Emergency Contraception

Symptoms

DEFINITION

• Seeking information about emergency contraception (morning after pill) after unprotected sexual intercourse
• Female patient
• Not pregnant

General

• Emergency contraception is very effective in preventing pregnancy after unprotected sexual intercourse.
• There are two types of emergency contraception: Emergency contraceptive pills ("Morning After Pills"; ECP) and intrauterine devices (IUD).

What are some situations in which emergency contraception might be considered?

• Not using any birth control method (unprotected sexual intercourse)
• Condom broke or slipped off penis
• Diaphragm or cervical cap was taken out too early
• Failed coitus interruptus (ejaculated inside vagina or onto female external genitals)
• Spermicide was used alone during second or third week of menstrual cycle
• Missed more than 2 oral contraceptive pills or started pill pack more than 2 days late
• Delay in getting scheduled contraceptive injection
• Sexual assault (not on oral contraceptive pill; no IUD)

Emergency Contraceptive Pills (ECPs)

• Emergency contraceptive pills (ECPs) are medications that prevent pregnancy after sexual intercourse. They are also called "morning after pills", "morning after contraception", or "day after pills".
• ECPs can be taken right away after sexual intercourse or up 120 hours (5 days) after sexual intercourse.
• Emergency contraceptive pills are less effective than ongoing contraception in preventing pregnancy.
• Emergency contraceptive pills do not prevent sexually transmitted diseases.
• Effectiveness: Emergency contraceptive pills are 95 per cent effective at preventing unintended pregnancy if taken within 24 hours of unprotected intercourse and 85 per cent effective if taken within 72 hours. The sooner the emergency contraception pills are taken, the more effective they are.
• Indications: To prevent unwanted pregnancy after forcedintercourse (sexual assault), failure of regular birth control (e.g., broken condom), or forgetting to use contraception.
• Cost: The typical cost of ECP is $20-30.

Where can I get emergency contraceptive pills?

• Your doctor
• Local public health clinic
• Local Planned Parenthood office
• Local pharmacy (available over-the-counter)

Do I need a prescription for emergency contraceptive pills?

• Australia: Emergency contraceptive pills became available over-the-counter in 2004.
• Canada: On April 19, 2005 the Canadian Ministry of Health approved the sale of Plan B (levonorgestrel) without prescription in pharmacies in Canada.
• United States: On August 24, 2006, Plan B (levonorgestrel) was approved by the FDA for nonprescription sale in pharmacies to women and men 18 and older in the United States. On April 22, 2009, Plan B was approved by the FDA for nonprescription sale in pharmacies to women 17 and older.

Intrauterine Device (IUD)

• IUDs are very effective in preventing pregnancy after unprotected sexual intercourse. An IUD can reduce the pregnancy rate by 99%. To prevent pregnancy, the IUD must be inserted by a doctor into the uterus within 5 days of unprotected intercourse.
• Advantages: It can prevent pregnancy for up to 5-10 years. Low risk of side effects (see below).
• Disadvantages: It is important to remember that an IUD does not protect against sexually transmitted infections (STIs).
• Side Effects: Some women experience mild cramps or back pain the first couple hours after the IUD is inserted into the uterus. Some women may have some mild cramping and bleeding for a week or two after insertion. Women may experience heavier menstrual periods after getting an IUD (especially a copper IUD).
• Cost: The typical cost of getting an IUD is $600 (US).

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See More Appropriate Topic (instead of this one) If

• How to PREVENT a sexually transmitted infection
• MENSTRUAL PERIOD, MISSED OR LATE
• VAGINAL BLEEDING, ABNORMAL

Should I Call?

WHEN TO CALL YOUR DOCTOR

Care at Home

HOME CARE ADVICE FOR EMERGENCY CONTRACEPTION

Emergency Contraceptive Pills (ECPs)

1. General Information on Emergency Contraceptive Pills (ECP):
   • Emergency contraceptive pills are just for emergencies.
   • Emergency contraceptive pills are less effective than ongoing contraception in preventing pregnancy.
   • Emergency contraceptive pills do not prevent sexually transmitted diseases.
2. How effective are ECPs? The following are some example statistics for women having unprotected intercourse in second or third week of their menstrual cycle:
   • No ECP treatment - 8 out of 100 women will get pregnant
   • ECP Treatment 72-120 hours after intercourse - 3-4 out of 100 women will get pregnant
   • ECP Treatment within 72 hours after intercourse - 1-2 out of 100 women will get pregnant.
3. Do ECP's have any side effects? Yes they do
   • Nausea - 30-60 % of women
   • Vomiting - 5-20 %
   • Abdominal pain - 10-20%
   • Fatigue and headache - 10-20%
   • Change in menstrual bleeding onset or amount - 50%
4. Do I need a prescription for ECP's? No, you do not need a prescription.
   • Australia: Emergency contraceptive pills became available over-the-counter in 2004.
   • Availability in Canada. On April 19, 2005 the Canadian Ministry of Health approved the sale of Plan B (levonorgestrel) without prescription in pharmacies in Canada.
   • Availability in the United States. In 2006 Plan B (levonorgestrel) was approved by the FDA for nonprescription sale in pharmacies to women and men 18 and older in the United States. Subsequently, on April 22, 2009, Plan B was approved by the FDA for nonprescription sale in pharmacies to women 17 and older. It is only available by prescription to women under 17 years of age.
5. Emergency Contraception Hotline - United States
   • Managed by the Association or Reproductive Health Professionals
   • Hotline provides information.
   • Hotline provides phone numbers of ECP providers.
   • Tollfree phone number: 800-584-9911
   • Their website has a lot of information on ECP: http://ec.princeton.edu/providers/index.html
6. Important Internet Resources on Emergency Contraception
   • The Emergency Contraception Website: http://ec.princeton.edu. This is a very useful website with answers to many FAQS. This website also lists physicians and clinics in the U.S. and Canada that provide emergency contraceptive pills.
   • Canadian Paediatric Society Adolescent Health Committee position statement: http://www.cps.ca/english/statements/AM/ah03-01.htm
   • International Consortium for Emergency Contraception: http://www.cecinfo.org/
7. Call Your Doctor If:
   • You have any questions.

Pregnancy Test

1. Home Urine Pregnancy Tests
   • Home urine pregnancy tests are inexpensive, accurate, and easy to use. Most drug stores sell these tests over-the-counter.
   • Urine pregnancy tests can often diagnose pregnancy during the week after the first missed period (2 weeks after ovulation).
   • Use of a first-morning urine specimen is recommended because the urine HCG concentration is highest in the morning.
   • When a home pregnancy test is negative, but there is still a high suspicion of pregnancy, you should either repeat the test in 3-5 days or go to your doctor's office for testing.
   • The urine pregnancy test can sometimes be falsely negative if the urine specimen has lots of blood in it. A small amount of blood (e.g., blood-tinged urine) should not interfere with the accuracy of the test.
   • More information is available at: http://www.4woman.gov/faq/pregtest.htm.
2. Pregnancy test, when in doubt:
   • If there is any possibility of pregnancy, obtain and use a urine pregnancy test from the local drug store.
   • Follow the instructions included in the package.
3. Call Your Doctor If:
   • Pregnancy test is positive or if you have difficulties with the home pregnancy test
   • You become worse

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.