5 pink pills 100 0.50 LevoraTM Watson 4 white pills 120 0.60 Lo/Ovral® Akrimax 4 white pills 120 0.60 LoSeasonique® Teva 5 orange pills 100 0.50 Low-Ogestrel® Watson 4 white pills 120 0.60 LuteraTM Watson 5 white pills 100 0.50 Lybrel® Wyeth 6 yellow pills 120 0.54 Nordette® Teva 4 light-orange pills 120 0.60 Ogestrel® Watcon 2 white pills 100 0.50 Portia® Teva 4 pink pills 120 0.60 Quasense® Watson 4 white pills 120 0.60 Seasonale® Teva 4 pink pills 120 0.60 Seasonique® Teva 4 light-blue-green pills 120 0.60 SronyxTM Watson 5 white pills 100 0.50 Trivora® Watson 4 pink pills 120 0.50 Notes: a Plan B One-Step, Next Choice, and ella are the only dedicated products specifically marketed for emergency contraception in the United States. Aviane, Cryselle, Enpresse, Jolessa, Lessina, Levora, Lo/Ovral, LoSeasonique, Low-Ogestrel, Lutera, Lybrel, Nordette, Ogestrel, Portia, Quasense, Seasonale, Seasonique, Sronyx and Trivora have been declared safe and effective for use as ECPs by the United States Food and Drug Administration. Outside the United States, more than 100 emergency contraceptive products are specifically packaged, labeled, and marketed. Levonorgestrel-only ECPs are available either over-the-counter or from a pharmacist without having to see a clinician in 60 countries. Plan B One-Step and Next Choice are available over-the counter to women and men aged 17 and older in the United States. A prescription is required for ella for women of all ages. b The label for Plan B One-Step indicates to take the pill within 72 hours after unprotected intercourse. Research has shown that that all of the brands listed here are effective when used within 120 hours after unprotected sex. The label for Next Choice says to take one pill within 72 hours after unprotected intercourse and another pill 12 hours later. Research has shown that both pills can be taken at the same time with no decrease in efficacy or increase in side effects and that they are effective when used within 120 hours after unprotected sex. c 30 mg ulipristal acetate within 120 hours after unprotected sex. d The progestin in Cryselle, Lo/Ovral, Low-Ogestrel and Ogestrel is norgestrel, which contains two isomers, only one of which (levonorgestrel) is bioactive; the amount of norgestrel in each tablet is twice the amount of levonorgestrel.

Copper T IUD

Copper T IUDs can be inserted up to the time of implantation—six to 12 days after ovulation⁹—to prevent pregnancy. Because of the difficulty in determining the day of ovulation, however, many protocols allow insertion up to only five days after unprotected intercourse. The latest WHO guidelines allow IUDs to be inserted up to day 12 of the cycle with no restrictions and at any other time in the cycle if it is reasonably certain that she is not pregnant.¹⁰ A copper IUD can also be left in place to provide effective ongoing contraception for up to 12 years.

ေဆး ၃ မ်ိဳးကို အေရးေပၚတားေဆးအျဖစ္ေပးတာ ကိုယ္ဝန္ရလမ္းမွာ မကြာျခားလွတာ ေတြ႔ရတယ္။

၁။ Levonorgestrel 0.75 mg ၂ ခါေသာက္ = ၁႕၅%၊
 

 

 

 

၂။ Levonorgestrel 1.5 mg တခါထဲေသာက္ = ၁႕၈%၊
 

 

 

၃။ Mifepristone 10 mg = ၂႕ဝ%၊



                အေရးေပၚတားေဆးေတြအျပင္ IUCD (IUD) သားအိမ္ထဲထည့္ရတဲ့ (ေကာ္ပါး) ပါ ပစၥည္းကိုလဲ သံုးႏိုင္တယ္။

 ေကာ္ပါး ထည့္ထားပံု

 

