6.1 Nausea and vomiting
Anti-emetics may reduce the incidence of nausea
and vomiting but routine administration is not recommended with
levonorgestrel regimen. If an antiemetic is prescribed, the client
should be informed about the usual side-effects of these medications
such as dizziness, and she should be advised to avoid driving, operating
machinery and taking alcohol. Vomiting occurring within 2 hours
of taking pill necessitates an additional dose or use of an alternative
method.
6.2
Bleeding
Any
irregular bleeding or spotting after ECP use should not be misunderstood
as periods. Next menstrual period may occur one week prior or later
than the expected time. Women having excessive or prolonged bleeding
should be
evaluated for pregnancy (intra-uterine or ectopic) and its complications.
The amount of bleeding in the following period is usually normal but slightly
heavier or lighter flow may be expected. 6.3
Missed period
A delay of 7 days from the expected date of periods was observed
in 13% of women in a WHO multicentric trial 6 . But to allay the
anxiety of the client and for earlier diagnosis, a urine pregnancy
test may be done when delay is more than one week. If negative at
this stage, wait for another one week. However, pregnancy test is
mandatory if the periods are delayed by more than two weeks from
the expected date, and then act according to the report.
6.4
Other side-effects
Side
effects like headache, mastalgia, dizziness, giddiness, abdominal
cramps etc. are usually minor and self limiting. Simple analgesics
can be prescribed if these are disturbing.
CLINICAL
CASE PROFILES
| |
| Ms
P is complaining of nausea after taking ECP 6 hours
back and is afraid that she will vomit if she
takes the second dose. How would you handle her complaint? |
| Explain to her that nausea is expected,
encourage her to take the second dose in time with food. |
| |
| Ms M vomited
8 hours after first dose. What should she do with second
dose? |
Reassure her that vomiting can occur,
and it means that the drug is already in circulation
and
acting. If there is any vomiting within 2 hours, she
needs to repeat the dose. |
| |
| Ms
R took ECP 28 days back, and has not had her periods
yet. How would you manage her? |
| Do a pregnancy test and manage accordingly. |
| |
| Ms
B started her period following ECP use but is complaining
of excessive flow. What can be done? |
Reassure her that some women may bleed
more. Give her haematinics and haemostats. She
should follow up if bleeding continues beyond one week. |
| |
| Ms
N is complaining of sever headache after second dose
of ECP. How can she be helped ? |
Remind her that headache is a possible
side effect and will not last long. She can take paracetamol
tablet for pain relief. |
|
|
