Surgical abortion

There are two techniques to perform a voluntary termination of pregnancy (abortion): the chemical method, using drugs, and surgical method by aspiration. If the first takes precedence over the second, it is nevertheless widely practiced, with 101,021 procedures performed in 2010, nearly half of abortions (46%).

According to the General Inspectorate of Social Affairs (IGAS), 40% of women in France will one day have recourse to abortion. Zoom on abortion by suction.
Surgical abortion: where, when, how?

The surgical abortion, also called suction abortion, is necessarily practiced in health care institutions, whether public or private. It lasts only ten minutes and requires mostly a hospital a few hours, allowing the patient to go home the same day. Technically, this method involves dilating the cervix with drugs (the same as those used in the medical abortion), then aspirate the contents using a probe. Prof. Nisand stresses that while "the gesture has no particular technical difficulty, it must be done slowly and can be done either under local anesthesia or under general anesthesia." This choice only depends on the patient.

In France, the surgical abortion can be performed until the end of the 12th week of pregnancy (SG), ie before the end of the 14th week of amenorrhea (absence of menstruation or SA). Women have the choice between surgical abortion and medical abortion, but beyond 7 SG / 9 SA, the High Authority for Health (HAS) recommends to favor the surgical approach. A position that openly criticizes Israel Nisand Professor, Head of Gynaecology Obstetrics Division at the University Hospital of Strasbourg, who questions this specific trend the Hexagon "This recourse to surgical abortion from 7 weeks of pregnancy a recommendation, not a legal requirement. It is important to remind women that they have the choice of abortion, even beyond this period, no offense to a small lobby doctors who would keep the monopoly surgical abortion, much better paid. "
A tip: make an appointment early, wait times in certain cities or regions are such that it is sometimes necessary to go beyond the famous 7 day cooling off period for an appointment on time.The surgical abortion under local anesthesia
Nadege, 28, has experienced an unwanted pregnancy 10 years ago, while taking birth control pills for a specific hormonal and adrenal problems. She preferred to local anesthesia, "for fear of likely general" but does not remember seeing the anesthesiologist before surgery. An aberration since according to the recommendations of the National College of Obstetricians Gynecologists French (CNGOF), "a pre-anesthetic consultation should be carried out systematically before any intervention if a method by aspiration has been decided, even if under local anesthetic action." For Professor Nisand, local anesthesia, "generating less complications," is preferable. In any case, this technique requires two qualities from the obstetrician: experience and empathy. It can thus be experienced quite satisfactory, both by the patient, who condones living in real time the "mourning" of the unwanted pregnancy by the doctor, who only has the feeling of being the " dirty work "instead of his patient. If Nadège has in fact felt no physical pain, nor during surgery, nor in the hours and days that followed, however it retains a very bad memory of its trade with the doctor that "[it] was felt that it was not in agreement with [her] choice and [he] spoke to [him] yelling. "The surgical abortion under general anesthesia
Mathilde, 26, has meanwhile undergone an abortion under general anesthesia last year. Even though she said he did not remember being asked his preference, she thinks "it was probably better that way." An opinion shared by the majority of patients Professor Nisand since almost 100% of surgical abortions performed in the University Hospital where he works are done under general anesthesia. This choice is one of the patients, usually HEALTH RESEARCH BULLETIN who wish to see nothing, hear nothing, not living "that time" in full consciousness.
For Professor Nisand, it is essential to systematically leave the choice to the women: "There are a lot of places where general anesthesia is necessary because, basically, it's the easy way: we did not to listen, reassure, you sleep ... It is more comfortable and easier for the medical profession. " Before choosing the best is always yet to really think and feel confident with the doctor. This was the case for Mathilde, who has the memory of a medical team "adorable and dédramatisante, not in judgment, always joking."The benefits of surgical abortion compared to medical abortion
Women who choose surgical abortion generally exceeded the seven weeks of pregnancy or do not wish to live the trauma of medical abortion in the solitude of their toilets or their bathroom, as is often the case for those opting for chemical abortions outside health facility (the tablets of Mifegyne ® ® Gymiso and then being in the presence of a physician during a consultation).
Surgical abortion is most appropriate for women who wish to be supported in less than 24 hours and painlessly, either for personal or professional reasons. The chemical abortion, often over several days and causes pain similar to those of childbirth, can be a source of anxiety and a real discomfort, especially for primiparas and have chosen the Option "home".Prices and management of surgical abortion
Since March 31, abortion is supported 100% by the health insurance for all women as part of a package. On the official website Ameli.fr, we read that "the surgical abortion is reimbursed by insurance at 100% disease on the basis of a variable flat rate (from € 437.03 to € 644.71) depending the health facility (hospital or clinic), the type of anesthesia (local or general) and duration of hospitalization. This price includes the preliminary analyzes to abortion, local or general anesthesia, the act of abortion and monitoring, reception and accommodation. It does not include two preliminary medical consultations and medical consultation control, chargeable extra and supported under the usual conditions. Note that the package Daily is not billable. " Some complementary health contracts provide total or partial support for not reimbursed by social security costs.What about the risks and consequences of surgical abortion?
Like any surgery, abortion Aspiration presents risks (plus the risk of potential complications of general anesthesia). The main ones are uterine perforation (rare but serious) or infection due to the introduction of instruments into the uterus. The failure rate of the method being almost zero (0.3% against 5% for medical abortion), it is important to remember that certain drug abortion "incomplete" will be "completed" surgically. As after delivery, bleeding can be expected in the days following the intervention.
Regarding the follow-up to contraception of women, the obstetrician advises to enjoy the action in proposing the IUD (intrauterine device or IUD), where the situation of women s 'are ready.
As for the cons-indications to surgical abortion, "the only one I would see a uterine malformation," the specialist adds that there are no painful sequelae or incompatibility with one or more subsequent pregnancies and the number of abortions is not limited in the life of a woman.
Whatever the method used, a monitoring and verification of consultation is carried out between the 14th day and the 21th day following the intervention.
If Nadège has never seen a psychologist in this event and that Mathilde ignores postoperative consultation, neither of today questions the choices she has always considered to be good. None not to be excluded mom ... when it's time!

