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Emergency Contraceptive Pill Or Morning-After Pill: Benefits, Uses, Timing, Efficacy And Side Effects

Emergency contraceptive (EC) pill or morning-after pill is emergency contraception used to prevent unintended pregnancy effectively after unprotected sexual intercourse. The EC is also used when there is a contraceptive failure such as condom breakage or missing on your daily oral pills for many days.

According to the WHO and many evidence-based studies, emergency contraception can help prevent around or over 95 per cent of pregnancies when taken within five days of sexual intercourse.

In this article, we will discuss details on an emergency contraceptive pill. Take a look

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What Does An Emergency Contraceptive Pill Do?

The EC pills help prevent pregnancy after unprotected sex by: [1]

  • Preventing or delaying the release of an egg from the ovaries so as to prevent fertilisation, at least until sperms are active in your body.
  • Thickening the cervical mucus that helps reduce the movement of sperm and blocks them in the cervix itself thus, preventing them from joining an egg in the uterus for fertilisation.
  • Thinning the lining of the uterus to prevent the implantation or attachment of the blastocyst to the uterus, in case the egg has already been fertilised by a sperm.
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    How Does An Emergency Contraceptive Pill Work?

    Most of the EC pills contain levonorgestrel (LNG), a second-generation synthetic progesterone hormone, along with norgester. Levonorgestrel is the active ingredient in the pill which is similar to the hormone progesterone produced in women's bodies.

    Ulipristal acetate is another synthetic progesterone receptor modulator found in many EC pills. Emergency contraceptives containing ulipristal have been approved by the United States FDA in August 2010 and are only available in a few developed countries, including India. [2]

    The LNG-based EC pill prevents or delays ovulation by impairing luteal functions. The gonadotropin-releasing hormone (GRH) is responsible for the secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). The FSH helps the egg to grow while LH helps in its release.

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    The progesterone in the EC pills signals the hypothalamus in the brain to delay the production of GRH. This leads to no egg or delay in egg production and its release. [3]

    The LNG also thickens the mucus in the cervix to prevent the successful migration of sperm to an egg. Its effect on thinning the lining of the uterus is, however, not yet clear.

    The ulipristal acetate EC pills are considered to prevent or delay ovulation by 24-48 hours, even on the day when LH is on a peak, meaning the day on which the egg is released and a woman is more fertile.

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    A study has shown that ulipristal pills can help prevent pregnancy even in the advanced follicular phase or when the LH has already begun, the time when the LNG pill is no longer effective. [4]

    Ulipristal pills also help thin the uterus lining, delay endometrial maturation and prevent implantation by making the uterus less receptive to the blastocyst.

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When To Take An Emergency Contraceptive Pill And At What Dose?

The EC pill can be taken at a dose of 1.5 mg orally within 72 hours of unprotected sex. Some EC pills also come in a dose of 0.75 mg, followed by another 0.75 mg dose if needed after 24 hours.

There is also 3 mg oral LNG available which is mainly given to people who are on certain types of medications like rifampin and carbamazepine or on herbs like St. John's Wort as they tend to lower the efficacy of EC pills. [5]

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Experts say that both the aforementioned forms of EC pills (LGN and ulipristal) can be effective for up to five days, however, the earlier they are taken, the better is the chance of contraception.

Another option for emergency contraception includes an Intrauterine device which can be inserted up to five days after unprotected sex or as early as possible to prevent the risk of getting pregnant.

Note: If vomiting occurs within two hours of EC pill administration, patients are suggested to repeat the dose.

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Who Can Use an Emergency Contraceptive Pill?

An EC pill can be taken by any adolescent girl who have reached menarche or women of reproductive age, and have had consensual or nonconsensual unprotected sex, and need emergency contraception desirably to prevent unintended pregnancy. According to the National Health Service (UK), girls under 16 can also use it.

According to the WHO, there is no age limit or no absolute medical contraindications to using the EC pill, unless for a few cases in which they are confirmed to be pregnant or have any undiagnosed vaginal bleeding or certain medical conditions like venous thrombosis, HIV, epilepsy or tuberculosis.

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Conditions Under Which An Emergency Contraceptive Pill is Recommended

Unprotected sexual intercourse could happen consensually or nonconsensually due to multiple and complex reasons. Some of the conditions in which emergency contraceptive pill is considered to be taken include: [6]

  • Ejaculation into genitals
  • Condom breakage
  • Condom slippage or incorrect use
  • Coitus interruptus as some amount of semen is also discharged before complete ejaculation that could cause pregnancy.
  • Expulsion of IUD or removal during the middle of the intercourse.
  • Incorrect use, breakage, tearing or dislodgement of a vaginal ring or contraceptive patch.
  • Missing on two or more combinational oral contraceptive pills.
  • Missing on progesterone-only pill within 48 hours.
  • Sexual assault or reproductive coercion, when the woman is not on any form of contraceptives.
  • Delay in contraceptive injection for more than a week.
  • Delay in a contraceptive implant.
  • Rape [7]
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    Efficacy Of Emergency Contraceptive Pill

    The efficacy of an emergency contraceptive pill is usually determined based on its failure rates. According to a study, ulipristal acetate EC pills have a failure rate between 0.9 to 2.1 per cent, while the failure rate of levonorgestrel-based EC pills is between 0.6 to 3.1 per cent.

    A study comparing the effectiveness of ulipristal acetate and levonorgestrel has shown that the prior is more effective as an emergency contraceptive pill for up to five days after unprotected sex, compared to the latter. [8]

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    The efficacy of EC pills can also be reduced depending on the bodyweight of women. Though there are only a few studies that have completely specified the relationship between the two, some studies do say that efficacy of an EC pill may reduce if the body mass of women is high.

    For women with a BMI of 30 kg/m2 or higher, the failure rate of EC pills using levonorgestrel is 5.8 per cent while for ulipristal is 2.6 per cent. Also, increasing the dose is not recommended, therefore, in such cases, other methods of contraception are suggested such as copper IUD. [9]

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Side Effects Of Emergency Contraceptive Pill

Some of the common side effects of EC pill include: [10]