Birth Control: Contraceptive Measures after Unprotected Sex

  • Medical Author:
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Introduction to birth control

If a woman is sexually active and she is fertile and physically able to become pregnant, she needs to ask herself, "Do I want to become pregnant now?" If her answer is "No," she must use some method of birth control (contraception).

Terminology used to describe birth control methods includes:

Regardless of the terminology used, sexually active people can choose from a variety of methods to reduce the possibility of their becoming pregnant. No method of birth control available today offers perfect protection against sexually transmitted diseases or STDs, except abstinence.

In simple terms, all methods of birth control are based on either preventing a man's sperm from reaching and entering a woman's egg (fertilization) or preventing the fertilized egg from implanting in the woman's uterus (her womb) and starting to grow. New methods of birth control are being developed and tested all the time. What is appropriate for a couple at one point may change with time and circumstances.

Unfortunately, no birth control method, except abstinence, is considered to be 100% effective.

Emergency contraception definition

Emergency contraception is a medication or device that is used to prevent conception after unprotected intercourse has already occurred. It is not intended for use as a primary method of contraception and is most appropriate as a back-up method. Between 2006 and 2010, about 1 in 9 women of reproductive age in the US report having used emergency contraception. Emergency contraception can involve the administration of hormones or the insertion of an intrauterine device (IUD).

What is emergency hormonal contraception (morning after pill)?

Emergency hormonal contraception is sometimes called "the morning after pill" or "postcoital contraception," although these are not the preferred terms, and actually can be misleading. It is actually a short course of the hormones found in oral contraceptives taken at a high dose. The exact regimen (the number of pills and the number of days) depends on the type of oral contraceptive used.

How does the morning after pill work?

Depending upon the time during the menstrual cycle that the emergency contraceptives are taken, these may prevent pregnancy by blocking the implantation of the fertilized egg in the uterus, by inhibiting ovulation, or by interfering with fertilization of the egg.

  • To be considered a possible candidate for emergency contraceptive pills a woman should take the medication within 72 hours of unprotected intercourse, although there is some evidence that they may be effective in the 5 days following intercourse.
  • Because the pills may be taken up to 72 hours later, the term "morning-after pill" is misleading.
  • However, the pills are most effective when taken as soon as possible after unprotected intercourse.
  • The only known contraindication to emergency contraception is pregnancy, so a woman must not be pregnant when these methods are used.
  • Emergency hormonal contraception may be taken on any day of the menstrual cycle.

What are the side effects of the morning after pill?

  • There are no serious side effects, but the pills may cause nausea and vomiting in some women.
  • These side effects may be controlled by taking an anti-nausea drug such as dimenhydrinate (Dramamine).
  • Frequently a doctor will give a prescription nausea medication, such as prochlorperazine (Compazine), at the same time as the emergency contraceptive pill.
  • A woman may also experience breast tenderness and a temporary disruption of her menstrual cycle.

Who can purchase the morning after pill?

  • One type of emergency hormonal contraception is available without a prescription in the US for people aged 17 or older (proof of ID is required for purchase).
  • It is also available for younger teens with parental permission.

What tests or exams are necessary before you can use the morning after pill?

Neither a physical examination nor any laboratory tests are required prior to use of the emergency hormonal contraception. It can be taken at any time during the menstrual cycle, and the next menstrual period typically occurs within one week of the expected time. The timing of the subsequent menses is, to some extent, dependent upon the time in the cycle at which the emergency contraceptive was taken.

What is the dosage, and what types of the morning after pill are available?

The most common type of emergency hormonal contraception involves the administration of the progesterone hormone levonorgestrel in two doses (marketed as Plan B in the U.S.).

Another formulation for emergency hormonal contraception uses estrogen along with levonorgestrel, but levonorgestrel-only medication may be more effective and causes less nausea compared to estrogen-containing products.

Clinical trials using low doses of mifepristone (known earlier as RU-486, sometimes called "the abortion pill") have shown that this agent is extremely effective as an emergency contraceptive when taken prior to ovulation, but it has not been approved for this use in the US. Mifepristone (Mifeprex) has been approved, in much higher doses, for terminating a pregnancy of less than 49 days' duration and must be taken under a physician's supervision.

Another type of anti-progestin medication that is similar to mifepristone in its structure and actions is known as ulipristal acetate. Ulipristal acetate (Ella) is marketed for emergency contraception in Europe and was approved by the US FDA in August 2010 for use in the US for emergency contraception up to 120 hours after intercourse. It is available by prescription only.

How effective is the morning after pill?

Although effectiveness of the oral contraceptives are dependent to some extent upon how soon after unprotected intercourse they are taken, efficacy studies have generally reported pregnancy rates of 0.2% to 3% with use of oral emergency contraception.

Does the morning after pill protect against STDS?

Emergency contraceptive pills do not protect women from sexually transmitted diseases (STDs).

Can the morning after pill be used as a primary form of birth control?

Emergency hormonal contraception or the morning after pill is not meant to be a primary birth control method. Once the emergency is over, a woman should receive proper counseling so that she can select an effective and appropriate contraceptive method to use on a regular basis if she continues to be sexually active.

What is emergency IUD?

Like the high dose of oral hormonal contraceptive, an IUD blocks the implantation of the fertilized egg in the uterine wall. Emergency IUD insertion can also be used to prevent a pregnancy after unprotected sex.

  • Copper IUD insertion is the most effective method of emergency contraception.
  • If the copper IUD (Paragard) is inserted within 5 days after unprotected sex, it is 99% effective in preventing pregnancy.
  • The copper IUD has the lowest failure rate of all emergency contraception options.

What are the complications or contraindications with emergency IUD?

  • Emergency IUD insertion does slightly increase the risk of pelvic inflammatory disease (PID).
  • Contraindications to the use of the emergency IUD include:
    • known or suspected pregnancy,
    • active pelvic infection,
    • copper allergy, and
    • certain anatomical abnormalities of the uterus.

Can emergency IUD be used as birth control?

An added advantage of emergency contraceptive use of an IUD compared to pills is that once the IUD is in place, it will provide the woman with a long-term contraceptive method if she chooses.

REFERENCE:

Medscape. Emergency Contraception.

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Reviewed on 2/18/2015
References
REFERENCE:

Medscape. Emergency Contraception.

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