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Emergency Contraception - A Bridge Toward Regular Contraception

There is a lot to consider about modern-day emergency contraception: what to use and when to use it; how it could affect you and much more. In this comprehensive article, we share everything you need to know about emergency contraception and its unique role as a BRIDGE to regular contraception.

Guest Article by Dr Sanchika Gupta

Emergency Contraception


Summary By Author: This article is sub-divided into two sections. The first section describes basic knowledge about emergency contraception: methods, types, how they work and are used, their effectiveness in preventing unintended pregnancy, associated risk, benefits, side effects and dispels some myths around their use. In the second section, we look at establishing linkages between emergency and regular contraception.  

Section I: Emergency Contraception, Basic Science.

What is Emergency Contraception (EC)?

Emergency Contraception (EC) for women refers to any device or drug used as an emergency procedure to prevent pregnancy after unprotected sexual intercourse (including sexual assault) or after a recognized contraceptive failure.

It is commonly known as:

  • “the morning-after pill”,
  • “post-coital contraception”,
  • “interception”,
  •  “postovulatory contraception”,
  • “visiting pill”,
  • “vacation pill.” [i][ii]

What are the types of Emergency Contraception (EC) and How Are They used? (Usage Method)

Emergency Contraception is widely available as hormones (estrogen, progesterone or ulipristal acetate) oral pills forms.

Time is of the essence to prevent unintended pregnancy.

You are advised to take the pill(s) at the earliest convenience after unprotected sexual intercourse.

For some forms, this will be up to 72 hours while for others it is up to 5 days.

Table 1 highlights different preparations (forms) and the use of Emergency Contraception Pills (ECPs).

Emergency Contraception - Analysis of Formulation & Hormone Content
Table 1: Emergency Contraception Pill Types


Intra Uterine Devices (IUDs) as Emergency Contraception:

  • The Copper-bearing IUD[i], (also known as “the Copper Coil” or “the Coil”) acts as an emergency contraceptive when inserted in the uterus by a specialized healthcare provider within five days of unprotected sexual intercourse.
  • According to the World Health Organisation (WHO), when inserted within 120 hours (5 days) of unprotected sexual intercourse, a copper coil is more than 99% effective in preventing unintended pregnancy[ii].
  • It is also widely used as a long-acting reversible contraceptive method in Asia and Africa.

A Copper Coil placed in the womb is an effective form of emergency contraception

How Do ECPs Work? (Mode of Action of ECPs)

  • ECPs prevent or delay the release of eggs from the ovaries (ovulation) by five to seven days.
    • By then, any sperm in the woman’s reproductive tract (womb and fallopian tubes) would have died, since sperm can survive there for only about 5 days.
  • If ovulation has occurred and the egg was fertilised, ECPs do not prevent implantation or disrupt an existing pregnancy.
  • ECPs are not an abortifacient drug - meaning- they do not cause abortion or death of the fetus.
  • There is no evidence that ECPs cause birth defects or harm the fetus if a woman is already pregnant and she takes ECPs or if ECPs fail to prevent pregnancy.

Pregnancy Test is an important test to do to check for emergency contraception failure

How effective is Your ECP?

  • The evidence suggests that women who use ECPs with (Ulipristal Acetate) UPA have a pregnancy rate of 1.2%.
    • (This implies that from 1000 women taking the UPA as a form of emergency contraception, only 12 will fall pregnant)
  • Those who use ECPs with (Levonorgestrel) LNG have a pregnancy rate of 1.2% to 2.1%.[iii][iv]
    • (This implies that from 1000 women using the LNG as their emergency contraception between 12 and 21 women will fall pregnant)

What is the effect of ECPs on Women’s fertility?

  • Women’s return to fertility after using any emergency contraception pill is immediate.
  • ECPs do not protect you from pregnancy due to unprotected sexual intercourse for more than 24 hours after you've taken them.
  • Therefore, to stay protected from pregnancy, women must begin to use another contraceptive method.

An emergency contraception pill held on a fingertip

Are there any Conditions where you Cannot Use ECPs? (Risks factors for using ECPs in different health conditions).

The World Health Organisation (WHO) has described different medical conditions in which women can safely use ECPs[v].

Please refer to the Table 2 below:

ConditionsEligibilityComments
PregnancyNO
BreastfeedingYES

· Can use LNG or COCs regimen
· Can use UPA regimen but breastfeeding is not recommended for one week after taking UPA since it is excreted in breast-milk. Breast-milk should be expressed and discarded during that time.

Past Ectopic PregnanciesYESCan use COCs, LNGs or UPA regimen
Severe Cardiovascular Disease, including Ischaemic Heart Disease, Cerebrovascular Attack (Stroke), or other Thromboembolic conditions (such as DVT or Pulmonary Embolus).YESCan use COCs, LNGs or UPA regimen
MigraineYESCan use COCs, LNGs or UPA regimen
ObesityYESCan use COCs, LNGs or UPA regimen
Currently on drugs known as CYP3A4 inducers (e.g. Rifampicin, Phenytoin, Phenobarbital, Carbamazepine, Efavirenz, Fosphenytoin, Nevirapine, Oxcarbazepine, Primidone, Rifabutin, St John’s wort/Hypericum perforatum)YES

Can use COCs, LNGs or UPA regimen
Table 2: WHO Medical eligibility criteria for using ECPs


What are the factors that facilitate long term use of Contraception?

