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EMERGENCY CONTRACEPTION - a patient's guide
Editorial Team
Overview
Emergency contraception is used to prevent pregnancy AFTER unprotected
sex.
Methods involve the emergency pill or the insertion of an IUD ("coil").
The emergency pill is also known as the "morning after pill"
but can be taken up to 72 hours after sex (preferably within 24 hours).
The emergency pill is taken as two pairs of pills, taken 12 hours apart.
There is a high rate of nausea from the emergency pill.
Another dose is needed if vomiting occurs within three hours of taking
the pills.
The IUD method is nearly 100 percent effective. There is up to a 5 percent
failure rate from the emergency pill.
What is it?
Emergency contraception is used after sexual intercourse when there
is a fear of unwanted pregnancy. It is also known as post-coital contraception.
There are two forms of emergency contraception:
- pills which must be started within 72 hours of unprotected sex.
- the Intrauterine Contraceptive Device (IUD), which must be inserted
within five days of possible fertilisation.
The emergency pill used to be known as the "morning after pill"
but its name has been changed to reflect the longer time period allowed
(72 hours) for it to be taken.
Unprotected sex is common when intercourse was not planned.
This mainly occurs with a new partner, an unexpected reconciliation,
under the influence of drugs or alcohol, or rarely in the
case rape and sexual assault.
Contraceptive failure is another common reason for seeking
emergency contraception. The most common problem is a broken
condom, or one that has come off during intercourse. Other
reasons include partial expulsion of an IUD, mistakes in
the use of a diaphragm, and missed oral contraceptive pills.
Emergency pill
The emergency pill is normally taken as two pairs of pills,
12 hours apart.
Due to the 72 hour time frame for treatment to be given,
there is some flexibility in when the pills can be taken.
If possible the first two pills should be taken in the morning
and the last two at night, to avoid the common side effect
of nausea from the pills (due to the oestrogen hormone).
They work by either preventing or postponing ovulation
(the release of an egg), or blocking the implantation of
an egg in the womb.
Standby emergency pills can be prescribed in some cases.
Some women may request them prior to overseas travel.
Nausea and vomiting are common side effects from the pills,
but this can be reduced by taking them with substantial
meals. Sometimes anti-nausea (antiemetics) are prescribed
in conjunction with emergency contraception.
There is a failure rate of up to five percent from the
emergency pill.
Vomiting within three hours after taking the pills may
cause the emergency contraception to fail. Women are usually
advised to take another dose if vomiting occurs, especially
if there is a high pregnancy risk. However, some experts
believe the vomiting implies that the pills have had a strong
effect and do not need to be replaced.
Your next period may be on time or it may come early or
late.
Emergency pills can be taken on two different occasions
during a menstrual cycle, and they will not cause harmful
effects if they are needed several times. They are not believed
to affect fertility.
Ectopic (fallopian) pregnancy is a risk of the emergency
pill.
The pills may not be prescribed for women with a past
history of blood clots (thromboembolism).
A small risk of birth defects if the pregnancy continues
cannot be ruled out. However, the risk is believed to be
less than when an oral contraceptive is taken in early pregnancy.
A pregnancy test should be taken three to four weeks after
taking the emergency pill to ensure it has been successful.
IUD emergency contraception
The immediate insertion of a copper IUD no longer than
five days after the date of ovulation can prevent a fertilised
egg from implanting in the womb and becoming a fetus.
This method is nearly 100 percent effective, and is used
when the emergency pill should not be used due to increased
risk factors, for women at a high-risk of pregnancy, or
when there have several episodes of unprotected sex.
In some cases, an IUD may be inserted if a woman vomits
three hours after taking the emergency pill.
The IUD can be used as a method of contraception following
insertion, or it can be removed after the woman's next period.
Ethical considerations
Some people do not share the modern view that conception
is not complete until implantation in the womb and believe
it begins with the fertilisation of an egg. They may believe
the use of emergency contraception is unethical.
Women concerned should also not use the IUD or the progestagen-only
pill because both these methods may block implantation in
some cases.
Future trends
There are moves in some countries to make emergency pills
available as an over-the-counter pharmacy medicine, ruling
out the need for a prescription.
Research is continuing to improve the safety profile of
emergency pills.
Getting help
Your doctor, or local Family Planning Clinic will be able
to help.
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