What Are Emergency Contraceptives?
Emergency contraceptives are methods to control unwanted pregnancy after unprotected sexual intercourse. The treatment is generally used for emergency situations such as sexual abuse, breakage of condoms during intercourse or missing out on more than two pills during the cycle of birth control pill in a month. In this article, we look at the types, effectiveness, and misconceptions of emergency contraceptives.
The oral contraceptive pills can prevent a woman from getting pregnant by delaying the ovulation temporarily. As it doesn’t contain RU-466 it cannot help in abortion and under any circumstance, it doesn’t prevent sexually transmitted diseases.
Types of Emergency Contraceptives
It is important to know the types of emergency contraceptives to be able to take the right decision and timely treatment.
There are 2 types of contraceptives which include:
- Oral contraceptives
- Intrauterine device or IUD.
There are 3 types of emergency contraceptives that can be taken over-the-counter. Women can generally get these from medical stores with or without prescription. However, there are certain emergency contraceptives that require a prescription as the dosage varies.
Emergency contraceptives are levonorgestrel hormone-containing pills that do not require any prescription. Some medicines in this category are:
- Plan B One-Step
- Take Action
- My Way
There are certain emergency contraceptives that one cannot get without a prescription and are needed to be taken more than once. They are less effective than levonorgestrel and cause nausea.
The third kind of emergency contraception pill is Ulipristal and one requires a prescription to get it from the store. They are a non-hormonal drug and affect the main hormones necessary for contraception.
How Do Emergency Contraceptives Work?
Here is how the emergency contraceptives work. The progestogen-only contraceptives retard the process of ovulation and therefore stop the fertilization procedure. The levonorgestrel works in a way that it interferes with the fertilization process. It thickens the cervical mucus and impairs the movement of the sperm or the egg. It works before the ovulation process begins and inhibits the implantation of the fertilized egg. The U.S. FDA-approved labels and European EMA-approved labels say that over usage of levonorgestrel pills may lead to endometrial changes that may further discourage implantation in the future.
The International Federation of Gynecology and Obstetrics (FIGO) published a declaration in 2011 suggesting that the LNG ECPs cannot prevent the implantation of a fertilized egg1. However, the progesterone-only contraceptives don’t increase the rate of ectopic pregnancy or affect the working fallopian tube. Different contraceptives work in different ways. The levonorgestrel helps in the prevention of pregnancy by momentarily stopping the egg from getting released or by preventing a fertilized egg from getting implanted into the uterus. It is needed to be taken as soon as possible and within 72 hours of unprotected sexual intercourse. It reduces the chances of pregnancy by 90%.
Another type of emergency contraceptive is UID that helps by stopping the implantation of the fertilized egg within 5 days of unprotected sexual intercourse. There are studies that even say that IUD is safe to use even at any time within the menstrual cycle but for clarity WHO has recommended guidelines that say it’s best to insert the IUD within a time span of 5 days of sexual intercourse. Copper-releasing intrauterine devices (IUDs) is one of the most effective ways, the copper toxicities released from it destroys the sperm and ovum. In the USA it is sold as ParaGard® T 380A Intrauterine Copper Contraceptive.
Effectiveness of Emergency Contraceptives – Who Should Avoid It?
It is important to know the effectiveness of emergency contraceptives and who should avoid it. Levonorgestrel if taken right after unprotected sexual intercourse it reduces the chances of pregnancy to a great extent. It is believed that 7 out of 8 women who take levonorgestrel right after unprotected sex face this situation. The particular contraceptive, however, loses its effectiveness if the person is obese and IUD is suggested to be used in such a case.
In terms of the effectiveness of emergency contraceptives, Ella is more effective and it also allows better protection. It has remarkably reduced the rates of pregnancy from 5.5% and 5.6% to 2.2% and 1.9% and its effectiveness didn’t reduce even after 120 hours of its usage. These medicines are available in almost all pharmacies. However, an IUD is an alternative to the contraceptive pills and can be 99% accurate in its results when inserted within a time span of 5 to 7 days. They are a copper-T intrauterine device that provides better protection than the ECPs.
