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Emergency contraception

Definition

Emergency contraception is a method to prevent pregnancy in women who have had unprotected sex, or for whom a barrier method has failed (slipped condom, diaphragm, or cervical cap, or broken condom).

Alternative Names

Morning-after pill; Postcoital contraception; Birth control - emergency; Plan B

Information

Emergency contraception may be used following many different situations, including:

• After intercourse in which no birth control method is used
• Sexual assault or rape
• When a condom breaks or a diaphragm slips out of place
• When a woman forgets to take birth control pills

Emergency contraception medicine is not the same as the "abortion pill." A woman who knows she is pregnant takes the abortion pill with the intent to end an early pregnancy (usually 4 to 7 weeks after conception). Emergency contraception pills are taken after unprotected sex to prevent pregnancy from occurring.

TYPE OF EMERGENCY CONTRACEPTION

Several types of emergency contraception drugs are available.

Two emergency contraceptive pills have been approved:

• Plan B One-Step is a single tablet that contains 1.5 mg of levonorgestrel.
• Next Choice is taken as two doses, which each contain 0.75 mg of levonorgestrel. Both pills can be taken at the same time or as two separate doses 12 hours apart.

Birth control pills, if available, can be used for emergency contraception. You must take two to five "regular" pills together to equal one dose of emergency contraception. It is best to talk to your health care provider about the correct dosage before doing this.

An alternative emergency contraception relies on insertion of a copper-releasing intrauterine device (IUD) within 5 days (120 hours) after unprotected intercourse. It can be removed after your next period, or left in place to provide ongoing contraception. The copper IUD reduces the risk of pregnancy by 99.9%.

MORE ABOUT EMERGENCY CONTRACEPTIVE PILLS

Both types Plan B One-Step and Next Choice are available over-the-counter (without a prescription) to women 17 years and older. Women younger than 17 can contact their health care provider to get a prescription for these pills. These pills are still considered safe to use for this younger age group.

Emergency contraceptives work best when taken within the first 24 hours after intercourse.

• About 7 out of 8 women who would have gotten pregnant do not become pregnant if emergency contraceptives are taken within 72 hours.
• These pills may still prevent pregnancy for up to 5 days after unprotected intercourse.

Emergency contraceptives work mostly by preventing or delaying the release of an egg (ovulation) - the same way that taking regular birth control pills works. It is possible that these drugs work by preventing an egg from being fertilized by a sperm, or by preventing a fertilized egg from implanting in (sticking to) the walls of your uterus (womb).

Mild and often unpleasant side effects from emergency contraception medication may include:

• Abdominal pain, fatigue, headache, and changes in menstrual bleeding.
• Nausea and vomiting are most common when an estrogen-containing pill is used. These side effects are less common with Plan B, which contains a synthetic progesterone.

After taking emergency contraception, a woman's next menstrual cycle may start earlier or later than expected and the menstrual flow may be lighter or heavier than usual.

• Most women will start their next period within 7 days of the expected date.
• If a woman's menstrual bleeding does not start within 3 weeks after taking emergency contraception, she might be pregnant and should call or visit her health care provider.

OTHER IMPORTANT FACTS

Women who believe that they are already pregnant and may have been for longer than several days should not take emergency contraception medicine. Also, women who have vaginal bleeding for an unknown reason should discuss this with their health care provider before taking emergency contraception.

Women who cannot take birth control pills regularly may often still be able to use emergency contraceptives, but they should also discuss this option with their health care provider.

If emergency contraception fails and the woman becomes pregnant, there do not appear to be any long-term effects on the pregnancy or the fetus.

Emergency contraception should not be used as a routine birth control method, because it is actually less effective at preventing pregnancies than most types of birth control.

References

Amy JJ, Tripathi V. Contraception for women: an evidence based overview. BMJ. 2009;339:b2895.doi:10.1136/bmj.b2895.

Prine L. Emergency contraception: myths and facts. Obstet Gynecol Clin N Am. 2007;34:127–136

Mischell DR. Family planning: contraception, sterilization, and pregnancy termination. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 14.