Women's Health: Emergency contraception - What you need to know
Many women have mixed feelings about emergency contraception. Will it work? How effective is it at preventing a pregnancy?
There is also confusion as to what methods are available, how they should be taken, and how they actually work to prevent pregnancy.
I will answer a few questions and help to make it a little clearer, and hopefully allay any fears one might have about using them.
Emergency contraception is the use of a particular method to prevent pregnancy after a woman has had intercourse without the use of a birth-control method, or if her current method fails - for example, if she misses two or more pills from her box of oral contraceptive pills, or if the condom breaks or slips off during sex.
There are two methods of emergency contraception that are available: the emergency contraceptive pills, commonly called the 'morning-after pill', and the copper intrauterine contraceptive device (IUCD), commonly called the 'Copper-T'.
The types of emergency contraceptive pills vary based on its contents. The progestin-only pills are the only ones available in Jamaica, and contain a hormone called levonorgestrel - the same hormone found in many contraceptive pills, just at a higher dose.
Other types of emergency contraceptive pills are the combination pills, which contain both oestrogen and progestin, and are similar to contraceptive pills (birth-control pills). However, they are less effective than the progestin-only type, and as such, is not a preferred method.
How are progestin-only emergency contraception pills taken?
On many occasions, patients call doctors - confused and in a panic. Which pill should I take first? The timeline - does it mean both pills are to be taken in the 72 hours? What if I take the second one late?
It is very simple.
Progestin-only emergency contraceptive pills are available as a single pill or as two pills. Ideally, this method should be taken as a single dose (1.5mg) within three days of unprotected intercourse.
Alternatively, it can be taken in two doses (0.75mg each) 12 hours apart.
However, the two pills are identical; it does not matter which pill you take first. Also, both doses can be taken at the same time. I always advise taking both together for simplicity, and to avoid missing the second dose.
MORE EFFECTIVE SOONER
The pills are more effective the sooner they are taken, so take them as soon as possible after having unprotected sexual intercourse.
How do the pills work to prevent pregnancy?
Emergency contraceptive pills prevent pregnancy by stopping or delaying the release of the egg from the ovary (by preventing ovulation). They may also work by preventing fertilisation of an egg (the joining of the sperm with the egg) by affecting the cervical mucus, or the ability of sperm to bind to the egg.
They are not effective once the process of implantation has begun, and they will not cause abortion.
You can experience some side effects after taking emergency contraceptive pills. Nausea and vomiting can occur after taking the progestin-only pills. You may have bleeding or spotting in the week or month after the treatment. Other possible side effects include the following:
-Abdominal pain and cramps
- Breast tenderness
These side effects usually go away within a few days.
Your next menstrual period may not occur at the expected time, but it should occur within a week of the expected time. If your period is more than a week late, it is possible you may be pregnant. You should get a pregnancy test and follow up with your health-care provider.
How effective are progestin-only emergency contraception pills?
I am sure we all have a friend, or have heard of somebody who got pregnant despite taking the emergency contraceptive pill. However, they still are quite effective.
In fact, they are up to 94 per cent effective in preventing pregnancy if taken early and as prescribed. 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.
- 58 per cent effective when taken within 72 hours.
It is also less effective if you have already had unprotected sex or birth-control failure earlier in your menstrual cycle, and if you have unprotected sex or birth-control failure again in the same menstrual cycle after taking the emergency contraceptive pill.
This is because it only protects against one incident of unprotected sex or birth-control failure.
Yes, you get pregnant later in your menstrual cycle after using emergency contraceptive pills.
I have repeated this for emphasis. One dose/use of the emergency contraceptive pill only protects against one incident of unprotected sex or birth-control failure.
It is possible to become pregnant later in the same menstrual cycle if you have used emergency contraceptive pills. To prevent pregnancy, you should use a barrier contraceptive method, such as a condom, until your next menstrual period occurs.
You can also start birth-control pills immediately after taking emergency contraception, but you also need to use a barrier method until your next menstrual period starts.
If you are desirous of an ongoing, highly effective contraceptive method, and find yourself in need of emergency contraception, the copper intrauterine contraceptive device is an ideal emergency contraception in such a case.
The copper IUCD, commonly called the 'Copper-T', must be inserted within five days of having unprotected sex for it to be effective. If used correctly, a copper IUCD is about 99 per cent effective in preventing pregnancy, making it the most effective form of emergency contraception available.
Once inserted, it has the added benefit of being used as an ongoing, long-term method of contraception. The patient can still, however, choose to change to another contraceptive method in the future.
As an emergency contraceptive, the copper IUCD primarily works by preventing fertilisation. It does this by causing a chemical change that results in damage to the sperm and egg before they can meet.
The copper IUCD is a very safe form of emergency contraception. The risks associated with its use for this indication are low.
WHY DID IT FAIL?
It is always a scary and anxious situation when emergency contraception is required. Having read and gained some knowledge on how they work and their effectiveness, I hope you are now comforted in the fact that emergency contraception is an easy, safe and effective way to prevent an unwanted pregnancy when used correctly.
But please note, it is for emergency use only. It does not protect against sexually transmitted infections, and is not meant for use as a regular contraceptive method, and it will fail you if used in such a way.
I will leave you with my usual anecdote concerning a patient who used the emergency contraceptive pill.
She came to me in shock, awe and confusion, stating, "I took the emergency contraceptive pill. I took it early, too, but my period didn't come and the pregnancy test I did says positive. It must be wrong or something. Can you do it again and check me, please?"
She was right! She did take the pills correctly and within three days of unprotected sexual intercourse, and, her pregnancy test was positive!
So, of course, now I had the task of explaining to the then quite anxious, distraught patient why it could have failed.
Upon questioning her, I realised that she had unprotected sexual intercourse earlier in the month, before taking the emergency contraceptive pill, which she stated occurred during her "safe days" (see article 'Myths about female sexual health', myth #7).
Still shocked but accepting the explanation, she allowed me to perform an ultrasound to determine the due date of the pregnancy. It coincided with conception being at the time of her first unprotected intercourse, and after seeing the foetal heart beating, she was overwhelmed with emotion and was actually happy.
She had a beautiful baby boy earlier this year.
- Dr Rhonda Reeves is the obstetrician/gynaecologist at Southdale Medical & Gynae Centre, Shop 6, Southdale Plaza. Email: firstname.lastname@example.org