• မ-မ်ိဳးဥထြက္လာျပီးတဲ့ေနာက္ သုက္ပိုးနဲ႔ေပါင္းစပ္ျပီး Implantation သားအိမ္-အတြင္းနံရံမွာလာျပီး တြယ္ကပ္ဘို႔ စုစုေပါင္း ၆ ရက္ကေန ၁၂ ရက္အထိ ၾကာတယ္။
• ဒါ့ေၾကာင့္ ဒီၾကားထဲမွာ Copper IUDs (ေကာပါး) ပါတဲ့ သေႏၶတားပစၥည္းတခု သားအိမ္ထဲကို ထည့္ေပးထားရင္ လာျပီး တြယ္ကပ္မႈ မျဖစ္ႏိုင္ေတာ့လို႔ ကိုယ္ဝန္မရေစႏိုင္ဘူး။
• အတိအက်ေျပာရရင္ မ-မ်ိဳးဥထြက္ျပီးေနာက္ ၅ ရက္အၾကာမွာ ထည့္ထားႏိုင္တယ္။
• တကယ္လို႔ အကာကြယ္ မပါဘဲ လိင္ဆက္ဆံတာဟာ မ-မ်ိဳးဥမထြက္ခင္ ၃ ရက္ကတည္းက ျဖစ္ေနအံုးေတာ့ လိင္ဆက္ဆံအျပီး ၈ ရက္အၾကားမွာ IUCD ထည့္လိုက္ရင္ ကိုယ္ဝန္မရေစႏိုင္ဘူး။

 

• သတိထားဘို႔က မ-မ်ိဳးဥထြက္တဲ့ရက္ သိဘို႔လိုမယ္။ ဘာဘဲျဖစ္ျဖစ္ အကာကြယ္မပါဘဲ လိင္ဆက္ဆံအျပီး ၅ ရက္အတြင္း IUCD ထည့္ရင္ ကာကြယ္ႏိုင္ပါမယ္။
• ေနာက္ဆံုး WHO လမ္းညႊန္ခ်က္အရ ရာသီ ၁၂ ရက္ေန႔ထည့္တာရတယ္။ ထည့္ထားျပီး ၁ဝ ႏွစ္အထိ ထားႏိုင္တယ္။
• ဒါေပမဲ့ လိင္ကတဆင့္ကူးစက္ေရာဂါရွိေနတဲ့ အမ်ိဳးသမီးေတြက IUCD မသံုးသင့္ဘူး ေရာဂါျပန္႔ေစမွာစိုးရတယ္။

                    Emergency Contraception အေရးေပၚ ကိုယ္ဝန္တားနည္းေတြရဲ႕ ထိေရာက္မႈ ဆန္းစစ္ခ်က္
၂ဝ၁၁ ဒီဇဘၤာလထဲမွာ စာတမ္းတခု ထုတ္ျပန္ထားတာရွိပါတယ္။ အေမရိကန္ ျပည္ေထာင္စု၊ (ပရင့္စ္တြန္) တကၠသိုလ္က စီးပြါးေရး နဲ႔ လူမႈေရးပညာ ပါေမာကၡ (ဂ်ိမ္းစ္-ထရူဆဲလ္) နဲ႔ (နယူးေယာ့ခ္) မွာရွိတဲ့ (ဂ်င္နယူတီ) က်န္းမာေရး-စီမံခ်က္က အထက္တန္း-ေဆးပညာရွင္ (ေရမြန္ အဲလီဇဘက္) တို႔ရဲ႕ ပူးတြဲေလ့လာခ်က္ ျဖစ္ပါတယ္။

