Postcoital contraception: How effective and what fetal risk, if ineffective??

PIP: Various postcoital contraceptive regimens are described. An antiemetic can be given to minimize the nausea and vomiting which are side effects of high-dosage estrogen. If pregnancy occurs despite treatment, the possible risk to the fetus is unknown. This method of contraception is only for emergency use. Regular contraception should be employed if sexual exposure is to be continuing.^ieng

Estrogens and menopause.

PIP: Recent reports suggest that the administration of estrogens to postmenopausal women is associated with an increased risk of developing endometrial cancer. Although the evidence is indirect, it is consistent with the recent introduction into the population of a carcinogen whose primary effect is on the endometrium. Estrogens have often been prescribed for trivial reasons and have been taken for long periods. The median reported length of estrogen use has been 10 years. There is a latency period in the carcinogenic effect so a more frequent incidence of endometrial carcinoma may yet follow. In the meantime, use of estrogens for specific menopausal symptoms is justified. There is less concern in prescribing estrogens for hysterectomized patients. Most emotional problems are better handled by counseling or short-term use of sedatives or tranquilizers. Senile osteoporosis may be benefited by estrogen therapy. Following oophorectomy early in life estrogen treatment may retard onset of osteoporosis but cannot reverse the aging process. Cyclic administration of estrogen use is advised with the lowest effective dose. Vasomotor symptoms require temporary treatment but atrophic vaginitis needs longer therapy. Reevaluation of patients at 6-month intervals at first and then yearly is recommended. A Papanicolaou smear should include material from the endometrial canal. Abnormal bleeding requires investigation. The patient should be informed regarding risks and benefits of estrogen therapy.^ieng