Emergency contraception 08

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Quentin, Morgane; Nabila, Subhan

Emergency Contraception (EC) is a general term for any contraceptive measure used after unprotected sexual relations, in order to prevent fertilization and thus pregnancy.
There are two types of measures:

  • Emergency Contraception Pill (ECP): oral way
  • Intrauterine Device (IUD): placed in the uterus

The pills release hormones that will prevent pregnancy, whereas the IUD is made of copper which has a spermicide effect. However, hormonal IUDs also exist. IUDs are considered most of the time as a normal contraception method but can be used as EC. ECs are considered as contraceptive and not as abortive measures.


When is EC used?

EC is used in a short lap of time (in a period of 72 hours) after unprotected sexual relations, if the condom breaks or in case of a too important oblivion of the pill, to prevent fertilization. ECPs have to be taken as quickly as possible in order to have the most chances of succes.
Conforming to the family planning's statistics, the efficience of the pill is:

  • 95%if taken in the 24 hours after the sexual relation
  • 85% in the 48 hours
  • 78% in the 72 hours
    ECs should be used only in case of unprotected sexual contact and not as a regular mean of contraception: they are not as efficient as condoms or preventive pills which are used before or during a sexual contact.

Moreover, it does not prevent sexually transmitted infections such as HIV. Only condoms do.


What are the different EC methods and how do they work?

There are two main EC methods: Emergency Contraception Pills or an Intrauterine Device.

Emergency Contraception Pill (ECP)

ECP or "morning-after pill" contain the same hormones (estrogen, progestin) as the preventive Contraception Pill, though at higher doses which will suspend the menstrual cycle and prevent pregnancy. NB: the name "morning after" is figurative. The fact that the ECP is not taken the morning after intercourse is not crucial since sperm can travel up to five days in the female genital track and fertilize the ovum at that moment.

  • Progestin-only pills: contain only progestin. They are known under different names depending of the country (Plan B, NorLevo, Prostinor-2,...). Progestin prevents the sperm from reaching the egg and keeps a fertilized egg from attaching to the wall of the uterus (implantation).
  • Combined pills: contain both progestin and estrogen. Aslo known as Yupze regimen, they are said to be less efficient and to provoke more severe secondary effects than progestin-only pills. They contain the same doses as other preventive Contraception Pills. Estrogen stops the ovaries from releasing eggs (ovulation) that can be fertilized by sperm.
  • Mifepristone (RU-486): is a steroid having anti-progesterone effects. It is contained in abortive pills (Mifegyne), however, taken at lower doses has a contraceptive effect.

Two of the most commonly used ECPs are Preven and Plan B.

What is Plan B?

Plan B are two white pills that sould be taken one after the other; the first one within 72 hours after the sexual intercourse, and the second one 12 hours later. But recently, a research revealed that one can take both pills at the same time within 120 hours after the unprotected sex. And as the sooner the pills are taken, the best it works, one should take both pills as soon as possible after the sexual contact.

Details about Plan B

Plan B only contains the progestin levonorgestrel and has not the same effects as RU-486, which is an abortion pill. Thus, Plan B should not be taken by an already pregnant woman. Nevertheless, if the pregnant woman takes Plan B, it won't cause birth defects.

Plan B can reduce the probability of pregnancy up to 89 %, and is more effective than Emergency Contraceptive Pills which contain both estrogen and progestin. However, it should not be taken as a regular contraceptive mean, because it is not as effective as usual contraceptive methods.

Medical experts confirm that Plan B is safe for almost every woman, but it may provoque nausea, fatigue, abdominal pain, headache, menstrual changes, dizziness, brest tenderness, vomiting and diarrhea. It causes however less vomiting and diarrhea than emergency Contraceptive Pills which contain both estrogen and progestin.

Plan B does not protect against sexually transmitted infections, including HIV.