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Medical abortion: abortion pill

The RU 486 or mifepristone or Mifégyne®, was born in France in 1980. Known then "abortion pill", she had led an outcry movements opposed to abortion. Previously reserved for the hospital, she has since July 28, 2004, available in some gynecologists and general practitioners.
 
The Mifégyne® has a molecular structure very similar to that of the steroid hormones and binds with high affinity to the progesterone receptor. She then a true anti-progesterone effect and acts in particular on the gravid uterus resulting in a softening of the cervix, an increase in the contractility of the uterine muscle and promotes the detachment of the embryo.
RU 486 abortion and
The medical abortion can be performed in medicine today "city". Nevertheless, this act should be performed under the supervision of a gynecologist or a general practitioner working in a network with a health facility with which he spent convention. This method can not be used beyond 7 weeks of no rules. Specifically, women will pay an initial consultation with his doctor who will inform the different techniques and propose him a psycho-social care. At a second meeting, she will sign a consent and then during the third consultation, tablet Mifégyne® (Mifepristone) will be administered. 48 hours later, the woman should take Misoprostol. You should know that interrupts pregnancy Mifepristone and Misoprostol causes the evacuation of the egg, as in a miscarriage. Finally a check-up is required from 15 to 20 days later. If this method is effective in 98% of cases, in 2% of cases, pregnancy can continue. So it is imperative to see your doctor to ensure no complications.
RU 486 and therapeutic abortions

  The Mifégyne® has profoundly altered the achievement of therapeutic abortions (ITG). The RU486 makes it possible to prepare the cervix and uterine muscle to the action of prostaglandins that are used to get contractions and cause expulsion of malformed fetus. Practically Mifégyne® tablets are taken two days before hospitalization scheduled for termination of pregnancy. This will significantly reduce the doses of prostaglandins necessary for expulsion.
In case of intrauterine death
When the fetus dies spontaneously (fetal death in utero), pregnancy does not necessarily end immediately and it is often necessary to speed up the work and the expulsion of the fetus, especially in order to avoid infections. Taking tablets Mifégyne® is then indicated to facilitate the action of prostaglandins. Often, under these conditions, the RU 486 is sufficient to induce labor.
The lines of research
Several studies are underway to validate or evaluate the effectiveness of RU 486 in other indications:

    Preparation of the cervix and trigger the forward work on living fetus;
    Emergency Contraception: Taking the RU 486 could be delayed up to 120 hours after intercourse potentially fertilizing while offering 85% efficiency and very good tolerance;
    In combination with methotrexate, RU 486 is used experimentally for the medical treatment of ectopic pregnancy (GEU);
    Medical treatment of certain tumors: breast, mé ningiome, leiomyoma.

