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What is Emergency Contraception?
Emergency contraceptives are methods of preventing pregnancy after
unprotected sexual intercourse. They do not protect against sexually transmitted
infections. Emergency contraception can be used when a condom breaks, after a
sexual assault, or any time unprotected sexual intercourse occurs. Do not use
emergency contraceptives as your only protection against pregnancy if you are
sexually active or planning to be, because they are not as effective as any
ongoing contraceptive method.
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Why is Emergency Contraception Important?
Each year, millions of women have unprotected intercourse and are left, in
the days that follow, with the fear of pregnancy and the feeling that nothing
can be done. Emergency contraception gives these women a practical option to
avoid pregnancy. Using one of the emergency contraceptive measures could reduce
a woman's risk of pregnancy by at least 89%.
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How long after unprotected sex can emergency contraceptive pills be taken?
Most clinical protocols and the instructions for Plan B state that the
treatment schedule is one dose within 72 hours after unprotected intercourse,
and a second dose 12 hours after the first dose. However, several recent
studies have found that the pills are effective when the first dose is started
up to 5 days (120 hours) after unprotected intercourse.
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When Should My Next Period Come after I Take Emergency Contraceptive Pills?
Your next period should come more or less on time. Several studies have
found that about half of women find that their next period starts within + 3
days of the anticipated onset, but that it is much more common for the next
period to come early than to be delayed. After taking ECPs, some women have
their period early, and some women have irregular bleeding that is not really
their period. The duration of the irregular bleeding is not predictable. You
should have another, normal period within the next month. If not, you might
consider getting a pregnancy test just to make sure you're not pregnant.
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What if I bleed after taking ECPs?
Some women do get unusual bleeding after using emergency contraceptive
pills because of the hormones in the pills. If that's the cause, it's not
dangerous, and it will probably go away by itself after you get your next
period. It's also possible that your unusual bleeding could be due to some
other cause, however, that could (rarely) be more serious. If you have other
symptoms like abdominal pain or dizziness, or if the problem lasts longer
than a few days or gets worse, or if you're just worried, you should call
your doctor.
Your next period should come about when you would have expected it, or
within a week earlier or later. If it doesn't come by a week after you expected
it, you might consider getting a pregnancy test.
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What are the side effects of ECPs?
Almost all women can safely use ECPs. The only absolute contraindication
to use of ECPs is confirmed pregnancy, simply because ECPs will not work if a
woman is pregnant. There are no long term or serious side effects from using ECPs.
About 50% of women who take combined ECPs experience nausea and 20% vomit. If
vomiting occurs within 1 hour after taking a dose, some clinicians recommend
repeating that dose. The non-prescription anti-nausea medicine meclizine reduces
the risk of nausea by 27% and vomiting by 64% when two 25 mg tablets are taken 1
hour before combined ECPs, but the risk of drowsiness is doubled (to about 30%).
The risk of nausea and vomiting with progestin-only ECPs is far lower than the
risk with combined ECPs: 23% experience nausea and 6% vomit.
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Why is Emergency Contraception Unknown?
There are two primary reasons why women do not know about emergency
contraception. The first is that clinicians do not routinely counsel women
about emergency contraception during regular visits. The second is that companies
that make pills (and the single IUD) than can be used for emergency contraception
have not actively promoted emergency contraception to the public.
Both the contraceptives approved by the FDA for emergency contraception and
those used for ordinary birth control can legally be used for emergency contraception.
Any clinician authorized to provide prescriptions may prescribe an approved drug for
an unlabeled purpose; the most common example is prescribing oral contraceptives to
regulate menstrual periods, or to reduce menstrual cramps. The FDA has explicitly
declared ECPs to be safe and effective. If widely used, emergency contraceptives could
substantially reduce unintended pregnancy and the need for induced abortion.
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Can I use ECPs if I am breastfeeding?
A woman who is exclusively breastfeeding and who has not had a menstrual period
since delivery is unlikely to be ovulatory and therefore may not need ECPs. However,
a woman who is providing supplemental feeding to her infant or who has had menses since
delivery may be at risk for pregnancy. A single treatment with ECPs is unlikely to have
an important effect on milk quantity or quality. Some hormones may pass into the breast
milk, but they are unlikely to affect the infant adversely.
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Is there a limit to the number of times emergency contraceptive pills can be used?
There are no safety concerns with using ECPs repeatedly. However, ECPs are not so
effective as any ongoing method of contraception. Repeated use of ECPs suggests that
you need to find an ongoing method of contraception that you can use correctly and
consistently.
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