Although commonly known as the 'morning after pill' or 'plan B', there are a few types of emergency contraception available, and they may not necessarily be in the form of a pill. To learn more about emergency contraception, you may wish to read our article introducing the basics of emergency contraception.
THE PROGESTOGEN PILL (LNG-EC)
The progestogen pill, or LNG-EC, contains the progesterone hormone called levonorgestrel. There are several brands available, but they all contain the same dose of levonorgestrel and these pills works by inhibiting the release of an egg (or ovulation).
How to take the LNG-EC?
The LNG-EC can be taken as soon as possible after you have had unprotected sexual intercourse at any time during your menstrual cycle. The earlier you take the pill, the more effective it will be, and it should be taken within 72 hours (three days) of having intercourse. Since its prime mechanism of action is to prevent or delay ovulation, it is not effective if ovulation has already taken place. The LNG-EC pill comes as either 1 tablet containing 1.5 mg of levonorgestrel or 2 tablets containing 0.75 mg of the hormone. If you have been prescribed 2 tablets, the most common method is to take the 1st tablet as soon as possible and the 2nd tablet must be taken 12 hours later (sometimes women are advised to take both tablets at once). If you forget to take the 2nd tablet 12 hours later, take it as soon as you remember. If there are any concerns with regards to this, please let the doctor know and get appropriate guidance. The LNG-EC can also be used more than once in a cycle. In some circumstances, higher doses of the LNG-EC might be required. These special circumstances that may call for higher doses includes being on certain medicines or having a BMI of over 30. Hence, it is important to discuss your medical history with a doctor to ensure that you are taking the safest and most effective pill.
Effectiveness of LNG-EC
The LNG-EC is effective as an oral emergency contraceptive method. However, for better protection against an unintended pregnancy, long term and regular forms of contraception should be used. Emergency contraception, as the name suggests, should only be used in emergencies.
Furthermore, the effectiveness of this pill is gradually reduced with time after you have had intercourse. It is sometimes used between 72 and 120 hours after intercourse, but the chances of it working are much less and particularly so after 96 hours (four days).
Side effects of LNG-EC
Experiencing side effects with the use of LNG-EC are uncommon. However, some women can feel sick for about 24 hours after taking the pill. Some may also experience vomiting, which the likelihood can be reduced by taking the pill with food. If vomiting has occurred within three hours of taking the pill, you can take another pill as soon as possible (you may need to get a further prescription for it). Your doctor may advise an anti-sickness tablet as well to prevent further vomiting.
Other side effects can also occur for a short period of time and are generally mild. They include diarrhoea, dizziness and breast tenderness. There may be some changes to your period in the following month after taking the pill. Your period may be early, or late, or you may get some erratic bleeding.
Who should not take the LNG-EC?
Most women can take this pill, however there are some for whom it may not be suitable. Those with a rare condition called porphyria, severe liver disease or conditions that might affect the pill’s absorption might not be able to take the LNG-EC. There might be some who are allergic to the pill or any of its ingredients, and these patients should not take the pill. Additionally, certain medicines, including herbal remedies, may interfere with the pill and affect its effectiveness.
Thus, to ensure that you have a safe and effective method of emergency contraception, it is very important to let your doctor know about your medical history, as well as any medicines or herbal remedies that you are currently on.
When can I start or continue my regular contraception after the LNG-EC?
You can start or continue any hormonal birth control method straight away. However, extra precaution such as condoms should be used for the next 7 days alongside the regular contraception. Alternatively, you may choose to abstain from having unprotected intercourse for the next 7 days to allow the contraceptive to be effective enough to provide adequate protection against an unintended pregnancy. ULIPRISTAL ACETATE PILL (UPA-EC) This pill has different brand names but is commonly known as Ella® and it is taken as a single tablet.
How do I take UPA-EC?
Like the LNG-EC, UPA-EC should be taken as soon as possible after having unprotected intercourse at any time during the menstrual cycle. The earlier it is taken, the more effective it is. It has an advantage in that, it can be taken up to 120 hours (5 days) after having intercourse. You can take this pill with or without food. Similar to the LNG -EC, if you vomit within 3 hours of taking the UPA-EC, you should consult a doctor to get an additional dose.
