What you need to know about Emergency Contraception

Why would I need it? Accidents happen! You need it to prevent pregnancy if you have unprotected intercourse. . But how likely are you to become pregnant anyway? Without intervention the average woman’s chance of becoming pregnant after one act of sexual intercourse is 8%. If you forget 2 or more pills in the first or last week of your pill pack or you forget your patch or ring or the condom breaks then it’s roulette time. What can I use? There are two main types of emergency contraception – the emergency contraceptive pill and the copper intrauterine device. The copper intrauterine device is the safest and most effective method of emergency contraception. Its failure rate is < 1 in 1000. There are 2 types of emergency contraceptive pill – levonorgestrel and ulipristal acetate. Levonorgestrel reduces the likelihood of pregnancy to 4 per 1000 if taken within 24 hours of intercourse. The rate of pregnancy rises to 2.7% when treatment begins 48 to 72 hours later. In more simple terms the copper intrauterine device lowers your chance of becoming pregnant by more than 99.9% if you put it in within 5 days of unprotected sex. Ulipritsal acetate lowers your change of getting pregnant by 85% if you take it within 5 days after unprotected sex. Levonorgestrel can lower your chance of becoming pregnant by 75 to 89% if taken within 3 days of unprotected sex. How does it work? The copper intrauterine device stimulates the production of fluid in a woman’s reproductive tract that kills sperm. It is a T shaped device that contains a copper wire that prevents sperm from fertilizing an egg. It can be inserted within 5 days of unprotected sex and can be removed by a doctor after the next period or used for ongoing contraception. The great news it that it lasts 10 years as a contraceptive device. The emergency contraceptive pills both delay ovulation. Ovulation is the release of eggs from the ovary before eggs are fertilized. The most important thing to note is that if you have already ovulated it is too late for these pills to work. You must know the length of your menstrual cycle and the latest date you have ovulated must be calculated. Your doctor will help you to figure this out. What should I use? Without a doubt the copper intrauterine device is the best option. However it can be difficult to get a health care provider who will fit it at short notice. It is not suitable if you have an allergy to copper or if you have Wilsons disease. Rarely problems with the womb or cervix mean that it cannot be fitted. More good news is it that |it will not react with other medications you are taking and it is not affected by your weight. It is safe to use while breastfeeding. Most women can use the emergency contraceptive pill and it is easy to access. Levonorgestrel may be ineffective if your BMI is >26 or your weight is >70Kg. Both levonorgestrel and ulipristal may interact with medications such as St. Johns’ wort, medicines use to treat epilepsy, HIV or TB, omeprazole or other medications which reduce acid secretion in the stomach and the rarely used antibiotics rifampicin and rifabutin. Levonelle is safe while breast feeding but the safety of ulipristal during breast feeding is not yet known. After I use emergency contraception what do I do? It s really important that if you take ulipristal that you do not start back on hormonal contraception for 5 days. Yes you read that correctly! Do not start back for 5 days. This is because ulipristal stops progesterone working properly and all forms of hormonal contraception contain a form of progesterone. Therefore if you start back on your pill straight away it makes your pill null and void! After 5 days when you do start back on your regular hormonal contraception you must use additional contraception for 7 days ( 9 days for the pill Qlaira and 2 days if you are using the progesterone only pill) If you take levonorgestrel then take your next dose of your usual contraception within 12 hours of taking the emergency pill and you must use additional contraception for 7 days etc as stated above. Emergency Contraception is no doubt complicated and unfortunately it is incorrectly used a lot of the time. My best advice is go to talk to a doctor who can help you make the best decision for your life.