Misconceptions Regarding Emergency Contraceptives
The most common myths regarding emergency contraceptives are that a woman who is using some other form of contraception does not require emergency contraceptives. Another misconception is that emergency contraceptives interfere with abortifacient. There can be situations when the condom breaks or a woman forgets to take her on-going contraception pills or the IUD is expelled. There are a number of situations that can occur even when using other methods of contraception and the woman may be in need of emergency contraception. Misconceptions of emergency contraceptives also include that women who have never given birth can never get an IUD. Also, that increase in the intake of emergency contraceptives can lead to an increase in the risk-taking nature of teens.
Such concerns must be properly discussed with the doctor rather than bearing misconceptions. People need to be more aware and educated regarding the consumption of emergency contraceptives to guide others in a better way that all are in need.
Case Study of Emergency Contraceptives
The unintended pregnancies in the USA have dropped from 51% in 2008 to 48% in 20112,3. The majority of pregnancy takes place due to non-usage or inconsistent usage of contraceptives that calls for emergency contraceptives. Ever since people have come to know about it, its usage has increased from 0.8% in 1995 to 20% from 2011 to 2018 with the women between the age group of 15-444. Ella has remarkably reduced the rates of pregnancy from 5.5% and 5.6% to 2.2% and 1.9% and didn’t lose its effectiveness even after 120 hours of its use.
There are certain barriers that abstain woman from getting emergency contraceptives such as health system barriers, gaps in knowledge, financial barriers, and practice barriers. 17 states in the District of Columbia have the facility to immediately inform the patients about emergency contraception. 13 states and D.C might provide emergency contraception on request and in Pennsylvania providers might also restrain from providing emergency contraceptives on moral grounds. Researches even show that it’s not only the person seeking help but also the providers’ lack of knowledge of emergency contraceptives. It shows that 95% of practitioners know about LNG whereas only 62% offer it and 29% are aware of Ulipristal whereas only 7% provide it.
A survey report on Georgia even says that only 3% of the people know about the extent of the possibility of success of Emergency Contraceptives. The financial barrier is the most unfortunate difficulty a person can face. Due to the lack of provision, one may not be able to protect herself from unwanted pregnancy. Another barrier that comes in the usefulness of the emergency contraceptives is the Practice Barrier. A practitioner may feel that if they let the people know about the usefulness of the emergency contraceptives then it may lead to a risk-taking nature among the teens. However, the US Medical Eligibility Criteria for Contraceptive Use, 2016 says that if the success of emergency contraceptives is more then there is no risk factor in an unwanted pregnancy.
Results and Discussion
Nevertheless, the above-discussed contraceptives must not be used by women who are already pregnant as it may result in the loss of the fetus. These contraceptives must also not be used by women having severe medical conditions and should always consult a doctor or health care practitioner before in-taking an emergency contraceptive. The consumption of the emergency contraceptives may result in nausea, vomiting, abdominal pain, headaches and also menstrual changes and these can be counted under the category of side-effects of the ECPs. Oral contraceptives are also advised not to be consumed more than four times a month.
Emergency contraceptives help in the prevention of unwanted pregnancy. However, it doesn’t help in the protection against sexually transmitted diseases or HIV which is the virus that causes AIDS. In case one wants to protect themselves from sexually transmitted diseases, then the only choice is to not engage in sexual relations with multiple partners.
- Finer LB and Zolna MR, Declines in unintended pregnancy in the United States, 2008–2011, New England Journal of Medicine, 2016, 374(9):843–852.
- Finer LB and Zolna MR, Shifts in intended and unintended pregnancies in the United States, 2001–2008, American Journal of Public Health, 2014, 104(Suppl 1): S43–S48.
- Daniels K et al., Current contraceptive use and variation by selected characteristics among women aged 15–44: the United States, 2011–2013, National Health Statistics Reports, 2015, No. 86.