Sun Protection
March 8, 2017
Hormonal Contraception
March 8, 2017

Emergency Contraception

 

Emergency contraception may be required after unprotected sex or if a contraceptive method failed e.g. a condom has split, or a pill has been missed or vomited etc.

 

There are two types of emergency contraception:

 

  1. The emergency contraceptive pill (morning after pill):  there are 2 forms of this treatment  choice: Levonelle which has to be taken within 72 hours (3 days) of sex, and ellaOne which must be taken within 120 hours (5 days) of sex.

 

  1. The IUD (intrauterine device, or “copper coil”):  can be inserted into the uterus up to 5 days after unprotected sex, or up to five days after the earliest time you could have ovulated. It can stop an egg from being fertilised or implanting in the womb.

 

Emergency contraception does not protect against sexually transmitted infections (STIs).

 

Facts about Emergency Contraception

 

Both types of emergency contraception are effective at preventing pregnancy if they are used soon after unprotected sex: less than 1% of women that choose the IUD get pregnant, whereas pregnancies after the emergency contraceptive pill are more common.

 

It is difficult to know how many pregnancies are prevented by the morning after pill, because there is no way to know how many women would have got pregnant if they did not take it!  A study published in 2010 showed that of 1,696 women who received the emergency pill within 72 hours of sex, 37 became pregnant (1,659 did not). Of 203 women who took the emergency pill between 72 and 120 hours after unprotected sex, 3 became pregnant.

 

MORNING AFTER PILLS

  • It is thought that ellaOne is more effective than Levonelle.
  • The sooner either pill is taken, the more effective it will be.
  • Either can cause symptoms of nausea, dizziness, lethargy, headache, tender breasts or abdominal pain.  Vomiting within 2 hours of taking the medication requires medical advice as a further dose may be necessary, or an IUD fitted.
  • Either can make the next period earlier or later than usual (or stay normal).  It is recommended to take a pregnancy test if the period is 7 days late.

 

IUD METHOD

  • The IUD can be left in as the regular contraceptive method after emergency fitting (and then lasts up to 10 years).
  • The IUD can make periods longer, heavier or more painful.  Some discomfort can be felt on insertion but painkillers and anti-inflammatories can help to relieve this.

 

There are no serious side effects of using emergency contraception.

Emergency contraception does not cause an abortion.

 

Where are Emergency Contraception’s Available?

MORNING AFTER PILLS: This depends on the Country – but generally most GP surgeries and some Pharmacies (where is it obviously helpful to know the name of the drug needed especially if you do not speak the local language!)

 

IUD METHOD: Is only available from suitably trained individuals (usually GPs or Gynaecologists).

 

THE MORNING AFTER PILLS

 

Levonelle: contains a synthetic version of the natural hormone progesterone. It is not known exactly how Levonelle works; it is thought to act primarily by preventing or delaying ovulation.

ellaOne: contains a hormone, which stops progesterone working normally. It prevents pregnancy mainly by preventing or delaying ovulation.

 

Levonelle and ellaOne do not continue to protect against pregnancy; this means that if further unprotected sex occurs after the morning after pill has been taken, there is another risk of pregnancy.

 

Neither emergency pills are intended to be used as a regular form of contraception. However, either can be used as emergency contraception more than once in a menstrual cycle if necessary.

 

Who can use the Emergency Contraceptive Pill?

Most ladies can use these medications; including girls under 16 years of age and those women who cannot usually use hormonal contraception (e.g. the combined contraceptive pill or contraceptive patch.)

  • Levonelle: The WHO (World Health Organisation) does not identify any medical condition that means a woman cannot use Levonelle.
  • ellaOne: The manufacturer advises that it should not be used by women who: are allergic to any of the constituents, have severe asthma treated with steroids, or those who suffer from certain very rare hereditary problems related to lactose metabolism.

 

Special Considerations: Breastfeeding Mothers

Levonelle: can be taken while breastfeeding. Although small amounts of the hormones may pass into breast milk, it is not thought to be harmful to the baby.

ellaOne: safety during breastfeeding is not yet known. The manufacturer recommends that breastfeeding is not undertaken for one week after taking this pill.

 

Special Considerations: Other Medications and Possible Interactions

The emergency contraceptive pill may interact with other medicines. These include:

  • Some epileptic medications
  • Some medicines used to treat HIV
  • Some TB treatments
  • Omeprazole and anti-acid stomach agent
  • Finally the herbal therapy “St John´s Wort”

Levonelle may still be used but the dose may need to be increased – a doctor or pharmacist will need to advise.

ellaOne cannot be used if one of these medicines are taken, as it may not be effective.

There should be no interaction between the emergency pill and most antibiotics. Although, 2 enzyme-inducing antibiotics, rifampicin and rifabutin, (used to treat or prevent meningitis or TB), may affect ellaOne while they’re being taken and for 28 days afterwards.

 

What to do with regular Hormonal Contraception (the pill, patch, vaginal ring or injection) after taking the “Morning After Pill”:

 

If Levonelle was used:

  • Take the next regular contraceptive pill, apply a new patch or insert a new ring within 12 hours of emergency contraception.  Then, continue taking the regular contraceptive pill as normal.
  • Additional contraception, such as condoms, should be used for the next 7 days if the combined pill, patch, ring, implant or injection are usually used.

 

If ellaOne was the treatment of choice:

  • Wait at least 5 days before taking the next regular contraceptive pill, applying a new patch or inserting a new ring.
  • Additional contraception, such as condoms, should be used whilst waiting to restart the usual contraceptive method and then for another 7 days (ie 5+7 =12 days in total)

 

THE IUD AS EMERGENCY CONTRACEPTION

 

The intrauterine device (IUD) is a small, T-shaped contraceptive made from plastic and copper. It must be inserted into the uterus by a trained health professional.

 

It can be used as an ongoing method of contraception.

 

Who can use the IUD?

Most ladies can use an IUD, including women who have never been pregnant and those who are HIV positive. But, a GP or gynaecologist will be needed to assess the medical history to check if an IUD is suitable.

An IUD is NOT an option if a lady has:

  • An untreated STI or a pelvic infection
  • Certain abnormalities of the womb or cervix
  • Any unexplained bleeding from the vagina e.g. bleeding between periods or after sex

Additionally, women who have a heart conditions should consult their cardiologist before IUD fitting.

 

Special Considerations: Breastfeeding Mothers

The IUD is safe to use for Mother and baby during breastfeeding, but the risk of complications during insertion is slightly higher.

 

Special Considerations: Other Medications and Possible Interactions

The emergency IUD will not react with any other medication.

 

This concludes my attempt at trying to be being practically helpful (from a distance) on the topic of contraception!  I really hope that the past 9 months has been worthwhile.  The most important thing to “take away” is, make a choice based on your needs and then actio

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