Advantages of ECPs

The "morning-after pill" is not 100 per cent effective, but the failure rate is quite low. It is about only 5 per cent if it is taken quickly, so it is quite efficient.

the ECP prevents an unwanted pregnancy before the embryo formation and so the eventual need of an abortion, it is now widely used by women who have had unprotected sexual relationship. In particular, it has proved of value to:

  • rape victims, who should insist they are given it
  • couples who have a condom break during sex
  • women who have been lured into having sex while they were under the influence of drink or drugs.

Disadvantages

The use of the ECP can cause at the woman some side effects such as nausea, abdominal pain, tire, dizziness,headaches, menstrual changes, or throwing up, if this happens within the 3 hours after taking the pill you have to take a new one(but only about 1 woman in every 60 actually throws up). Usually these side effects disapear after 48 hours, except the menstrual changes. And after taking the pill you feel like just before your menstruations (pre-menstrual symdrom) but in even worse...
Another disadvantage is that the ECP doesn't protect against sexually transmitted diseases such as the HIV for exemples, only comdoms do, and it is less efficient than the pill or the comdom.

How to get it?

In Switzerland, since already a few years, people can buy the emergency pill at two places. However, some conditions need to be respected.
At the pharmacy: you have to be at least 16 years old and it costs 25-.
At the family planning: at any age, you just have to fill a questionnary, without having to give your name or your phone number if you don't want to, it is confidential. It costs here only 10- but if you don't have enough money they give it to you anyway. Eventhough the pill is really efficient if it is taken within the 72 hours after the sexual relationship, the gave it up to 5 days, if it can prevent an unwanted pregnancy.


EC pill: an example: NorLevo

In Switzerland, before 2002, a pill called Tetragynon, that contained progesteron and estrogen, was distributed. It consisted into four pills which had to be taken by two at an interval of 12 hours. It had important side effects, as throwing up.
Now there is a pill called NorLevo, which contains only a derivative of estrogen (levonogestel), and consists into one single pill, with very few and light side effects.

Copper-T Intrauterine Device

The Copper-T is an intrauterine device (IUD) that some women use for regular birth control, but you can also go to see a doctor or other trained clinician, so they can insert it up to five days after an unprotected sexual relationship to prevent pregnancy.It can be installed up to the 19th day of a woman's menstrual cycle, and kept up to 5 years. The IUD which can be used as an emergency contraceptive method is the GYNEFIX. It is an original model, with no core grid, made of a simple string on which cylindrical covers (offering 300mm2 of copper) are attached. It can easily adapt to any kind of uterus (either small, or irregularly shaped). When it is used as an emergency contraceptive mean,it is put in a different way from the other IUD; it is fixed by a knot that is "stung" in the far end of the uterine.

Advantages

As emergency contraception, the Copper-T IUD is much more efficient than the other types of emergency contraceptive pill (or “morning after pill”) because it reduces the risk of getting pregnant by more than 99%. Another advantage to the Copper-T IUD is that you can keep it in place to prevent pregnancy for up to 5 years.

Disadvantages

An IUD might not be the best birth control for you if you could be at risk of sexually transmitted infections (STDs). If you aren’t absolutely sure you and your partner are both STD free – or if one of you might have sex with someone else – that increases your chances of being exposed to common STDs like chlamydia or gonorrhea (and these STDs often show no symptoms, therefor, getting tested may be the only way to know if you’ve been infected). Being forced to have sex can also expose you to STDs. In rare cases, these STDs can cause a pelvic infection at the time the IUD is inserted or soon afterwards. Untreated pelvic infection can make you infertile ( which means unable to have a baby). For more information: IUD

Ethical problems

With emergency contraceptions, some women have been confronted to some ethical problems: actually EC has been put more than once as the same level as abortion. But it has been made clear that morning-after pills aren't the same as mifepristone (Mifeprex), the so-called abortion pill. Emergency contraceptive pills such as Plan B prevent pregnancy. The abortion pill terminates an established pregnancy — one in which the fertilized egg has attached to the uterine wall and has already begun to develop.
For further information, see Contraception Ethics


References

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