Emergency Contraception

AKA: The Morning After Pills, Post-Coital Contraception

Mid-cycle intercourse can result in a ten to thirty percent chance of pregnancy if no contraception is used. Pregnancy is most likely to result from intercourse occurring on the day of ovulation and during the 3 days prior to that. Ovulation (release of the egg from the ovary) is most likely to occur 2 weeks before the next expected menstrual period. Studies have found that use of the Emergency Contraceptive Pills (ECP) during the high-risk time in the cycle; can decrease the risk of pregnancy by 75% or more. ECP does not eliminate the risk of pregnancy, ECP reduces the risk.

Reasons for considering use of ECP include:

  • failure to use a reliable method of birth control at the time of intercourse,
  • the barrier method you used failed (condom breakage, diaphragm slipped out of place),
  • sexual assault f intercourse with ejaculation is thought to have occurred,
  • missed birth control pills-either 2 or more pills in a cycle or missing a single pill at the start of the active pills (pill free interval of 8 days or more).

If you want to reduce the possibility of pregnancy. we recommend the use of Plan B (levonorgestrel) as an emergency contraceptive method. Plan B contains progesterone-levonorgestrel. The ECP appears to work by hormonally altering the lining of the uterus. Pregnancy is maybe prevented by interfering with implantation of a fertilized egg (blastocyst).

Instructions

Take 1 of the tablets as directed in your prescription within seventy-two hours of intercourse, take the second tablet twelve hours after the first dose. ECP is most effective if taken within 24 hours after intercourse.

A possible side effect is nausea, which usually subsides within the first day. Nausea is less common with Plan B. The single hormone method (Plan B) has considerably less risk of nausea and vomiting which is one of the methods main advantages. Nausea with any of the methods is usually mild, but can be a problem. Taking ECP with food will help decrease the risk of nausea. To prevent nausea with either product. there are several anti-nausea medications available. The most common side effect is drowsiness. Read the package label and do not take with alcohol.

Over the Counter Anti-Nausea Medication Options

  • Meclizine (Dramamine II) 25mg 1-2 tablets 1 hour before ECP dose, repeat if needed in 24 hours.
  • Hydramine (Benadryl) 25 mg 1-2 tablets 1 hour before ECP dose, repeat as needed every 4-6 hours.
  • Dimenhydrinate (Dramamine) 50 mg 1-2 tablets 1/2 - 1 hour before ECP dose, repeat as needed every 4-6 hours.
  • Cyclizine (Marezine) 50 mg 1 tablet 1/2 hour before ECP dose, repeat as needed every 4-6 hours.

There is some controversy regarding what to do if a woman vomits within 1-3 hours following use of ECP. Options include:

  1. take an anti-nausea medication such as Meclizine, wait a 1/2 hour and repeat the ECP dose,
  2. take the Meclizine as above and place the replacement or next dose ECP tablets deep in the vagina where they will be dissolved and absorbed thereby bypassing the stomach,
  3. do not take a replacement dose but do take Meclizine and complete the course of ECP. Some clinicians believe if there was enough medication absorbed to cause nausea and vomiting side effects. there will have been enough hormone absorbed to cause its pregnancy preventing effect.

Serious side effects occur rarely with oral contraceptives and are probably less likely with a few tablets for ECP. However, if you develop any of these symptoms go to the Health Center or St. Michael’s Emergency Department:

  • Severe headache,
  • Visual blurring or loss,
  • Severe chest pain or shortness of breath,
  • Severe abdominal pain,
  • Severe leg pain or swelling,
  • Difficulty speaking or weakness,
  • Yellowing of your skin (jaundice).

You should take ECP within 72 hours after intercourse. The failure to prevent pregnancy rate goes up if three days or more have elapsed since intercourse. Most women will get a period within 21 to 30 days after completing the ECP if it is taken soon after intercourse. If you do not get a period within thirty days after ECP, return to the Health Center. If you do become pregnant following the use of ECP as instructed, it is unlikely that the brief exposure to the medication will have any adverse effect on the embryo. ECP will not work if you have an established pregnancy. It will not cause an abortion of an implanted embryo/fetus. ECP will not prevent or treat a sexually transmitted disease.

Obtaining ECP

Note that this is sometimes called the "morning after pill." Making arrangements to obtain this method can wait until health care providers are awake and pharmacies open the next day. If it is a weekday, call the Health Center (346-4646) at 7:45 a.m. and obtain an appointment. If it is a day when the Health Center is not open, call one of the Health Center physicians.

If your situation involves a sexual assault, you are advised to be evaluated at St. Michael's Hospital Emergency Department. There are many complex issues in a sexual assault and they can help you with them. The Emergency Department will only dispense ECP in that context. The Emergency Department will not evaluate your situation or prescribe ECP over the phone.

If you have ever had a stroke, heart attack, blood clots in legs or lungs, breast cancer, diabetes, high blood pressure, or liver, kidney or heart disease - you should discuss your circumstances with a physician before taking ECP.

If you rely on a barrier method of contraception such as condoms or a diaphragm. or if you rely on withdrawal as a birth control method, studies have shown a 5 to 15% risk of pregnancy over a year of typical sexual activity. Careful use of one method, or combining two methods will reduce your risk of pregnancy. An additional option is to have either a prescription for ECP or an ECP package on hand. Talk with your clinician about this.

The ECP is not recommended as a routine contraceptive method because of the side effects and failure rate. It is an "emergency" alternative when other methods appear to have failed or unforeseen circumstances have put you at risk for pregnancy. You should have another form of contraception available if you expect to have intercourse in the future.