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Teenage girls in distress

In young women under 18 years, abortion is the result of more than two pregnancies: 6000 minor so decide every year to abortion. Among teens, unintended pregnancies are actually the contraceptive accidents, a hazardous contraception or no contraception at all.

"When I learned I was pregnant, the idea of ​​keeping did not come to mind." Sophie, 18 years and high school in Paris is sure she made the right choice, there are just a year: "Keep a child when you're 17, it's only decide to raise or make your life with a love of youth. I could envisage neither one nor the other solutions. Adolescence, it does not live with a baby in her arms, but with lovers, friends and the right to irresponsibility. I really want a child, but I do not want to do it lightly. "

"It can not happen to me"
Teenagers know the different ways to protect themselves but think that the risk is for the others: "I used to think, like all my girlfriends that it could not happen to me," recalls Sophie recognizes still have Unprotected sex: "Last time, I immediately took the morning after pill ...". A serious contraceptive project is more easily compatible with "adolescent behavior makes testing and risk behaviors." *Teen sexuality, taboo
The relationships that Sophie has with her mother allowed her to not be alone with this unwanted pregnancy and the decision to end it. "She was with me throughout this story: when I took the test during the preliminary interview ... I know now that I was very lucky." The absence of dialogue with parents plunges very many girls in deep distress. This afraid to face the gaze of adults is also one of the main reasons for the belated recognition of these pregnancies and, in the most serious cases, exceeded the legal time of abortion: "For a girl say, "I'm pregnant" is actually saying "I slept." When love relationships were never discussed at home, it's a shame sometimes insurmountable, "said Martine Leroy, Family Planning Nantes. "While sex is everywhere present in our consumer society, youth sexuality, it is a taboo subject, including, I would say especially in families from all social classes. Minor in Pregnancies are often perceived by parents as an attack on family integrity ". These are the girls who generally collect confidences: "Because they know I have the experience, my girlfriends and my cousin come to me when they have missed a period or when they were the love with nothing. With them, they are only dealing with these problems. "Priority to prevention
In this context, the lifting of the parental authorization requested for years by many doctors, associations or unions, and provided in the new law on abortion, will facilitate the course of hundreds of young girls.
But the essence remains for field workers, information and prevention, within and outside the school environment: "Information too rare and too theoretical is received by teenagers, but they do not know how to use it in their daily life, their own body. This shift is often the cause of unwanted pregnancies. It should set up discussion groups where teens can discuss concrete experiences, "concludes Martine Leroy.
When asked Sophie if her abortion sequelae left him psychologically or emotionally, she said: "I do not regret, but there is one thing I wish I know if my baby was a girl or boy ... "

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Unwanted pregnancies: distressed teen

In minor, more than half of pregnancy leads to a voluntary termination. To better meet these teenagers in distress, free emergency contraception and the end of the parental consent for abortion were introduced in 2002. What are the results of these measures?

What solutions for minors in situations of unwanted pregnancy? In the days following the report, girls may resort to emergency contraception in pharmacies issued free of charge. Beyond this period, the management of abortion can now intervene without parental permission. Initiated in 2002 by the Health Insurance, these measures have recently been evaluated.

Emergency Contraception: mixed results
Since January 2002, Health Insurance facilitates access by underage women to the morning after pill. Pharmacists and school nurses can deliver it for free and anonymously. This provision aims to prevent later use of medical or surgical abortion.

