What are the 4 Types of Emergency Contraceptives?
Key Points on Emergency Contraceptives
- Emergency contraception (EC) is highly effective, preventing over 95% of pregnancies when taken within five days after unprotected intercourse.
- EC can be used in various scenarios, including unprotected sex, concerns about contraceptive failure, improper contraceptive use, and cases of sexual assault without contraception coverage.
- Two primary types of emergency contraception are available: copper-bearing intrauterine devices (IUDs) and emergency contraceptive pills (ECPs).
- The copper-bearing IUD is the most effective emergency contraception method.
- Recommended ECP regimens by WHO include ulipristal acetate, levonorgestrel, or combined oral contraceptives (COCs) comprising ethinyl estradiol and levonorgestrel.
Understanding Emergency Contraception
Emergency contraception is a contraceptive method used to prevent pregnancy after sexual intercourse, with optimal effectiveness when taken within five days but more successful the sooner it’s used post-intercourse.
How Emergency Contraceptives Works
Emergency contraceptive pills prevent pregnancy by delaying or preventing ovulation and do not induce abortion.
Copper-bearing IUDs prevent fertilization by altering sperm and egg interactions before fertilization. They do not affect established pregnancies or developing embryos.
Who Can Use Emergency Contraceptives?
Emergency contraceptives are suitable for any woman or girl of reproductive age and has no absolute medical contraindications.
There are no age restrictions for its use. General eligibility criteria for copper IUDs apply to their use for emergency contraception.
When to Use Emergency Contraception
EC can be employed in various situations, including:
- Unprotected intercourse.
- Cases of sexual assault without effective contraceptive protection.
- Concerns of possible contraceptive failure due to incorrect use, such as condom issues, missed contraceptive pills, or improper use of other methods.
Types of Emergency Contraceptives
There are four primary methods of emergency contraception:
- ECPs containing UPA (ulipristal acetate).
- ECPs containing LNG (levonorgestrel).
- Combined oral contraceptive pills (COCs).
- Copper-bearing intrauterine devices.
Effectiveness of Emergency Contraception
Studies show that ECPs with UPA have a pregnancy rate of 1.2%. ECPs with LNG have a pregnancy rate of 1.2% to 2.1%.
The sooner these methods are taken, the more effective they are, with UPA being particularly effective within 72-120 hours.
Common side effects of ECPs include nausea, vomiting, slight irregular vaginal bleeding, and fatigue, which are typically mild and resolve without further treatment. Vomiting within two hours requires re-dosing.
ECPs with LNG or UPA are preferred due to fewer nausea and vomiting cases. These drugs do not harm future fertility.
There are no restrictions for medical eligibility when using ECPs. However, repeated ECP use may necessitate counseling on more suitable and regular contraceptive options.
Copper-Bearing Intrauterine Devices
A copper-bearing IUD, when used as emergency contraception, should be inserted within five days of unprotected intercourse.
This method is highly effective, with over 99% effectiveness when inserted within 120 hours.
Safety and Eligibility
Copper-bearing IUDs are safe for emergency contraception, with a low risk of complications such as Pelvic Inflammatory Disease (PID).
Eligibility criteria for general copper IUD use apply for emergency purposes. It’s not suitable for women at high risk of sexually transmitted infections (STIs).
Emergency contraception is a crucial option for women and girls seeking to prevent unintended pregnancies.
Its accessibility should be integrated into family planning programs, including post-sexual assault care and humanitarian settings.
WHO continually updates its guidance based on emerging evidence, ensuring the latest information is available.
(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