Emergency Contraception

What is emergency contraception and when is it used?

There are three types of emergency contraception now available to women. These are two types of pill, and the intrauterine contraceptive device (IUCD) - also called 'the coil'. These will be discussed in turn. Emergency contraception can be used:

• If you have had sex without using contraception.
• If you have had sex, but there was a mistake with contraception. For example, a split condom or if you forgot to take your usual contraceptive pills.

The progestogen pill

This is a pill that contains levonorgestrel which is a progestogen hormone. The brand name is Levonelle®. You can get it free on prescription or you can buy it from pharmacies without a prescription. The usual dose is one pill which contains 1.5 mg of levonorgestrel. (Some women need a higher dose if they are taking certain other medication. For example, women taking certain anti-epilepsy medicines.)

When do I take it and how does it work?

Take the pill as soon as possible after unprotected sex. The earlier you take the pill, the more effective it is. It is thought to work either by preventing or delaying ovulation (the release of an egg each month) or by preventing the fertilised egg from implanting (settling) in the uterus (womb). It is not thought to cause an embryo that is already implanted into the womb to 'abort'.

How effective is the progestogen pill?

Although emergency contraception is effective, it is not as reliable as regular planned contraception. Therefore, it should only be used in emergencies. The progestogen pill becomes gradually less effective the more time elapses after having unprotected sex. However, there is a good chance of preventing pregnancy if it is taken up to 72 hours after unprotected sex. If this pill is taken within 24 hours after unprotected sex, about 95 in 100 pregnancies are prevented. If it is taken between 25-48 hours after unprotected sex then about 85 in 100 pregnancies are prevented. If it is taken between 49 and 72 hours after unprotected sex, then about 58 in 100 pregnancies are prevented. It is sometimes used between 72 and 120 hours after unprotected sex but the chance of it working is much less than if it is taken within 72 hours.

Are there any side-effects with the progestogen pill?

Side-effects with the emergency progestogen pill are uncommon. However, some women feel sick for about 24 hours after taking the pill and a few vomit. This may be less likely to happen if you take the pill with food.

If you vomit within three hours of taking the pill then:

• Take another pill as soon as possible. (You may need to get a further prescription, or buy another pill from the pharmacy. You may also wish to get a prescription for some anti-sickness tablets.) OR
• An intrauterine contraceptive device (IUCD) can be inserted (see below).

Other mild side-effects occur in some women for a short time, such as abdominal pain, headache, tiredness, dizziness and breast tenderness.

Who should not take the emergency progestogen pill?

Most women are able to take the progestogen emergency contraceptive pill. For example, women with a rare condition called porphyria should not take it. If you were to be pregnant, there is no evidence to show that taking the emergency progestogen pill is harmful.

Ulipristal pill

Ulipristal acetate (also called ellaOne®) is a type of emergency contraceptive pill that was launched in the UK in 2009. It is taken as one single tablet.

When do I take it and how does it work?

Take the pill as soon as possible after unprotected sex. The earlier you take the pill, the more effective it is. It can be taken up to 120 hours (five days) after having unprotected sex. It is a type of hormone which seems to work by stopping or delaying ovulation (release of an egg). It may also have an effect on the lining of the uterus (endometrium).

How effective is the ulipristal?

Although emergency contraception is effective, it is not as reliable as regular planned contraception. Therefore, it should only be used in emergencies. It becomes gradually less effective the more time that elapses after having unprotected sex.

One recent study looked at over 800 women who had received ulipristal. Ulipristal prevented over 98 out of 100 pregnancies. This study showed that ulipristal is actually more effective than the progestogen emergency pill.

Who should not take ulipristal?

Ulipristal can not be taken if there is any possibility that you might be pregnant. It also cannot be taken if you have certain liver diseases or have severe asthma. Ulipristal can also interfere with certain medications, including rifampicin, phenytoin, and carbamazepine. Your doctor will be able to give you more information about this.

It is currently only licensed if you are aged 18 or over.

Are there any side-effects of ulipristal?

Side-effects with the ulipristal pill are uncommon. These can include headaches, feeling sick, abdominal pains and irregular vaginal bleeding.

If you vomit within three hours of taking ulipristal then you will need to take another tablet. You will need to get another prescription for this.

Some reasons why the emergency contraception pills are less likely to be successful

• If you take the progestogen pill more than 72 hours or the ulipristal pill more than 120 hours after unprotected sex.
• If you vomit within three hours of taking the pill and do not take a repeat dose.
• If you had unprotected sex at another earlier time.
• If you have unprotected sex again after taking emergency contraception.

The intrauterine contraceptive device (coil)

An alternative method of emergency contraception is to have an intrauterine contraceptive device (IUCD) inserted by a doctor or nurse. This can be done up to five days after unprotected sex. It has the advantage of providing ongoing contraception and is also more effective than taking hormone tablets (it is almost 100% effective). See separate leaflet called 'Intrauterine Contraceptive Device (The Coil)' for details.

Some other points about emergency contraception

• Most women have their next period at about the usual time. Sometimes it is a few days earlier or later than expected. See a doctor or nurse if your next period is more than seven days late or if it is lighter than usual. A pregnancy test may then be advised.
• Your next menstrual cycle may also be shorter or longer than usual.
• There is still a small risk of pregnancy even if you use an emergency contraceptive correctly.

Follow-up after receiving emergency contraception

You may want to discuss your regular contraceptive needs with a doctor or nurse. This may be best in a relaxed follow-up consultation.

An important message

See a doctor urgently if you have any lower abdominal pain or abnormal vaginal bleeding over the next 2-6 weeks. These are the main symptoms of an ectopic pregnancy. This is rare, but it is best to be aware of the possibility as it is a serious condition. Also, see a doctor if your next period is more than seven days late or if you have any other concerns.

Further information

Your GP, practice nurse and pharmacist are good sources of information if you have any queries.

The fpa (formerly the family planning association) also provide information and advice.
fpa's Helpline: 0845 310 1334 or visit their website www.fpa.org.uk

References

• Contraception - emergency, Clinical Knowledge Summaries (2007)
• Emergency contraception, Faculty of Family Planning and Reproductive Health Care RCOG (2006)
• Glasier AF, Cameron ST, Fine PM, et al; Ulipristal acetate versus levonorgestrel for emergency contraception: a Lancet. 2010 Jan 28. [abstract]
• Fine P, Mathe H, Ginde S, et al; Ulipristal acetate taken 48-120 hours after intercourse for emergency Obstet Gynecol. 2010 Feb;115(2 Pt 1):257-63. [abstract]
• Faculty of Sexual and Reproductive Healthcare, Ulipristal Acetate - New Product Review, October 2009