  Among the medications available, and NorLevo EllaOne® are now counter in pharmacies (and issued free of charge and anonymous to minors).
Note, regardless of the chosen molecule, the more it is taken early, more effective it will be.
According to monitoring by the Health Insurance, minor would received information from free device. In August 2002, 74% of abortion pills boxes issued were for minor against only 2% in January 2002. However, according to the Information Center - abortion Ile de France, "few pharmacists deliver the pill free either. because they lack information about it, the law is very recent, or because they disagree with the approach. Some fear that this measure encourages minors to be less vigilant and to take the morning after pill as a contraceptive normal ". Thus, some pharmacies often continue to charge the drug while minor can get it for free.
Recall that the morning after pill does not protect against the risk of sexually transmitted diseases, including AIDS and hepatitis B.Each year, 6,000 abortions among minors
For minor, abortion raises more questions. "They come to us to be counseled about the centers performing abortions, but also for listening carefully respecting their anonymity," says one at St Denis Planning Center (93). The parental consent, often difficult to ask, is no longer mandatory for minor since May 2002. Young women may therefore decide only to terminate their pregnancies. However, they must appeal to a mentor who will support them throughout the process. This person, a major, can be a relative, (e) ami (e), a member of an association. But the ideal is of course to collect from parents written authorization to practice abortion.
As the major, non-emancipated minor have a period of 12 weeks to make an abortion. After the first medical consultation, young women are required to undergo a social consultation. They are then referred to a health facility, public or private. "However, some hospitals do not apply the new measures. They do not always accept the request of a minor without parental consent, because of the potential risks associated with general anesthesia" deplores a counselor of St Denis Planning.
When the agreement is given, the state guarantees the anonymity and support costs related to the operation: up to 80% for cases where parental consent was given, 100% for only minor and beneficiaries of the Universal Health Coverage.Inform minor first!
Inform remains a priority. Surveys reveal that 3 rd class, two thirds of young girls think that the first reports are not fertile, and three-quarters are convinced that it is impossible to get pregnant when you have a report for the rules! Results that do not support recent information campaigns on contraception.
The National Education conducted prevention campaigns and Planning Centres multiply interventions in colleges (3rd class) and high schools. Contraception is free, accessible free of charge and without age requirement in the planning centers.
Regarding abortion of the young woman, the lack of knowledge is even more flagrant 2. The girls are scared, delaying the first consultation and therefore more late intervention than other women. Late abortion also carries more risk. Finally, a young age at first pregnancy is correlated with repeated use of this procedure.
The best way to avoid it is to use effective contraception at first intercourse. The best solution is to go for the duo: condom and pill can protect you from sexually transmitted infections and unwanted pregnancy.

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IVG: summer distress ...

On the eve of the summer, the voluntary interruption of pregnancy (abortion) is again center stage. As every year, women will face shortages of beds, at risk of exceeding the legal deadlines. But beyond this seasonal problem, the law is still applied. Under pressure from associations, the government has finally reacted. The measures announced will it be sufficient?

On June 8, 2004, several organizations defending the right to abortion launched a cry of alarm about the delay by health authorities regarding the application of the Act of July 4, 2001 1. A week later, they were received by members of the cabinet of the Minister of Health and did not went away empty handed.
Insufficient appreciation of abortion package

  Abortion practice is a poorly paid health act to a care facility. Blocked for thirteen years, the assumption is far from meeting practitioners. Results: many structures refuse abortions. "Currently, the cost and the inadequate reimbursement of these interventions are such that more and more hospitals or private clinics establishments disengage" tells us Dr. Guy-Marie Cousin, president of the National Union of Obstetricians and Gynecologists of France (Syngof ). A view shared by Maya Surduts secretary general of the Coordination of associations for the right to abortion (Cadac), which states that "The assessment made by the National Association of Centers of abortions and contraception (ANCIC) demanded a reassessment of 300% of abortions package due to the changing practices (use of disposable equipment, increased professional insurance, etc.). Under pressure from associations, the act will be revalued by 30%, it is still off the mark ... Result: while in some regions (Ile-de-France, Provence-Alpes-Cote d'Azur, Rhône-Alpes), private clinics ensured two thirds of abortions, they represent only half ".Associations have also got the imminent release of the decree on medical abortion in town. On July 2, 2004, the Official Gazette published the decree on medical abortion 2. On 23 July 2004, the order pricing of this act is finally published.Abortion from hospital to homeOnce the system is developed, women can go to a doctor who has an agreement with a public or private institution. After a week of reflection, the patient receives a dose of Mifégyne® (which stops the pregnancy) before returning two days later prostaglandin to facilitate expulsion. After their "miscarriage" home, a new control visit is planned. In addition to leaving the hospital setting, the advantage is not to risk being out due to time delay waiting too long in hospital. The new decree has clarified some points in particular regarding the information and mode of drug supply:

