Nov 03 2009

Emergency Contraception or The Morning-After Pill

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BEFORE WE START, Let’s Get This Straight

It is ALWAYS better and safer to take precautions before sex.

It is NEVER a good idea to just have sex and worry about getting pregnant afterwards.

Emergency Contraceptives REDUCE your risk of getting pregnant, it does not take the risk away.

Oops, What now?

Why do we need emergency contraceptive pills (ECPs) (also known as ‘the morning after pill’ (MAPs))?

  • The condom broke or slipped off
  • You forgot to take your pill, insert your ring, get your shot, or apply your patch for birth control
  • Your partner did not withdraw (pull out) in time
  • Diaphragm or cervical cap slipped out of its proper place
  • Unplanned sex without protection
  • Drunk sex and not sure what exactly happened
  • Misjudged your "safe" days using natural family planning (FAM or NFP)
  • You were forced to have unprotected sex (sexual assault and rape)

The Answer

Emergency Contraceptive Pills or ‘The Morning After Pill’ (as it is often called) is meant for just this. It allows you to safely recover from poor decisions or regular birth control failure. These pills are very strong birth control pills that will deliver enough birth control hormones to almost instantaneously modify your fertility cycle and prevent you from becoming fertile.

There are a number of emergency birth control pill regiments available:

  • Dedicated ECPs
  • Normal birth control pills used as ECPs

 

A few facts about ECPs

  • The sooner you take it, the better the chances are to avoid becoming pregnant. It is NOT an abortion pill. After you are pregnant, it is no use taking it. 
    • Within 24 hours of sex: 95% effective
    • Between 25 and 48 hours: 85%
    • Between 49 and 72 hours: 58%
  • If you are already pregnant, you will stay pregnant and there are no known side effects for the baby.
  • It will mess up your menstrual cycle and cause you to have withdrawal bleeding before your period is due.
  • It may mess with your real cycle to make your menstruation late, making you think you are pregnant
  • It is only effective if taken during the first 36 hours after he ejaculated inside you
  • The Morning After pill is just a high dose hormonal birth control pill
  • It is branded differently in different countries
  • You may have to be an adult to buy it depending on where you live
  • You might need a doctor’s prescription to get it depending on where you live
  • It should not be used as long term contraception.
  • Some older versions needs you to take two pills
  • Some brands are available as older 2 pill doses and one pill doses. The number of pills does not make a difference to its efficacy but less pills make it less cumbersome to take.
  • In many countries emergency contraceptives are available over the counter without a prescription but not available to girls under 17 years old without a prescription. This is because it has not been tested on extremely young girls because of the ethics of testing it on girls under 17 years old. This does not mean that it is damaging or harmful to these girls but only that it is not tested or approved by drug regulators like the FDA for these girls.
  • Emergency contraception works like normal hormonal birth control:
    • Make uterus wall unfriendly to implantation <- Primary function in an ECP
    • Can delay or prevent ovulation – This does not have much value as an ECP after ovulation took place
    • Make cervical mucus unfriendly to sperm to keep it out of the uterus and away from the egg– This does not have much value in an ECP after sex took place

Side Effects

  • You might feel sick for a short time after taking this medicine. About one in four women (25%) who take this medicine will feel sick.
  • You might actually be sick (vomit) after taking this medicine. This is not usual. Be sure to read the pill pack insert to see what to do if it happens to you. Typically it is not a problem after three hours. But before the three hours is up, you may need to take another dose.
  • Your period might be different. Most women will not have a normal period at the expected time after taking ECPs. but some may have their period later or earlier than normal. You might also have some irregular bleeding or spotting until your next period. If your period is more than 5 days late or is unusually light or unusually heavy, or especially painful, you should contact your doctor, nurse or pharmacist as soon as possible.
  • You might have tender breasts, headaches, lower abdominal (tummy) pain, diarrhea, feel dizzy or feel tired after taking this medicine. These symptoms should get better within a few days.
  • If any of the following happens, see a doctor or nurse immediately:
    • Severe pain in your leg (calf or thigh)
    • Severe abdominal pain
    • Chest pain or cough or shortness of breath
    • Severe headaches, dizziness, weakness, or numbness
    • Blurred or loss of vision or trouble speaking
    • Jaundice (if you see a yellowish tint in the whites of your eyes, your skin, or your mucus membranes)
  • If you think that this medicine has affected you in any other way that is not mentioned above, tell your doctor, nurse, pharmacist, or family planning clinic.

You can see that many of these side effects are the same as early pregnancy symptoms so it is important not to loose your head and get worried.