• ေလ့လာမႈ ၁၂ ခုလုပ္ရာမွာ Levonorgestrel ေဆးပါတဲ့ အေရးေပၚ ကိုယ္ဝန္တားေဆးကို သံုးစြဲခဲ့တဲ့ အမ်ိဳးသမီးေပါင္း ၁၃၅ဝဝ ကို ေလ့လာခဲ့ၾကတယ္။ ကိုယ္ဝန္ကို တားဆီးမႈ ၅၂ ကေန ၁ဝဝ% ရွိတာေတြ႔ရတယ္။
• Combined regimen ေခၚတဲ့ ေဆးႏွစ္မ်ိဳးတြဲကို သံုးခဲ့သူ အမ်ိဳးသမီးေပါင္း ၃၈ဝဝ ေယာက္ကို Meta‐analysis (မီတာ-အနာလိုက္စစ္) ၈ ေနရာမွာ ေလ့လာေတာ့ ထိေရာက္မႈ (၅၆-၈၉%) ၇၄% ရွိတာေတြ႔ရတယ္။
• ဒိေနာက္မွာ ပိုေသျခာတဲ့ ဆန္းစစ္ခ်က္အသစ္အရ ၄၇-၅၃% ထိေရာက္မႈရွိတယ္လို႔ သိလာရတယ္။
• ေလ့လာမႈ ၂ ခုအရ ကိုယ္ဝန္ရႏိုင္ေျခ ဝ႕၅၁% ရွိတယ္။ Combined regimen (Yuzpe regimen) ေဆး ၂ မ်ိဳးတြဲထက္ Levonorgestrel regimen ေဆးတမ်ိဳးထဲက ကိုယ္ဝန္ ရႏိုင္ေျခ ထက္ဝက္နည္းတယ္။
• ေဆးေပးနည္း ၂ မ်ိဳးလံုကို လိင္ဆက္ဆံအျပီး ျမန္ျမန္ေသာက္ရင္ ထိေရာက္မႈ ပိုမ်ားတယ္။
• ေနာက္ေလ့လာမႈ အေသးတခုအရ အဲလို ေဆးေသာက္ခ်ိန္ ေစာတာ၊ ေနာက္က်တာက မထူးျခားတာ ေတြ႔ရတယ္။
• ေဆးေသာက္ခ်ိန္ဆိုတာ လိင္ဆက္ဆံအျပီး ၇၂ နာရီလို႔ အတိအက်ေသာက္ေစတဲ့ Plan B, One‐Step, Next Choice စတဲ့ ေဆးမ်ိဳးေတြ ျဖစ္တယ္။
• ေနာက္ေလ့လာမႈေတြအရ ဒီေဆးေတြဟာ လိင္ဆက္ဆံျပီးေနာက္ ၁၂ဝ နာရီအထိ ေနာက္က်ေသာက္တာလဲ ထိေရာက္မႈ အသင့္အတင့္ ရွိတယ္။
• WHO trials ကမာၻ႔က်န္းမာေရးအဖြဲ႔ရ႕ ေလ့လာမႈ ၄ ခုအရ Levonorgestrel regimen ေဆးဟာ ၁၂ဝ နာရီအထိ ေနာက္က်တာမွာ ထိေရာက္မႈ မကြာဘူးလို႔ သိရျပန္တယ္။
• ေဆးေသာက္သူ အမ်ိဳးသမီးရဲ႕ Body Mass Index ကိုယ္ခႏၶာ အရြယ္အစားကလဲ စဥ္းစားရတယ္။
• ေနာက္ အေရးေပၚ တားနည္းတမ်ိဳးျဖစ္တဲ့ သားအိမ္ထဲကို Copper-bearing IUCDs ပစၥည္းထည့္နည္းဟာ ကိုယ္ဝန္ရလမ္း ဝ႕၁% သာရွိတယ္။


Ref:::::http://www.womenscenter.com/afterpill.html
         Dr Tint Swe
          http://www.arhp.org/Publications-and-Resources/Clinical-Proceedings/EC/Methods
        http://en.wikipedia.org/wiki/Emergency_contraception

ပိုစ့္ 1972 မွ 1940 ထိ download link မ်ား ကို မာတိကာ က link မ်ား မွ ေဒါင္းမွသာ အဆင္ေျပပါမယ္.....