    Drug abortion are practiced until the end of the 5th week of pregnancy;
    The control period for consultation and verification abortion should be made between 14 and 21 days after the abortion, instead of 10 to 15 days;
    The decree imposes more perform abortions as recommended by the National Health Accreditation Agency (ANAES) but only to practice monitoring of women as outlined in these recommendations;
    Only physicians who have signed a contract with a health facility practicing abortion can have access to medicines."We were committed to this notion of agreement with a referral center and are pleased that it has been accepted. This care network will be particularly useful to receive the patient for complications or to take stock of the practices regularly" tells us Dr. Guy-Marie Cousin. For the moment, very few specialists or not signed such agreements. How patients can they identify? "One can imagine the model of the directory of abortion clinics, a list of practitioners adhering to such agreements. This list may be available in the abortion centers but also with associations like the French Movement for Family Planning" tells us Dr. Danielle Gaudry, head of the Confederation of French movement for family planning.Summer 2004: avoid a new catastrophe!Pending a new interview with members of the cabinet of the Minister of Health scheduled for September 7, 2004, the associations do not release the pressure. Thus, they regret that the Ministry has not been published before engaging a circular care structures to ensure a minimum service. Every summer, women in distress face shortages of beds and delays are getting longer. "During this period, this expectation may exceed 3-4 weeks, which increases the number of women in legal timeout an abortion ... Women are still forced to make several tens of kilometers, to another French center or even abroad, who can support them, "says Maya Surduts us. The use of medical abortion in the city should not allow this situation to improve. Before becoming a common practice, the circular will happen in institutions, agreements between hospitals and doctor must be signed, the holiday Revenue staff will be trained ...Moreover, the associations continue to note that some hospitals still refuse to practice abortions beyond 10 weeks of pregnancy or carry out abortions among minors without parental consent. Minor which are among the most affected by unwanted pregnancy ... According to the results of the 2000 Health Barometer 15-25 3 7.5% of sexually active girls of that age reported having used an abortion ( IVG). This rate is significantly higher among 23-25 ​​years (10.4%). If we add that the use of the morning after pill is far from exceptional (13.9% of girls 15-25 years), then it is obvious that a major awareness-raising, information and Education is necessary. Meanwhile, women in distress can contact the phone numbers below

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In France, emergency contraception is underutilized

 One third of pregnancies are planned, including a large part due to contraceptive failure. The abortion still appears as the women's favorite way to stop it, despite the existence of emergency contraception, although less traumatic physically and psychologically.
Emergency contraception is still underutilized. The fact that a new pill of this type, effective longer be marketed and now repaid might be possible to reduce the recourse to abortion, and a better understanding of the risk of pregnancy and wider use new effective contraception available today.The number of abortions did not decline
210,000: the number of interruptions Volunteers Pregnancy (VIP) carried out each year in France. A number that has remained stable since the mid 80 The appearance of the emergency contraceptive or "morning after pill" or the "day after" will therefore not result in less recourse to abortion, which appears more than ever as the method of choice to terminate an unwanted pregnancy (60% of unplanned pregnancies result in abortion, against 40% 30 years ago), commented Dr. Caroline Moreau, an epidemiologist at Inserm, during a press conference organized by HRA Pharma.