Various sources of evidence suggest that women’s voluntary and long-term use of a specific contraceptive method depends on the degree of comprehensive information, education and counselling they have about it.

Benefits, Side Effects & Myths of Emergency Contraception.

It is important that you know not only the benefits but possible side effects of your emergency contraception.

Some of these are highlighted in Figure 1.

Figure showing Benefits and Side effects of Emergency Contraception

Figure 2 below addresses common myths you may know about using emergency contraception.

Figure addressing common myths of Emergency Contraception


Section II: Emergency Contraception, a Transition Phase to Regular Contraception.

Emergency Contraception is a bridge to regular contraception

  • It is very important to understand that women use ECPs because they do not want an unintended pregnancy.
    • ECPs give you the power and autonomy over your body to take a second chance to prevent unintended pregnancy.
  • However, ECPs are not a regular method of contraception.
    • There are several other methods available in the contraceptive basket of choice for the unique needs and requirements of women to fulfil the unmet need for contraception.
  • A woman’s partner has an equal responsibility towards the decision-making process for use of methods of contraception.
    • Actually, your partner is an intermediary in the use of emergency contraception and acts as a bridge in this journey towards regular contraception.
  • Your partner can support you by making ECPs handy and available.
    • They can seek information from a healthcare provider to understand the correct use of the methods.
    • They can proactively encourage you to connect with healthcare providers for regular contraception.
  • Any sort of contraception is a shared responsibility between couples and it will have a positive influence over their health, well-being and happiness!

Control leads to compliance; autonomy leads to engagement.

Author Daniel H. Pink


HormonePopular Brand Name
Ulipristal AcetateElla, EllaOne, Esmya, Fibristal
LevonorgesterelAlesse, Altavera, Alysena, Amethia, Amethyst, Ashlyna, Aviane, Camrese, Chateal, Climara Pro, Cycle 21, Daysee, Emerres, Enpresse, Erlibelle, Escapelle, Falmina, Introvale, Isteranda, Jadelle, Jaydess, Jolessa, Klimonorm, Kurvelo, Kyleena, Lessina, Levlen, Levodonna, Levonelle, Levonest, Levosert, Levora, Liletta, Loette, Logynon, LoSeasonique, Lutera, Lybrel, Marlissa, Microgynon, Microlut, Microvlar, Min-Ovral, Miranova, Mirena, My Way, Myzilra, Next Choice, Nordette, Norgeston, NorLevo, Norplant, One Pill, Option 2, Orsythia, Ovima, Ovranette, Plan B, Plan B One-Step, Portia, Postinor, Postinor-2, Post Pill, Preventeza, Ramonna, Rigevidon, Quartette, Quasense, Seasonale, Seasonique, Skyla, Sronyx, Tri-Levlen, Trinordiol, Triphasil, Triquilar, Tri-Regol, Trivora, and Upostelle.
IUDCopper Coil, Copper IUD (Variety of brands per country; check with your provider.)
Common Brand Names for Different Emergency Contraception Types

More Reading

Can You Use Contraception Safely When Overweight?

Oral Contraceptives and Weight Gain

Doc's Corner - Pregnant Despite Contraception!

References

[i] “Emergency Contraception: a Review of Current Oral Options.” The Western journal of medicine. Copyright 2002 BMJ Publishing Group, May 2002.

[ii] “Hormonal Contraception.” Williams Textbook of Endocrinology (Thirteenth Edition). Content Repository Only! December 3, 2015.

[iii] “Family Planning - A Global Handbook for Providers.” World Health Organization. February 20, 2018.

[iv] “Emergency Contraception.” World Health Organization. Accessed August 22, 2020.

[v] “Emergency Contraception.” World Health Organization. World Health Organization. Accessed September 4, 2020.

[vi] . “Can We Identify Women at Risk of Pregnancy despite Using Emergency Contraception? Data from Randomized Trials of Ulipristal Acetate and Levonorgestrel.” Contraception. U.S. National Library of Medicine, October 2011.

[vii] “Effect of BMI and Body Weight on Pregnancy Rates with LNG as Emergency Contraception: Analysis of Four WHO HRP Studies.” Contraception. Elsevier, August 12, 2016.

[viii] “Medical Eligibility Criteria for Contraceptive Use.” World Health Organization. August 29, 2019.


About the author: Dr Sanchika Gupta is a healthcare specialist with 7+ years of experience, both as a clinician and public health professional in national and international NGOs. Her fieldwork in different geographies across India spans a wide breadth of the public health realm viz. family planning, sexual and reproductive health and rights, adolescent health, maternal and child health. Declaration: This is the original written work of Dr. Sanchika Gupta. Should you need any further information, please do not hesitate to contact her at the email-id: sanchika12@gmail.com or tweet @sanchika_gupta.


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