Emergency Contraception. All You Need To Know
Emergency contraception (EC) can be remarkably effective, preventing over 95% of pregnancies when taken within 5 days after intercourse.
This valuable form of contraception can be employed in various situations, such as unprotected intercourse, concerns about contraceptive failure, incorrect contraceptive use, or even following sexual assault when no contraception coverage is present.
The two primary methods of emergency contraception include copper-bearing intrauterine devices (IUDs) and emergency contraceptive pills (ECPs).
Notably, the copper-bearing IUD is considered the most effective form of emergency contraception available.
Understanding Emergency Contraception
Emergency contraception, often referred to as the “morning-after pill,” is a method of contraception designed to prevent pregnancy after sexual intercourse.
While its effectiveness is maximized when taken within 5 days, it is crucial to note that the sooner it is administered following intercourse, the more effective it becomes.
How Emergency Contraception Works
Emergency contraceptive pills operate by averting or delaying ovulation, and they do not terminate a pregnancy.
On the other hand, the copper-bearing IUD prevents fertilization by inducing changes in sperm and eggs before they can unite.
Importantly, EC does not interfere with established pregnancies or pose any harm to developing embryos.
Who Can Benefit from Emergency Contraception?
Emergency contraception is suitable for any woman or girl of reproductive age who wishes to prevent an unintended pregnancy.
There are no medical contraindications, and age is not a limiting factor.
The eligibility criteria for general use of a copper IUD also apply to its use for emergency purposes.
Situations Warranting Emergency Contraception
EC is a valuable option in several scenarios, including:
- When no contraception was used.
- In cases of sexual assault when effective contraception was absent.
- Concerns about possible contraceptive failure, stemming from improper or incorrect use, such as condom breakage, missed oral contraceptive pills, or diaphragm issues.
- Instances of withdrawal failure, spermicide inefficacy, or miscalculation of fertility awareness methods.
- Expulsion of intrauterine contraceptive devices (IUDs) or hormonal implants.
Ensuring Timely Availability
Providing an advance supply of emergency contraceptive pills to women ensures that they have immediate access following unprotected intercourse, thereby enhancing the effectiveness of this contraception method.
Transitioning to Regular Contraception
Following the use of emergency contraceptive pills, women can comfortably transition to or initiate a regular contraception method.
For instance, after using emergency contraceptive pills with levonorgestrel (LNG) or combined oral contraceptive pills (COCs), women may resume their contraceptive regimen immediately or consider a copper-bearing IUD.
Different Methods of Emergency Contraception
The four primary methods of emergency contraception include:
- ECPs containing ulipristal acetate (UPA)
- ECPs containing levonorgestrel (LNG)
- Combined oral contraceptive pills (COCs)
- Copper-bearing intrauterine devices (IUDs)
Effectiveness and Safety
Research indicates that ECPs with UPA or LNG have a pregnancy rate of 1.2%, while COCs have a slightly higher rate ranging from 1.2% to 2.1%.
Ideally, these methods should be taken as soon as possible within 120 hours of unprotected intercourse, with UPA demonstrating increased effectiveness between 72 and 120 hours.
Side effects from emergency contraceptive pill use are generally mild and similar to those of regular oral contraceptives, including nausea, vomiting, slight irregular vaginal bleeding, and fatigue.
Importantly, these side effects are typically manageable and subside without additional treatment.
Medical Eligibility and Additional Guidance
Emergency contraception is typically suitable for most women, with no strict medical restrictions.
However, it is advisable to counsel women who frequently rely on emergency contraception to explore more consistent and effective contraception options. Additionally, while obese women may experience slightly reduced effectiveness with ECPs, there are no safety concerns.
Copper-Bearing Intrauterine Devices
The copper-bearing IUD emerges as the most potent form of emergency contraception when inserted within 5 days of unprotected intercourse, boasting over 99% effectiveness in preventing pregnancy.
This method is especially suitable for women seeking a highly effective, long-term, and reversible contraceptive option.
- Effective Hormone Free Family Planning Methods with Less Side Effects
- Natural Family Planning: A Comprehensive Guide to Fertility Awareness
Safety and Medical Eligibility for Copper IUDs
Copper-bearing IUDs are generally safe and have minimal risks of complications. Medical eligibility criteria for their general use also apply to their emergency contraceptive use.
However, they should not be inserted following sexual assault due to the potential risk of sexually transmitted infections.
Expanding Access to Emergency Contraception
The World Health Organization (WHO) emphasizes the importance of integrating emergency contraception into family planning programs and ensuring access for all women and girls at risk of unintended pregnancy.
It also underscores the need to incorporate emergency contraception into post-sexual assault care and services for those in emergency and humanitarian settings.
Ongoing Commitment to Research and Guidance
The WHO remains committed to continually reviewing emerging evidence and updating its guidance accordingly through its Continuous Identification of Research Evidence (CIRE) system.
This commitment ensures that women have access to the most up-to-date and effective methods of emergency contraception.
(1) Can we identify women at risk of pregnancy despite using emergency contraception? Data from randomized trials of ulipristal acetate and levonorgestrel.
Glasier A, Cameron ST, Blithe D, Scherrer B, Mathe H, Levy D, et al. Contraception. 2011 Oct;84(4):363-7. doi: 10.1016/j.contraception.2011.02.009. Epub 2011 Apr 2.
(2) Effect of BMI and body weight on pregnancy rates with LNG as emergency contraception: analysis of four WHO HRP studies.
Festin MP, Peregoudov A, Seuc A, Kiarie J, Temmerman M. Contraception. 2017 Jan;95(1):50-54. doi: 10.1016/j.contraception.2016.08.001. Epub 2016 Aug 12.
(3) Family planning: a global handbook for providers 2011 Update
Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs and World Health Organization