What To Expect after taking ECP

  • After a contraceptive failure or an unplanned sexual encounter, take ECP as quickly as possible.
  • If this was first time you had sex, or it was rough, you may bleed and spot a bit for a day or two.
  • You can feel nauseous, get headaches, experience sore breasts and lower back pain from the high dose hormones. The hormones can make you emotional or make you break out with achne
  • You can feel sick and lose your appetite, be restless and unable to sleep due to stress and worry.
  • Seven days after taking the ECP you can expect period like bleeding. This can be accompanied by PMS symptoms, especially cramps. This bleeding may start a bit earlier (after five days). It can be just spotting, or like a full period. If you do not get this, it is not an indication of anything.
  • Expect your next real menstruation to be late, or even absent. ECP can also change your schedule for a month or two, or even permanently. Depending on where in your cycle you were, it can give you a new cycle start date.
  • Take a pregnancy test 21 days after the sex to make sure you did not get pregnant. Repeat the test 7 days later to confirm the results.
  • Evaluate the circumstances that cause the birth control failure, and take corrective actions.
  • Get a spare pack of ECPs to put in your medicine cabinet for in case it happens again.

ella – A new type of morning after pill

ella is a new generation of emergency contraceptives that can be taken up to 5 days (120 hours) after the sex. It still makes a difference when you take it – as soon as possible is advisable. One advantage of ella is that it can stop ovulation much better than other ECPs

ella contains a 30mg dose of ulipristal acetate (UPA). A comparison between clinical trails with UPA or with levonorgestrel (LNG) for EC showed that UPA has higher efficacy. Both treatments have similar side effects. The mechanism of action of both LNG and UPA for EC is by delaying or inhibiting ovulation. However, UPA (ella) appears to have a direct inhibitory effect on follicular rupture that allows it to be effective even when administered shortly before ovulation, a time period when LNG (Plan B, ipill, Postinor, Levonelle),  is no longer effective. How ella works when you are most fertile

The negative is that you have to get a doctor’s prescription to get ella. That means that you have to wait a longer time, unless you have a prescription ready. ella is also available from Planned Parenthood in the USA. There you can get a prescription and the pill at the same time.

When you use only condoms for birth control, it is recommended that you have a dose of emergency contraceptive pills ready in your medicine cabinet

 

Normal Birth Control Pills (BCPs) as ECPs

Many of the normal birth control pills can be used as emergency contraception. Here is a list with the suggested dosages:

Oral contraceptives that can be used for emergency contraception (in high doses) in the United State

Progestin-only pills

Next Choice by Watson     
Plan B by Teva
Plan B One-Step by Teva

Combined Progestin and Estrogen pills

Alesse by  Wyeth
Aviane by Barr/Duramed
Cryselle by Barr/Duramed
Enpresse by Barr/Duramed
Jolessa by Barr/Duramed
Lessina by Barr/Duramed
Levlen by Berlex
Levlite by Berlex
Levora by Watson
Lo/Ovral by Wyeth
LoSeasonique by Barr/Duramed
Low-Ogestrel by Watson
Lutera by Watson
Lybrel by Wyeth
Nordette by Wyeth
Ogestrel by Watson
Ovral by Wyeth
Portia by Barr/Duramed
Quasense by Watson
Seasonale by Barr/Duramed
Seasonique by Barr/Duramed
Sronyx by Watson
Tri-Levlen by Berlex
Triphasil by Wyeth
Trivora by Watson

 

Emergency Contraception Brand Names

Plan B

http://cache.jezebel.com/assets/resources/2007/07/Plan%20B%20boxes.JPG

http://cache.gawker.com/assets/images/jezebel/2009/08/plan-b.jpg

http://jerkmag.files.wordpress.com/2009/03/nm_plan_b_070914_ms.jpg

 

Postinor2

http://2.bp.blogspot.com/_vAxB0_PxMpg/R38YUqVG5pI/AAAAAAAAAZw/hpGdz4HpeUw/s400/IMG_2111%2B(Large).JPG

 

Levonelle OneStep

http://www.bbc.co.uk/health/images/300/spl_morning_after_pills.jpg

 

ella

ella

 

References:

Not-2-Late – Emergency Contraception Information from Princeton University

Emergency Contraception – Wikipedia

Plan B One-Step – Barr Pharmaseuticals (Duramed)

Postinor – Gedeon Richter

Levonelle One Step – Bayer HealthCare Bayer Scherring Pharma

ella – Watson Pharmaceuticals

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