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Emergency Contraception (EC)

Emergency contraceptive pills are readily available at Brady Health Center.

Call for an appointment within 72 - 120 hours of the unprotected sex. Although recommended to be given within 72 hours published literature indicates that EC (emergency contraception) is effective even up to 5 days post incident. The sooner it is given, the better. There is a fee for the Emergency Contraceptive Pill.


When is Emergency Contraception Appropriate?

No contraceptive method is 100 percent effective, and few couples can use their method perfectly every time they have intercourse. Emergency contraception provides an important safety net when:

  • A condom breaks
  • No contraceptive is used.
  • A woman misses 2 or more contraceptive pills in a row or starts a new pack 2 or more days late.
  • A diaphragm or cervical cap slips out of place.
  • A woman is more than 2 weeks late for a contraceptive injection.
  • Intercourse occurs unexpectedly and without contraceptive protection.
  • A woman is raped.

Emergency Contraception is not a substitute for regular contraceptive use. It is less effective than regular contraception (used correctly) and provides no protection from HIV or sexually transmitted infections (STI's). However, in emergency situations, it can play an important role as a back up for other methods. It is second-chance contraception.


What is my risk of pregnancy from unprotected intercourse?

The risk of pregnancy is virtually 0 during the first three days of the cycle (day 1 of the cycle is the first day of bleeding). The risk begins to rise steadily thereafter, reaching 9% on about day 13, begins to decline slowly thereafter to about 1% on day 25, and remains at about 1% as late as day 40 and beyond. (Average cycle length is 29 days, but it is normal to have cycles that last anywhere from 20 days or less to 40 days or more.) However, it is important to note that these figures are averages and that the risk for an individual woman may be higher or lower. The important point is that almost any act of unprotected intercourse entails some risk of pregnancy and that EC can reduce this risk substantially.


How long after unprotected sex can emergency contraceptive pills be taken?

Although EC is often called the "morning after pill," you can actually use any type of EC pill for up to 5 days (120 hours) after unprotected sex and still significantly decrease the chance of pregnancy. However, EC should be taken as soon after unprotected intercourse as is practical.

In the US, there are two different types of EC pills---Ulipristal Acetate (ella) and progestin-only EC (Plan B One-Step, Next Choice One Dose, Next Choice and Levonogestrel Tablets).

Ella is a prescription only product.  It is more effective than progestin-only EC products particularly on the 4th or 5th day after sex.  It is more likely to work when taken closer to ovulation (release of the egg) than the progestin-only EC.  ella is approved for 5 days after unprotected intercourse with no decrease in effectiveness.

Plan B One-Step and Next Choice One Dose are just one pill that you take as soon as possible after sex.  The instructions for Next Choice and Levonogestrel Tablets (which contain 2 pills) say to take the first dose within 72 hours after sex and the second dose 12 hours later (however studies show you can take both pills at the same time).  Studies also show that progestin-only EC can be taken up to 5 days after sex, with a decline in effectiveness on the 4th or 5th day.

So if you are using progestin-only EC, it is more effective the sooner you take it after sex.  If you are using ella, you can take it up to 5 days after unprotected sex with no decline in effectiveness

Brady Health does keep Plan B One-Step in stock.  An appointment is needed for administration.  Also a prescription for ella can be obtained with an appointment with one of the nurse practitioners.

 

How effective is emergency contraception?

On average, if 100 women have unprotected intercourse once during the second or third week of their cycle, 8 will become pregnant. Labeling for Plan B One-Step, Next Choice One Dose, Next Choice and Levonogestrel Tablets state that the treatment prevents 7 of the 8 pregnancies that would otherwise have occurred.  Also if  you take the progestin-only EC within the first 24 hours after sex, they reduce the risk of pregnancy by up to 95%.

The risk of pregnancy taking ella within 24 hours after sex is about 65% lower than the risk after taking the progestin-only EC; if taken within 72 hours after sex, the risk is 42% lower.  While effectives of the progestin-only EC declines with delay in treatment, the effectiveness of ella does not

While all the types of EC pills are safe and effective, they are not as good at preventing pregnancy as ongoing birth control.


What are the side effects of ECP?

Almost all women can safely use ECP. The only absolute contraindication to use of ECP is confirmed pregnancy, simply because ECP will not work if a woman is pregnant. There are no long term or serious side effects from using ECP. Side effects of ECP may include nausea, vomiting, fatigue, headache, dizziness, and breast tenderness.  Some women experience unexpected bleeding.  Emergency contraception may cause your period to come early or late.

 

How does Emergency Contraception work?

Emergency contraceptive pills prevent pregnancy primarily or perhaps exclusively by delaying or inhibiting ovulation (release of the egg).  There is no evidence that either of the FDA-approved EC options (levonogestrel or ulipristal acetate) works after an egg is fertilized.  EC will not cause an abortion.  There is no time when the EC pills available in the US would end a pregnancy once it has started.  EC pills don't have any effect if you are already pregnant.

Further information on EC is available at The Emergency Contraception Website or call Brady Health and ask to speak to one of the RNs or Nurse Practitioners.