Sun | Nov 18, 2018

Dear Doc | Why am I pregnant?

Published:Sunday | August 19, 2018 | 12:00 AM

Q Dear Doc, I am very upset! I would like to know why I am pregnant if I took the emergency contraceptive!

I had unprotected sex and took the emergency pill within the three-day window as is recommended, so you can imagine my surprise when my period did not come and the pregnancy test was positive. Could something have been wrong with the pills I got why they didn't work? Please help! I need some answers!

A I am very sorry to hear about your situation, but unfortunately, there could be many reasons why the emergency contraceptive pill failed.

Emergency contraception is intended to prevent pregnancy by reducing the chance that the egg will be fertilised by sperm. It does this by preventing ovulation, and also to a lesser extent preventing implantation of a fertilised egg. That being said, its effectiveness is dependent on where a woman is in her cycle. It also depends on the type of emergency contraception used, as well as how soon after unprotected sex the woman takes emergency contraception, what type of emergency contraception she uses, and her weight.

Regarding where a woman is in her cycle, recall that emergency contraception works to prevent ovulation, If unprotected intercourse occurs at the time of ovulation, or one to two days before ovulation, when a woman is most fertile, the emergency pill may be less effective.

The pill is also most effective if taken within 72 hours of intercourse. The closer to the time of unprotected intercourse it is taken the better. They are up to 94 per cent effective in preventing pregnancy if taken early, their effectiveness however decreases with time as follows: 94 per cent effective when taken within 24 hours, 85 per cent effective when taken within 48 hours and 58 per cent effective when taken within 72 hours.

There are various types of emergency contraceptives and various pill preparations. Pill preparations can be either a single dose or two dose regime. The single dose is easier to take and less likely to cause confusion or a missed or delayed second dose. The two dose regime requires for the second pill to be taken 12 hours after the first pill. If this timing is delayed or forgotten, it can fail.

As it relates to weight, research has indicated that emergency contraceptive pills, may not work as well in overweight or obese women as they do in normal weight women. For this reason, women who weigh 165 pounds (75 kilograms) or more are advised to consider another form of emergency contraception, such as a copper IUCD (Intrauterine Contraceptive Device) instead of emergency contraceptive pills. The copper IUCD works well in women of any weight.

And finally, emergency contraceptive pill can cause nausea and vomiting. If you vomit within an hour after taking the pills, then it will not work. In such a situation you should take medication for nausea and vomiting and then take then another full dose.

I had a patient in a situation similar to yours once, and after delving more into her history realised she vomited after taking her first dose, She said she didn't see the pill in what she vomited and figured she was fine and proceeded without repeating the first dose.

Q I keep getting hiccups. They last for long and drinking water as they say doesn't help and I sometimes even choke on the water. This is affecting me and I keep looking stupid as a big man who keeps having hiccups. Do I need to see a doctor for medicine to prevent this?

A Hiccups can be quite bothersome, I know. They happen when your diaphragm, which is the muscle that separates your chest cavity from your abdomen, suddenly contracts. When this happens, you take in air, and then your voice box closes shut. This is what causes the "hic" sound.

Most hiccup episodes last less than 48 hours. Rarely, they can last longer, than a month at which time they are called "intractable hiccups."

In most cases, hiccups go away on their own with no lasting effects. But in cases where they can last a long time, they can lead to problems such as poor nutrition, tiredness, and reduced appetite.

Here are a few things you can try:

- Hold your breath for 30 seconds or longer.

- Breathe out against your closed mouth and nose (similarly to how you would on a plane to pop your ears).

- Stimulate the back of your throat, for example, by gulping cold water, gargling with water, or swallowing a teaspoon of sugar.

- Pull your knees up to your chest and lean forward.

You should see your doctor if you have hiccups that last longer than 48 hours.

If the self-help steps listed above do not work, there are a number of prescription medicines that can help. Surgery might be needed to treat some people with extreme symptoms who do not get better with other treatments, but this is rare.

deardoc@gleanejm.com