Emergency Contraception
The potentially life-changing reality of an unwanted pregnancy causes real anxiety for most people. One of the last-ditch methods for preventing a pregnancy is emergency contraception, the key word being emergency.
There are many reasons for using emergency contraception after sexual intercourse: ordinary reasons such as a broken condom, forgotten birth-control pills, unprotected sex in a committed relationship, or a one night stand, and horrible, extreme situations like sexual assault. The decision to go to “Plan B” must be taken quickly, can be quite traumatic, and can also result in potential physical side-effects.
We have already written about hormonal birth control (the pill, vaginal rings, skin patches, hormonal IUDs) and non-hormonal birth control (male and female condoms, contraceptive sponges, vasectomy, tubal litigation, non-hormonal IUDs). All these methods require careful planning and regular action, but life does not always go as planned.
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The psychological toll of being responsible for birth control already falls disproportionately on women. With the added time constraint of an emergency, the situation becomes even more daunting. It is best to have a plan in place. Just in case.
Decide for yourself if emergency contraception is something you would use and how you would ideally like to react in a situation where it would be needed. Of course, each situation is unique and your reactions in the moment might differ from what you imagine as you plan.
If you have a long-term sexual partner, you can also discuss potential scenarios with them. How would they be likely to react if the condom broke?
Millions of women have been in this situation. Whatever your decision, you are not alone.
Emergency contraception is designed only to prevent pregnancy and does not prevent or treat sexually transmitted infections. STIs can only be prevented by using barrier methods such as condoms.
Types of emergency contraception
There are two types of emergency contraception—the emergency contraceptive pill and the IUD. The emergency contraceptive pill further divides into two types; the most common and accessible is “Plan B”.
Emergency contraceptive pill
Plan B is a colloquial name (and a brand name) for emergency contraceptive pills that can be taken right after unprotected intercourse. They are also known as “morning after” pills, although you can take them immediately after sex without waiting until the next morning.
Plan B is most effective if used within 72 hours (three days) but can still work if taken within five days after vaginal sex. As time passes, the potential effectiveness decreases. The morning after pill is approximately 75% to 89% effective and the sooner you take it, the better.
Emergency contraceptive pills use the hormonal medication levonorgestrel. In some pills, it is also combined with oestrogen. Levonorgestrel is a progestin hormone that thickens the cervical mucus and inhibits ovulation, making successful fertilization much less likely. It cannot stop an ongoing pregnancy or prevent an already fertilized egg from implanting in the endometrium (the lining of the uterus).
There are various brand names, but you can simply ask for emergency contraception or plan B at the pharmacy. Emergency contraceptive pills can be readily bought without a prescription and without age limits at all pharmacies, and many grocery stores.
You can also order Plan B pills online but be sure to check the credentials of the site. Use only FDA approved medications from trusted sources that arrive in undamaged packaging with complete instructions.
Potential side effects
Modern emergency contraception no longer causes heavy bleeding like it did in the past and most likely will not induce a full period to begin the next day. Light spotting, however, may occur.
The most common side-effects include:
- changes in your next period—it can be lighter or heavier
- changes in your menstrual cycle
- nausea
- headaches
- vomiting
- fatigue
- abdominal pain
- breast tenderness
- acne
If you vomit soon after taking the pill, you may not have consumed enough of the medication for it to be effective.
If you experience severe side-effects such as excessive bleeding, loss of consciousness, or extreme pain, seek medical help immediately.
A morning after pill usually costs between $40 and $60. They can be gotten for less at specialized care centres, such as Planned Parenthood. You need only one pill to prevent a pregnancy. If money is an issue, try contacting a local crisis centre or sexual health clinic for assistance.
In some places, contraceptives, including Plan B and IUDs, are free for people under the age of 16. Check your local laws online.
The other pill
Another medication—ulipristal acetate—is also used for emergency birth control. Unlike levonorgestrel, ulipristal acetate can be harmful for a pregnancy that has already begun. This is mostly a prescription medication that you will not be able to buy over the counter.
The efficacy of ulipristal acetate is 1–2% higher than that of levonorgestrel, and its window of effectiveness is longer—up to 5 days, without losing efficacy.
Health care practitioners in some regions of the world are trying to make it available without prescription.
The side effects are similar to those of the more common morning after pill.
Counterindications
A sometimes overlooked but very important fact is that the morning after pill may not be effective if you are overweight. The limit of 155 pounds is often cited for Plan B, and 195 pounds for ulipristal acetate. In this case, you can still use a copper (non-hormonal) IUD, which has no weight limits.
Ulipristal acetate is not recommended for breastfeeding mothers. If no other option is available, you can take it, but the milk should be discarded for the next 1–2 days.
Do not take the morning after pill if you:
- are using other hormonal contraceptives
- have a serious liver condition or asthma
- are using certain HIV medications (contact your doctor for more information)
- know that you are already pregnant
You might think that you will have a better chance of preventing pregnancy if you take more than one pill, for example, one day after and three days after unprotected sex. There are no additional risks to doing so, but no benefit either. Either it works the first time, or it doesn’t.
The IUD
The intrauterine device, or IUD, is commonly used for long-term contraception. There are two types of IUDs—those that contain hormones and those that contain copper. Copper IUDs can also be effective as emergency contraception if inserted within the first 5 days after unprotected intercourse. The IUD is more efficient than either of the morning after pills, has fewer side effects, and weight does not influence its effectiveness, however, inserting an IUD requires professional assistance, the procedure is invasive, and an IUD is more expensive than a pill. This makes the IUD much less accessible as a method of emergency contraception, especially with the tight deadline of 5 days.
The copper IUD is a small, T-shaped device made of plastic and copper that is inserted directly into the uterus by a professional healthcare provider. It releases a tiny amount of copper into the uterus and fallopian tubes that acts as a spermicide to prevent fertilization. If an egg has already been fertilized, an IUD can prevent it from implanting into the lining of the uterus. The IUD can also further interfere with a pregnancy, if it has already begun, therefore it is not recommended for women who are already pregnant. (Recent studies indicate that hormonal IUDs may be as effective as copper IUDs for emergency contraception, but more information is needed.)
Make an appointment for an IUD insertion with your gynaecologist as soon as possible after the unprotected intercourse. Discuss the option of using the IUD as a long-term contraceptive.
The IUD is one of the most effective forms of both long-term and emergency contraception with a 99% success rate if used in a timely manner and inserted correctly.
The most common side-effects of IUD use include:
- Internal damage to the cervix if the IUD is inserted poorly or slips out of place
- Changes to the menstrual cycle
- Periods may become heavier and longer if the IUD is used as long-term contraception
Preparation
You can buy a morning after pill ahead of time and save it in case of emergency. If stored appropriately, ulipristal-acetate-based pills have a shelf life of about three years, while levonorgestrel-based pills have a shelf life of about four years. Remember, they are not intended for regular use.
The only 100% sure way of preventing pregnancy is abstinence—not engaging in vaginal intercourse at all. If you do want to be sexually active but don’t want to get pregnant, consider your options. Long-term hormonal contraception is much more efficient than the morning after pill, and condoms have the added benefit of STI prevention.
Be kind to yourself and practice safe sex!
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