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Emergency Contraception

A brief overview

What is it?

Emergency Contraception (EC) is a method of contraception that reduces the risk of an unintended pregnancy following unprotected sexual intercourse (UPSI).

What types of EC are available?

The Copper Intrauterine Device (Cu IUD) also known as copper coil / non hormonal coil is the most effective method of emergency contraception

The Cu IUD is the most effective method of EC and should be considered by ALL women who have had unprotected vaginal intercourse and do not want to conceive.
It works primarily by stopping fertilisation through its toxic effect on sperm and the egg. It also adversely affects the movement and viability of sperm and the viability and transport of the egg. If fertilisation does occur, the local inflammatory reaction resulting from the presence of the Cu-IUD prevents implantation.
The Cu IUD can be inserted for EC within 5 days after the first unprotected vaginal intercourse in a cycle, OR within 5 days of the earliest estimated date of ovulation (but only if there has been only ONE episode of unprotected sexual intercourse since the first day of your last period).
It is the only method of EC that is effective after ovulation has taken place.
It also has the advantage of providing immediately effective ongoing contraception.

Ulipristal Acetate Emergency Contraception (UPA-EC)

The current brand in the UK is called ‘EllaOne’. UPA-EC acts by delaying ovulation for at least 5 days, until sperm from the episode of unprotected sex are no longer viable.
UPA-EC can be taken up to 120 hours after Unprotected Vaginal Intercourse.
You need to wait for 5 days before starting any hormonal method of contraception as the hormones may make UPA less effective at preventing a pregnancy.
UPA-EC is not effective as EC when administered after ovulation has taken place.

Levonorgestrel Emergency Contraception (LNG-EC)

There are different brands in the UK. LNG-EC acts by delaying ovulation for at least 5 days, until sperm from the episode of unprotected sex fare no longer viable.
LNG-EC can be taken up to 72 hours after Unprotected Vaginal Intercourse.
The evidence suggests that LNG-EC is ineffective if taken more than 96 hours after UPSI.
LNG-EC is not effective as EC when administered after ovulation has taken place

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Few important facts!

Emergency Contraception and Weight Evidence suggests that the effectiveness of the Cu IUD is not affected by body weight or Body Mass Index (BMI). LNG-EC appears to be less effective in those with a BMI greater than 26 kg/m2 or weight greater than 70kg. UPA-EC may be less effective in those with a BMI of greater than 30 or weight greater than 85kg.
Emergency Contraception and Illness If you vomit within 2 hours of taking your EC, a second dose will need to be given. There are other conditions that can potentially affect the absorption of the EC such as bowel and digestive problems. It is important that you speak to your local Pharmacist or Doctor if you have a medical condition and require EC.
Pregnancy and Breastfeeding There is a small risk of expulsion of the Cu IUD at the time of insertion in the period just after delivery. There is also a small risk of perforating the uterus. Fortunately, these risks are low. For these reasons, insertion of a Cu IUD should be avoided between 48 hours and 28 days after delivery. The safety of UPA-EC during breastfeeding has not been studied, therefore, breastfeeding women should be advised not to breastfeed and to express and discard milk for a week after they have taken UPA-EC. Studies with LNG-EC report no harmful or adverse effects on the infant or on breastmilk production, therefore, women can continue to breastfeed after using LNG-EC.

FAQ

Will my next period be affected?

UPA-EC and LNG-EC can cause your next period to come early, or later. If your next period is delayed by over 2 weeks, speak to your doctor as you will need a pregnancy test to exclude a pregnancy.

The Cu IUD can cause irregular bleeding which can begin soon after insertion of the device. It can cause regular periods to become heavier and more painful. It is important to speak to a doctor immediately if you experience any changes in your bleeding pattern, pain, or abnormal discharge.

What if I take other medication?

The effectiveness of UPA-EC and LNG-EC can be reduced by certain drugs. These include drugs used in the treatment of epilepsy and tuberculosis, some antifungal medications, over-the-counter St John’s Wort, stomach acid suppressants such as esomeprazole, and some anti-retroviral medication.

It is important that you speak to your local Pharmacist or Doctor if you take any prescribed or over-the-counter medication.

How effective will it be at preventing a pregnancy?

The overall pregnancy rate following insertion of the Cu IUD has been reported to be about <0.1%, so less than one in a thousand.

Studies show that the overall pregnancy rate after administration of UPA has been reported to be about 1–2%. This means that out of 100 women who take UPA-EC after UPSI, about 1–2 will become pregnant. This risk is much higher if UPA-EC is taken closer to the time of ovulation.

Studies show that the overall pregnancy rate after administration of LNG-EC has been reported to be about 0.6-2.6%. This means that out of 100 women who take LNG-EC after UPSI, less than 1 to just over 2 women will become pregnant. This risk is much higher if UPA-EC is taken closer to the time of ovulation.

……. So, remember, it’s all about the timing of intercourse relative to ovulation.

When is the best time to take EC?

The best time to take your EC or to have a Cu IUD fitted is immediately after the episode of unprotected penetrative vaginal sex.

What is the most effective method?

The Cu IUD is the most effective method of emergency contraception.