Emergency contraception (EC) refers to methods of contraception that can be used to prevent pregnancy after unprotected sex. Any woman or girl of reproductive age may need emergency contraception to avoid an unwanted pregnancy at some point in their life.
This method of contraception is useful in several situations, including unprotected sex, possible contraceptive failure (such as a broken condom or forgetting to take the pill), and sexual assault. It can prevent up to over 95% of pregnancies when taken within 3 - 5 days after intercourse.
Methods of emergency contraception are the copper intrauterine device (IUD) and the emergency contraceptive pills (ECPs). The copper IUD is the most effective form of emergency contraception available.
When Can You Use Emergency Contraception?
Emergency contraception can be used in several situations following unprotected sex. These include:
- When no contraceptive has been used
- Following sexual assault (without protection)
- Concern of possible contraceptive failure, from improper or incorrect use, such as a broken condom
- You have missed 3 or more oral contraceptive pills
- You are more than 3 hours late from the usual time in taking the progestogen-only pill (minipill)
- You are more than 2 weeks late for the norethisterone enanthate (NET-EN) injection
- You are more than 4 weeks late for the Depo (DMPA) injection
- You are more than 7 days late for the combined injectable contraceptive (CIC)
- Breakage, tearing, or early removal of a diaphragm or cervical cap
- Failed withdrawal (ejaculation in the vagina or on external genitalia)
- Failure of a spermicide tablet or film to melt before sex
- Miscalculation of the abstinence period when using fertility awareness-based methods
- Intrauterine contraceptive device (IUD) that has slipped out of the vagina
What Kinds Of Emergency Contraception Are Available?
Emergency contraceptive pills prevent pregnancy by stopping or delaying ovulation. They do not cause an abortion as is commonly thought. Copper IUDs prevent fertilisation by causing a chemical change in sperm and egg before they meet, thereby making fertilisation impossible. Emergency contraception will not harm a developing embryo (baby in the womb).
Copper IUDs are the most effective emergency contraceptive available. The copper IUD (or copper coil) is a non-hormonal IUD that uses copper to prevent pregnancy. Copper affects the way sperm move which prevents sperm from reaching and fertilising an egg. The copper also thickens the cervical mucus, which makes it difficult for sperm to reach an egg. It can also prevent a fertilised egg from being able to implant itself in the uterus (womb).
Emergency pills are not intended to be used as a regular form of contraception. If you have unprotected sex at any time after taking the emergency pill, you can become pregnant. There are no serious or long-term side effects from taking the emergency contraceptive pill but it can cause headaches, stomach pain, and changes to your next period.
There are 2 types of emergency contraceptive pills, namely:
- Levonelle - contains levonorgestrel, a synthetic version of the natural hormone progesterone produced by the ovaries. It is thought to stop or delay ovulation (the release of an egg). Levonelle has to be taken within 3 days of sex to prevent pregnancy.
- ellaOne - contains ulipristal acetate, which stops progesterone from working normally. This also works by stopping or delaying the release of an egg and needs to be taken within 5 days of sex to prevent pregnancy.
Some women vomit (get sick) when they take the emergency contraceptive pills. You should get medical attention if you vomit within 2 hours of taking Levonelle or 3 hours of taking ellaOne. You may be advised to take another dose or have an IUD fitted.
Who Can Use Emergency Contraception?
You should tell a GP, nurse, or pharmacist about any medical conditions you have and what medicines you are taking. They can correctly advise you on your safest and best options for emergency contraception.
Emergency Contraceptive Pills
Most women and girls under 16 can use the emergency contraceptive pill, including women who cannot use hormonal contraception, such as the combined pill and contraceptive patch. However, you may not be able to take the emergency contraceptive pill if you:
- Have severe asthma
- Take the herbal medicine St John's Wort
- Take certain medicines used to treat epilepsy, HIV or tuberculosis (TB)
- Take antacids (medicine to make your stomach less acidic) such as omeprazole
- Take certain antibiotics such as rifampicin and rifabutin
You cannot use ellaOne if you take any one of these medicines. You can still take Levonelle but might need to increase the dose.
Copper IUDs are the most effective type of emergency contraception. After a copper IUD has been fitted it can remain in place and continue to guard against pregnancies for up to 10 years.
Certain situations and medical conditions preclude the emergency use of copper IUDs, namely:
- A woman who has been sexually assaulted should not have a copper IUD fitted as she may be at high risk of a sexually transmitted infection such as chlamydia and gonorrhoea.
- An active pelvic infection such as pelvic inflammatory disease (PID)
- Abnormalities of the uterus, including fibroids
- A copper allergy or Wilson’s disease (copper metabolism disorder)
- Unexplained vaginal bleeding
- Cervical cancer
- Severe thrombocytopenia (when the platelet count in your blood is too low)
Although repeated use of emergency contraception may not harm your health, it should not be used as a regular contraceptive. If you are not yet using contraception, or if you struggle to use your current contraceptives properly, you should consider using a more reliable way to protect yourself from unwanted pregnancies.
There are several methods of contraception that are safe, long-acting and convenient. These include the contraceptive injection (such as Depo), the contraceptive implant, and copper or hormonal intrauterine devices (IUDs). You should speak to your GP or nurse about your best options.