  These abortions are performed mostly in women who do not wish to carry their pregnancy to term, a fairly common situation if you believe data from the COCON (Inserm, 2000-2004) and the Health Barometer INPE (Report "Contraception: the French know that?", 2007). They show that a third of pregnancies are unplanned, representing 350,000 pregnancies each year. However, 2/3 of these pregnant women without having desired using contraception at the time of its occurrence. Pill failure in 1/4 of cases (an oversight or a stop in 90.5% of cases) and failure methods "natural" time 1 to 5. These are also used by some women, pill remains the reference method of contraception for women 57.4%, and even 88% of young people between 15 and 25 years, despite the availability of effective contraceptives such as implants or vaginal ring.The morning after pill best known youth
For these women, the laboratories have therefore developed a pill called "catching up". Repaid and sold without a prescription pill levonorgestrel (Levonelle ®, HRA Pharma) has "boosted" the use of emergency contraception, which increased by 72% in 5 years. Much more than older women, young women have appropriated this pill, whose use rose from 16-32% among 20-24 years and 12-30% among 15-19 year olds. High-profile, pregnancies occurring in young girls surely there are many.
Conversely, in women 25-34 years old, the use of morning-after pill is only spent 10 to 16.8%, and 7.1 to 9.7% for those aged 35-44 years. To believe that, beyond 25 years, women do not feel concerned by the risk of unwanted pregnancy. Or they do not see themselves as the target of this emergency contraceptive method. The figures lean towards this second hypothesis, since women of this age contribute to 60% in the number of abortions, which amounts to 250 000 per year.
One can regret the insufficient use of morning-after pill, in favor of a voluntary interruption of pregnancy painful both physically and mentally. Thus, one third of women aged 18 to 44 are potentially at risk of an unwanted pregnancy, but only 11% of them use emergency contraception. Day after pill sales prove one of the low attractiveness, with a ceiling of 1.2 million units in 2008 when the needs are estimated at 24 million (number of risk reports related to improper use of the pill or condom ).An underestimation of the risk of pregnancy
Why such a gap between the needs and the use of emergency contraception? According to a survey of women who performed an abortion, many of them underestimate the risk of pregnancy to which they are exposed in inadequately protected intercourse (61.2%). Some admit to not having thought (19.9%) when others say they thought it was too late to be effective (12.4%).
For Dr. Christian Jamin, endocrinologist gynecologist in Paris, "the speech insisting that we should not abuse the emergency contraception was understood that it is not tolerated." Belief that doctors are struggling to fight, especially since his demedicalisation (purchase without prescription) led them to "gradually withdraw from the emergency contraceptive field." The expert therefore calls on health professionals to reinvest this field of women's health and to address the issue of emergency contraception during their consultations. "The issues of abortion and emergency contraception should be part of any gynecological consultation, and emergency contraception should be prescribed to any woman who does not wish to carry a pregnancy to term or who live very poorly" , insisted the specialist.
No question as to consider the emergency pill as a contraceptive in the long term. "Emergency contraception should remain punctual and considered a second chance compared to conventional contraception". On this point, the data from a survey 2 on the impact of emergency contraception on the conventional method are reassuring: this event has led 20.3% of women to choose more effective contraception and not to abandon the methods medical.EllaOne ® now repaid
If the arrival on the market 1 year ago of the latest generation ® EllaOne emergency pill has not really made a difference, a refund of 65% announced September 20, 2010 by the HRA Pharma laboratory could compete. * This new molecule based ulipristal acetate is a selective modulator of progesterone receptors and thus acts by inhibiting ovulation, which gives it great efficiency, assured Erin Gainer, President and CEO of HRA Pharma.
Unlike Levonelle ® (reference molecule), whose efficacy decreases rapidly within hours after sexual intercourse, that of Ellaone ® is maintained for 5 days, which corresponds to the lifetime of the spermatozoa in the genital tract. This is the first generation of products to intervene at this stage of the cycle. It is also nearly 2 times more effective if taken within 3 days after the report, according to the results of a study 3, and 3 times more if taken within 24 hours, which were incorporated by the European Medicines Agency in the Summary of Product Characteristics of this pill.
ellaOne is directly available in pharmacies without prescription required. And if it is fairly well tolerated, women need to know that 10-15% of them may experience nausea (and not vomiting, which only occur in less than 3% of women), headache and breast tenderness within 48 hours after taking. They will however much less spotting (bleeding between cycles) and will see the arrival of their next menstrual delayed for about two days.
In summary, you should know that today, NorLevo EllaOne® and are freely available in pharmacies (and issued free of charge and anonymous to minors) and that, regardless of the chosen molecule, the more it is taken earlier, more effective it will be.
According to a Harris Interactive poll conducted in late August 2010 with 1000 persons:
- Nearly one quarter of women of childbearing age of the children resort to any means of contraception, or they do not have sexual relations (33%) or because they wish to have a child.
- 40% use the pill well ahead of contraceptive methods, far ahead of methods called "barriers" (mainly male condoms, and to a much lesser extent female condoms, cervical cap and the diaphragm) who seduce only 18% of women (especially young, single and without children).
- 4% of women and 1% of men chose a method of permanent contraception (tubal ligation tubes or non-surgical method for raw, vasectomy for the latter).
- For a vast majority of French (83%), contraception is a couple of case. Young women (15-24), however, are more numerous (25%) to think that it is instead an exclusively female case.
- Women willingly approach the subject of contraception with their gynecologist (62%), they consider best able to address this issue (79% women); they also talk with their partner (45%); GP, judged less competent on this issue is rarely sought. Most young people turn more readily to their family environment (65%), friendly (59%) or partner (56%) than to a health professional (48% to 42% by gynecologist and general practitioner).
- If men have no problem to talk about contraception (87% find it easy to talk with their partner), they are however only 44% have given advice about this and 34% have asked a particular method.