Ulipristal acetate consists of 1 tablet that is taken once. It is not recommended to take the pill again during the same menstrual cycle, as its safety and effectiveness has not been studied. It is important to understand that pregnancy can still occur despite taking this pill. Therefore, it is always best to consider other precautions (such as condoms) or starting regular contraception (when appropriate) to reduce the risk of getting pregnant.
Effectiveness of UPA-EC
Just like the LNG-EC, UPA-EC is a reliable source of emergency contraception. Although, it is not as reliable as regular contraception and is recommended to only be used in emergencies. Its effectiveness also decreases the longer the delay is before taking the tablet.
Ulipristal acetate may be slightly more effective than the LNG-EC pill, particularly when taken between 3-5 days after unprotected intercourse. UPA-EC is also unlikely to be effective if taken after ovulation. Moreover, its effectiveness can be reduced if the BMI is more than 30.
Side effects of UPA-EC Most women can tolerate this pill well. Some may experience some side effects which include nausea, vomiting, headaches, abdominal discomfort, dizziness, muscle pain and fatigue. You can try to alleviate some of the side effects by taking the pill after food, having pain-relief, and resting until the effects subside. You may experience some spotting or bleeding within 2-3 days after taking the pill. Like the LNG-EC, your period may be different for the next month. It may be earlier or later than expected, or you may experience some erratic bleeding.
Who should not take UPA-EC? This pill is suitable for most women. However, there are some situations which may either make one not suitable to take the UPA-EC or additional precaution are required. If you have severe asthma or liver disease, this pill may not be suitable for you. The pill is also not suitable for those who may be allergic to any of the ingredients in the pill. If you are breast feeding, you may require special instructions. Like the LNG-EC, some medicines and herbal products may also affect the effectiveness of the pill. Hence, please discuss your medical background with a doctor before taking this emergency contraceptive.
When can I start my regular method of contraception after the UPA-EC?
If you are starting or continuing a progestogen containing contraceptive method it is recommended that you wait for 5 days. This is because the effectiveness of both methods of contraception can be reduced if they are taken close together. In the meantime, a barrier method (condom) should be use or you could abstain from having sexual intercourse for those 5 days.
Additionally, once you have started on your regular contraception, it is also advisable to continue taking extra precautions until effective contraceptive cover has been achieved or until your next period. You may discuss with your doctor how many days you may have to take extra precautions for, as this will depend on the type of regular contraceptive you are taking.
THE COPPER INTER-UTERINE DEVICE (IUD)
The copper IUD is the most effective method of emergency contraception. The copper IUD is a small T-shaped copper device, which is inserted into the uterus for up to 5 days after having unprotected sexual intercourse. It is a non-hormonal based long-term method of birth control. Other than being more effective compared to other emergency contraception, it also provides ongoing contraceptive benefit. Its main mechanism of action is to prevent fertilization of the egg and implantation of the fertilized egg.
There are a large proportion of unintended or unplanned pregnancies worldwide. Although an unplanned pregnancy does not necessarily mean it is unwanted, many do end up in terminations, which can cause emotional and physical health risks. Emergency contraception can be very effective at preventing pregnancy after unprotected sexual intercourse, but it may not always work. Regardless of which method of emergency contraception is chosen, planning and taking responsibility gives you the best chance of being in control of when and if you become pregnant. Our doctors will be very happy to discuss contraception and family planning methods that best suit you.
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References
https://www.healthhub.sg/a-z/medications/309/Levonorgestrel-prostinor-2
https://bestpractice.bmj.com/patient-leaflets/en-gb/pdf/3000186/Contraception%3A%20emergency%20contraception.pdf
https://www.healthhub.sg/a-z/medications/152/Ulipristal-Acetate-30mg
https://patient.info/sexual-health/contraception-methods/emergency-contraception
The Faculty of Sexual & Reproductive Healthcare of the Royal College of Obstetricians & Gynaecologists. (2017, Amended 2020). Emergency Contraception. Retrieved from https://www.fsrh.org/standards-and-guidance/documents/ceu-clinical-guidance-emergency-contraception-march-2017/
Bearak J, Popinchalk A, Alkema L, Sedgh G. Global, regional, and subregional trends in unintended pregnancy and its outcomes from 1990 to 2014: estimates from a Bayesian hierarchical model. The Lancet Global Health. 2018;6(4):e380-e9.
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