In order to work, emergency contraception must be used soon after unprotected sex occurs. How soon after depends on a number of factors, including whether the pregnancy has implanted, the health of the woman and whether she may already be pregnant.
Emergency contraceptives in pill form are popularly known as the “morning-after” pill. They go by such brand names as Next Choice One Dose, Ella and Plan B One-Step and can be used up to five days after unprotected sex. However, manufacturers caution that the medications have a better chance of working if taken sooner rather than later.
The vast majority of the market uses Plan B One-Step, which has as much as 99 percent of the market share. Plan B was approved in 1999 and is available in generics Next Choice and Levonorgestrel tablets. Ella was approved in 2010. It is estimated that about 12 million packages are sold annually, according to research by the IMS Health and SymphonyIRI Group, both market research firms.
Morning-after pills contain either levonorgestrel or ulipristal acetate. Plan B One-Step is available over-the-counter without a prescription, but ulipristal may have a prescription for purchase.
The pills operate depending on where the woman is in her menstrual cycle. They can either prevent or delay ovulation, block fertilization or stop a fertilized egg from implanting in the uterus. The last function is debated among medical professionals, and there is some evidence that levonorgestrel doesn’t stop the fertilized egg from implanting. Whether Ella has the same limitation isn’t clear.
Morning-after pills are not the same as the so-called “abortion pill,” known as mifepristone (commercially, Mifeprex) or RU-486. That drug will terminate pregnancy when the fertilized egg has attached to the uterine wall and has begun growing.
The morning-after pill is not fool-proof and may not prevent pregnancy, which is why it is not recommended for routine contraceptive use. Even if used correctly, it can fail, and it offers no protection against sexually transmitted diseases.
Doctors recommend that patients not take the morning-after pill if they are allergic to any of its components; if taking St. John’s wort, barbiturates or other medications that may interfere with its efficacy; or if already pregnant. Those who are overweight may not be as susceptible to the pill’s effects on the body as it is for normal-weight women.
Ulipristal use requires that a woman is not pregnant or breastfeeding because it can affect the unborn fetus in ways that aren’t entirely clear. Taking levonorgestrel if already pregnant will have no effect.
Side Effects of Emergency Contraception
The morning-after pill has effects beyond pregnancy. Ingesting it can cause vomiting or nausea, fatigue, breast tenderness, headache, bleeding between periods or heavier than usual menstrual flow, and abdominal cramps or pain.
If vomiting commences within two hours of taking the morning-after pill, it may be necessary to consult a doctor. The medical professional will advise whether another dose is necessary to achieve protection.
Keep in mind that the morning-after pill is good only for the preceding incident of unprotected sex. Consequently, it will not provide protection for unprotected sex after taking the pill. Users of the pill should resume regular birth control methods. The pill may delay a period by up to a week. If it does not resume after that, take a pregnancy test.
Any bleeding or spotting issues after using the morning-after pill that lasts more than a week or severe abdominal pain that develops within three to five weeks after taking the pill should be checked by a medical professional. Symptoms could be a sign of a miscarriage or ectopic pregnancy, the latter a pregnancy where fertilized eggs implant outside the uterus in a fallopian tube or other location. That condition is potentially life-threatening.
Pill-Free: The Copper IUD
The copper IUD option for the morning after is sold under the brand name ParaGard. It must be used within five days after unprotected sex.
ParaGard is inserted into the uterus and provides long-term birth control beyond the period after unprotected sex. It is a T-shaped plastic frame that has copper wire on its stem and two copper sleeves that continuously bathe the lining of the uterus in copper, which creates an inflammatory reaction that is toxic to sperm. This helps prevent fertilization and will prevent implantation on the uterine wall.
ParaGard can prevent pregnancy up to 10 years after insertion but can be removed at any time. It can be used while breastfeeding and decreases the odds of endometrial cancer and potentially cervical cancer. It also has fewer side effects than hormonal birth control.
Some women should not use ParaGard. Those who have uterine abnormalities that interfere with retention of the device or its placement are not good candidates, as are those who have existing pelvic infections, including pelvic inflammatory disease.
Others who have uterine or cervical cancer; vaginal bleeding with no readily apparent cause; allergies to plastic, copper or any other aspect of ParaGard; Wilson’s disease, which causes copper to accumulate in the body; previous problems with an IUD; and those who are at high risk of a sexually transmitted infection are not good candidates.
While highly effective, ParaGard is also not foolproof. Less than 1 percent of ParaGard users will get pregnant in the first year of use and are at higher risk of an ectopic pregnancy. ParaGard also does not protect against sexually transmitted diseases.
Side effects of ParaGard insertion include backache, anemia, cramps, bleeding between periods, pain during sex, inflammation of the vaginal area, vaginal discharge, severe menstrual pain and heavy bleeding.
There is also a risk that a woman may expel the ParaGard device from the uterus, particularly if the woman has never been pregnant, has prolonged or heavy periods, severe menstrual pain, previously lost an IUD, is younger than age 20, or had the device inserted immediately after childbirth or a second-trimester abortion. Women may not even feel the expulsion.
Doctors will evaluate ParaGard candidates before implantation. They will often request a pregnancy test and other lab work before doing the procedure. The ParaGard is inserted after cleansing the vaginal and cervix area with an antiseptic solution and will insert it using an applicator tube. The patient may experience fainting, dizziness, nausea, low blood pressure and a slower-than-normal heart rate during the procedure.
One major disadvantage ParaGard has compared with morning-after pills is its accessibility. Many healthcare providers are not trained to insert it, and getting an appointment with the right practitioner can exceed the five days after unprotected sex.
Only you and your doctor can agree on the best form of emergency contraception, should you need it. So when a potential disaster strikes, talk to a healthcare provider.