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 Pill omissions remain the main causes of failure of oral contraception. To avoid unwanted pregnancy, better predict incident. With Doctissimo, discover exactly what to do to stay protected. Warning, the rules are clear and vary from pills.

  

An oversight is not a disaster, if only we know how to respond. By the requirement of the first box, it is very important to note the precautions to take in response to this possibility. Everything is a matter of hours, but also pills. Find out which category your pill.The progestogen pills (pills or combined)
Learn more about pills or progestogen combined pillsForgetting is less than 12 hours:
It must immediately take the missed pill and take the following at the usual time. There is no risk of pregnancy if the delay remains below 12 hours;Forgetting exceeds 12 hours:
As before, take the missed pill and immediately take the following at the usual time. If several pills have been forgotten, immediately take the final two tablets, lay the other missed pills and continue the plate. It is also essential to use more local contraception (condoms) for seven days; it is the closest of the week interruption oversights (beginning or end plate), which cause the highest risk of ovulation.
If unprotected intercourse within 72 hours of oblivion, it is recommended, furthermore, to take emergency contraception (the morning after pill NorLevo by). The pill will be resumed the next day only treatment with NorLevo®. Another hormonal emergency contraception is ellaOne® that can be taken up to 120 hours after intercourse at risk. EllaOne® is also available in pharmacies, with or without a prescription. If it is over a longer period, regardless of the selected molecule, the more it is taken earlier, more effective it will be.
Moreover :

     If it is one or more of the last seven tablets of the plate that have been forgotten, it will take at the end of the plate, continue with the next pack without week off (case of 21 packs of pills). With Adépal and Miniphase, the plate should be started by colored tablets (throwing white). With continuous Varnoline, 28 tablets, do not complete the insert, which contains nothing but green tablets, and immediately start a new pack (if two of the last seven white pills were missed, take two tablets immediately forgotten, then finish the plate without taking pills and green chain immediately with another label).

     For Minesse Mélodia and pills, the situation is different: the platelets contain 28 tablets that are taken continuously (the last 4 tablets of the wafer are placebos). If you forget, whatever the period, just take the missed tablet immediately and the following at the usual time, and keep the brochure, as usual. If several tablets are forgotten, take the final two tablets forgotten the plate and continue as usual. We must of course also use another form of contraception for 7 days if forgetfulness is greater than 12 hours, especially if forgetfulness occurred at the beginning or end plate;
    If vomiting or diarrhea very important within two hours of taking the pill, take the next pill on the plate plate and continue as usual. The next pack will be started a day earlier.
    We must not allow more than seven days between packs of 21 tablets. If you forget when taking a new pack (longer period to 7 days) should be used in addition to oral contraception, local contraception for 7 days.
Progestin-only pills microdosées (or minipills)
Learn more about progestin-only pills or microdosées minipills
The regularity of the jacks is even more important for these pills which for the most part, do not block ovulation. If you forget, take the missed tablet immediately and take the next tablet at the usual time:If forgetting is less than 3 hours:
There is no other precautions;If forgetfulness is greater than three hours:
You must use a local contraception for at least the following 10 days (Vidal recommends 15 days). If unprotected intercourse within 24 hours of an oversight of over three hours, take emergency contraception. However, that emergency contraception is not necessary in case report in the days before oblivion as these progestin-only pills work mainly by making cervical mucus impermeable to sperm.Progestin pills macrodosées
When estroprogestative contraceptive pill is against-indicated, macrodosées of progestin-only pills can be used for contraception. In these cases, what to do if you forget depends on two conditions:If forgetfulness date less than 72 hours:
There are no consequences, take your pill and continue your plate normally;If forgetfulness is more than 72 hours:
Risk of pregnancy exists. Take the missed tablet as soon as you remember the day and the tablet as usual and continue your plate normally until the end of the cycle. Use in addition a method of local contraception for 28 days. Warning, if intercourse took place in the 3 days preceding oblivion, you must consult a doctor or a pharmacist to use emergency contraception.
Regardless of the pill used, if the omissions are increasing, it is probably best to consider another method of contraception.

