Why ectopic pregnancies have become common

Did you know that you risk having an ectopic pregnancy if your emergency contraception fails to prevent pregnancy?

A what, you ask? An ectopic pregnancy. One in which the foetus develops outside the uterus, typically in a fallopian tube.

Research linking failed contraceptives to ectopic pregnancies is not yet conclusive, but it is concerning in a country where emergency pills are regularly abused.

Retailing at between Sh150 and Sh200, Postinor 2, commonly known as the 'morning-after pill' or 'P2', has become somewhat of a household name.

Chemists experience peak sales between Friday and Sunday, but maintain they still make good sales during the week. 

Three years ago, Erica* (not her real name) missed her period but dismissed it as an after-effect of p2. 

She had been engaging in unprotected sex with her boyfriend of about a year, and she would take the pills thereafter. 

"I would take them three or four times a week because we rarely used protection. I was completely sure they would keep me from getting pregnant," she said. 

He was her first sexual partner, and conversations with her friends suggested the pills were the safest way to prevent pregnancy. 

"When I talked to my friends about it, they told me their boyfriends bought the pills for them and it always worked. So I was sure about it," she said. 

She started to suspect she was pregnant after experiencing fatigue and nausea.  A pregnancy test came back positive. 

"I started getting scared that my sister would realise I was pregnant so I had to get rid of the pregnancy," she said. 

Despite taking the pills again, Erica fell pregnant and aborted for the second time. 

Ellen* took P2 for the first time seven years ago, when she also lost her virginity. 

"I took all of them together because I was afraid if I took one pill and skipped the other for 12 hours, it would fail," she said. 

She has been taking both pills at the same time ever since.

"Once I take them, I feel a pinch in my abdomen and it gives me a lot of anxiety and panic attacks because I don't want to get pregnant. I'm not ready," she said. 

The pills have never backfired on her. 

"I take them once or twice a year. The rest of the time I use condoms or withdrawal," she said. 

Ellen says she is not convinced taking the pills 12 hours apart will work, so prefers to take the dose at once. 

MANUFACTURER'S GUIDE

A packet of Postinor contains two pills. The pills are used to prevent pregnancy when taken within 72 hours (three days) of unprotected intercourse.

It is recommended they are taken 12 hours apart due to the drug's half-life. Half-life is the duration of action of a drug. This is the period of time required for the concentration or amount of drug in the body to be reduced by half.

Kenyatta Hospital obstetrician/gynaecologist Dr Allan Ikol, however, said most girls take the pills at the same time.

"Taking both pills increases your chances of suffering the side-effects and also an overdose," he said. "The best option is to follow the instructions from the manufacturers."

Ikol said the pills are more effective when taken 12 hours apart. After 12 hours, the effectiveness of the first pill wears out and the first dose may not have been adequate. 

However, Postinor is suitable for use as an emergency contraceptive and not as a regular, long-term contraceptive. 

The main ingredient in Postinor is the hormone levonorgestrel. A single pill contains 1.5mg of the hormone.

A comparison to other contraceptives, such as Microgynon pills, which contains 150 micrograms of the hormone, shows the level of levonorgestrel in P2 is 10 times higher. 

Microlut pills contain 30 micrograms of levonorgestrel, which means the level of the hormone in P2 is 50 times higher. 

Okol said while there are no clear-cut instructions on a recommended timeline, the pill should be taken during 'unsafe' days.

"Unsafe days occur when the ovum is fertile. It is recommended that the drug is taken around the fertility window," he said.

Ikol disagreed with the theory that the drug is less likely to prevent pregnancy if constantly taken.

However, the doctor stressed that those with a regular cycle can monitor their calendars and take the pill when the egg is ready for fertilisation. 

According to Mayo Clinic, a menstrual cycle is counted from the first day of one period to the first day of the next one. 

The cycles are not the same for women and typically occur every 21 to 35 days, lasting two to seven days.

COMMON SIDE-EFFECTS 

The doctor adds of late, the most common side-effect is ectopic pregnancies, which occur after the P2 fails to prevent conception. 

An ectopic pregnancy happens when a fertilised ovum implants itself and grows outside the uterus. In a normal pregnancy, the fertilised egg attaches to the lining of the uterus.

Ectopic pregnancies mostly occur in the fallopian tube, which typically carries the egg from an ovary to the uterus. Others parts of the body where the pregnancy may occur include the ovary, abdominal cavity or the cervix. 

Apart from a failed P2, other factors that can lead to an ectopic pregnancy include an infection in the pelvis or one contracted after induced abortion(s). 

"Another contributing factor is when conception occurs with an intrauterine device, such as the copper coil, still in the body," the gynaecologist said. 

According to the American Pregnancy Association, other factors include infection or inflammation of the fallopian tube causing partial or complete blockage, scar tissue from a previous surgical procedure on the tube, and previous surgery on the tubes causing adhesions and abnormal growths or a birth defect.  

The pregnancies cannot be carried to full term and are terminated at the earliest sign. 

DANGERS ASSOCIATED

Ikol says the first danger of an ectopic pregnancy is the surgical risk. "Apart from normal risks associated with surgery, patients may face infertility in the future," he said. 

He adds that some internal bleeding due to a ruptured ectopic pregnancy may lead to death. A rupture occurs when the fallopian tubes break if stretched too much by the growing pregnancy.  

Other P2 side-effects include nausea, vomiting, constipation, diarrhoea, dizziness, breast tenderness, headache, delayed menses and abnormal bleeding. 

"In abnormal bleedings, one may notice spotting or heavy flows that cannot be explained," Ikol said.

Ikol advises using a condom for those with more than one sexual partner or in polygamous relationships. 

However, the doctor warns that those who constantly practise unsafe sex risk exposure to sexually transmitted diseases, unwanted pregnancies, and pelvic inflammatory infection. 

"The pelvic infection occurs because, during unprotected sex, you are not protected against any infections your partners may have," he said. 

He, however, adds that the method of contraception always depends on the client's preference. "Other alternatives are combined pills and intrauterine devices or implants," he said. 

Combined pills are oral contraceptives that contain estrogen and progestin. The coil, also known as the ‘copper coil’, is a small T-shaped device that sits in your womb for five to 10 years. 

Other examples of the devices are Mirena, a hormonal IUD and one recently introduced in the market called IUD bead. 

Edited by Tom Jalio