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Emergency contraception: the role of the pharmacist

Nearly 95% of emergency contraception demands are without a prescription. These products available in pharmacies without a prescription since 2001 are free for minor since January 2002. But the pharmacist's role goes far beyond the simple issue.

"The issuance of emergency contraception without a prescription and free for minors is in my opinion a revolution comparable to that of the legalization of abortion," says bluntly Jean Lamarche, pharmacist and member of the National Council of order.


Inform and prevent

To fight against a still significant number of abortions, the law allows the delivery without prescription emergency contraception since December 2001 and free for minors since January 2002.

Emergency contraception is the only hormonal specialty without prescription. This feature gives the pharmacist a leading role. "The pharmacist is an important link in the chain of information that frames contraception. It is indeed present in pharmacies to remind and assist each prescription of regular contraceptive advice and information, particularly in case of accidents and oversights "says Jean Lamarche.
While these pills oversights are common (65% of women on the pill forget at least once a year), most women are unaware of the risks of pregnancy in case of higher oblivion to 12 hours (3 hours the minipills) and the importance of rapid use of emergency contraception. For that improves the situation, the pharmacist must deliver information on contraception permanently and reiterate on issuance of any contraceptive method. Addressing the risk of failure, to end the myth of the 14th day (which is not the exclusive day of ovulation) are all tasks of the pharmacist, who must know more respond to the emergency ... or better anticipate it.Receive emergency
The effectiveness of emergency contraception is optimal if taken early, within 24 hours following risk sex (but by no means a 100% effectiveness). For the speed of decision is optimal, the issuing in advance of a box of Levonelle ® or EllaOne® associated with the renewal pill could be an interesting option. But on this point, Jean Lamarche admits he struggled to educate physicians through the national council of the order.
However, things have changed since NorLevo® EllaOne® and are now counter in pharmacies (and issued free of charge and anonymously minor) .A note, regardless of the chosen molecule, the more it is taken earlier, more effective it will be. The manufacturer, HRA Pharma has deferred the announcement of this dispensation without prescription to have time to train pharmacists in personalized advice on emergency contraception.
"The issue in advance does not cause abuse, but enhances however an early remedy for contraceptive accident. Given the effectiveness of these products, it is best to always have a box The slogan itself with -. The urgency, it is anticipated - is in this respect excellent "says Jean Lamarche.
But this vision is still optimistic because despite the many announcements made in professional journals all pharmacists are not properly trained in prevention, and they are not all made vis-à-vis emergency contraception.Too many pharmacists still violate the law
"Too many pharmacists ignore the free issue of Levonelle ® for minors. Yet repayment is extremely fast and easy, great confidence has indeed been developed so that the pharmacist be easily repaid without an identity control minor is required. It is therefore pharmacists to invest to better manage the preventive aspect of public health "admits Jean Lamarche.
A no-brainer if you look at the number of practitioners who respect the law. "It is estimated that half of the pharmacists major cities and two-thirds in Paris do not respect the law and thus affranchiraient the obligation to deliver a box of free Levonelle ® to minors who request it. Currently the 'National Pharmacists deals very seriously this issue with different information in our newsletter last year. Moreover, the head of the regional council of the College of Pharmacists has sent personalized letters to recalcitrant pharmacies "admits Jean Lamarche.
Ignorance of the law, souvenirs related to repayment difficulties in the first months of merchantability or moral overtones of another age? Difficult to see clearly. Yet the stakes are high: 6000 than 10 000 minor undergo a yearly abortion.

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