Pregnancy Risk Associated With Emergency Contraception

Should long term contraception after taking emergency contraception be started?
Is there still a risk of pregnancy if unprotected intercourse occurs again after taking emergency contraception?
Can pregnancy occur after having unprotected intercourse and the man did not have an orgasm?
After using emergency contraception pill, when can regular contraceptive use be started?
Is implantation of the fertilized egg commonly associated with vaginal bleeding?
Once using the morning after pill, when is the best time to take a pregnancy test to be certain of its accuracy?
After using emergency contraceptive pills, how will it affect those that use natural contraception?
What is the risk of becoming pregnant when not using any form of contraception or barrier methods (male and female condoms, diaphragm, cervical cap, sponge) fail?
If a patient appears to have a normal menses, can they still be pregnant?
After using emergency contraception, can pregnancy still occur during the same menstrual cycle if unprotected sex occurs again?
Once emergency contraception is used, when can regular contraceptive use be started to prevent unintended or unwanted pregnancy?

Should long term contraception after taking Emergency Contraception be started?

More Frequently Asked Questions

Yes. Long term contraception after taking Emergency Contraception should be advised to all patients to start immediately. Emergency Contraception used after one episode of unprotected intercourse in a monthly menstrual cycle can reduce of incidence of pregnancy by 75 to 90% if taken in less than 72 hours. Emergency Contraception is not very effective over a one year period of time in preventing pregnancy. It is estimated that 40 percent of women who use combined estrogen and progestin birth control and 20% of women who use Plan B (levonorgestrel, Next Choice,) get pregnant within a year. Permanent methods of birth control and rate of pregnancy within a one year period of time are the following:

Birth Control Method Incidence of Pregnancy in One Year
1) Intrauterine Device (IUD) 1%
2) Birth Control Pills 3 – 4%
3) Withdrawal 12%
4) Condoms 18%
5) Rhythm Method 20%

In addition to long term birth control measures being more effective, the side effects are less compared to combined birth control pills or levonorgestrel (Plan B, Next Choice, Progestin only) that are used for emergency contraception.

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Is there still a risk of pregnancy if unprotected intercourse occurs again after taking emergency contraception? 

Yes. There still is the risk of pregnancy if unprotected intercourse occurs again after taking emergency contraception. Emergency Contraception is meant to be used one time in a menstrual cycle. Seven out of 8 pregnancies do not occur if Plan B Emergency Contraception is used in 72 hours or less after one episode of unprotected intercourse. More than one episode of unprotected intercourse increases that chance of pregnancy. This is why it is strongly suggested that abstinence, or a long standing birth control method be started immediately after using the emergency contraceptive. A long term form of birth control should be started within 12 hours of using Emergency Contraception which becomes effective after 7 days of usage.

It is also accepted to repeat the dosage of the Emergency Contraceptive being used if unprotected sex occurred again after 12 hours of using the Emergency Contraception. Using Emergency Contraceptive pills as the primary form of birth control is not very effective as 20%t of patients who use Plan B and 40% or patients who use combined oral contraceptives become pregnant within a year period of time.

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Can pregnancy occur after having unprotected intercourse and the man did not have an orgasm?

In several studies it was noted that no motile sperm were found in pre ejaculate fluid (fluid noted prior to orgasm). If sperm are not mobile, they are unable to swim in the female genital tract to fertilize the ova in the fallopian tube. These were small studies and further studies are needed to confirm these studies. There can be a very fine difference between pre-ejaculate and ejaculate fluid and therefore Emergency Contraception (morning after pills, day after pill, post coital contraception, day after contraception, Plan b) is advised for women who are not using any form of contraception. Emergency Contraception does not protect against HIV or Sexually Transmitted Disease (STD).

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After Using Emergency Contraception pills, when can regular contraceptive use be started?

The use of Emergency Contraceptive pills (morning after pills, day after pills, post coital contraception, day after contraception, Plan B) does not contraindicate the continuation of a regular method of contraception Neither Plan B (Next Choice, levonorgestrel) or combined oral contraceptive pills (birth control pills) used as Emergency Contraception provide effective contraception to cover the remainder of the patients menstrual cycle so either effective contraception or abstinence is advised. Women on birth control pills should begin taking them once again within 12 hours of taking the Emergency Contraceptive pill. Women can be started on regular birth control pills if it is certain that they are not pregnant and they either abstain or use a barrier method of birth control (female or male condoms) for a week and they should then be protected from becoming pregnant. A woman having an emergency IUD inserted who chooses to keep it in place for continuous contraception, should follow up in 3 to 6 weeks to exclude perforation, expulsion, or infection as the incidence of the latter two are highest in the first month of inserting the IUD.

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Is Implantation of the fertilized egg commonly associated with vaginal bleeding?

Early pregnancy is associated with 10 to 50% chance of vaginal bleeding and it is normally very light compared to the patient’s regular menses. Bleeding at the time of implantation appears to be rare. It seems to occur more frequently 5 days after implantation has occurred.

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Once using the morning after pill, when is the best time to take a pregnancy test to be certain of its accuracy?

The best time to do a pregnancy test after taking the morning after pill for Emergency Contraception is 10 days after having unprotected sex. Prior to 10 days, it is difficult to determine if the individual is pregnant as it can take up to 10 days for implantation to take place and the pregnancy test will not be positive until the fertilized egg is implanted into the uterine wall. Due to ovulation not taking place or delay in ovulation, 10 days may not be long enough for the pregnancy test to be positive especially if unprotected intercourse occurred again after taking the morning after pill.

The morning after pill reduces the chance of pregnancy if you have had unprotected intercourse. The earlier that they are taken after the one episode of unprotected sex, the more effective the morning after pill is at reducing an unintended or unwanted pregnancy.

If the morning after pill is taken while pregnant, it is not the abortion pill and will not cause an abortion. There is no evidence that morning after pills are toxic or cause birth defects to the fetus.

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After Using Emergency Contraceptive pills, how will it affect those that use natural contraception?

Using hormonal Emergency Contraception will affect the normal hormone pattern and alter fertility indicators. After using Emergency Contraceptive Pills, one should not rely on family planning indicators for two complete menstrual cycles which allows time for the cycle to return to normal and for natural family planning indicators to be reliable.

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What is the risk of becoming pregnant when not using any form of contraception or barrier methods (male and female condoms, diaphragm, cervical cap, sponge) fail? 

There is no time in the menstrual cycle that there is no risk of pregnancy following unprotected intercourse. This is especially true if the cycle is irregular or if there is uncertainty about the date of the last menstrual period. Only about 30% of women had their fertile period (defined as six fertile days during the menstrual cycle) within the days of the menstrual cycle identified by clinical guidelines. Timing of fertility can be highly unpredictable. The probability of pregnancy in the first 3 days of the cycle appears to be negligible. The chance of pregnancy can be anywhere from 3 to 30 percent in a cycle depending on when ovulation takes place in the cycle. The risk is highest on the days right before you ovulate reaching the maximum of 30%. After the first 3 days of the cycle, the risk rises steadily reaching 9% on day 13% of the cycle and then begins to decrease the remainder of the cycle until on day 25 the incidence of pregnancy is 1%.

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If a patient appears to have a normal menses, can they still be pregnant? 

We see patients almost on a daily basis who state that they have had normal periods and only missed one and they are found to be several months up to 38 to 39 weeks pregnant. When histories are taken carefully, it is noted that the bleeding the patient is experiencing on a monthly basis is not a normal menstrual cycle for that patient. It is rare for a woman to have a normal menses but still be pregnant. It is reported that 10 to 50% of women can have some type of bleeding that occurs at least one day early in pregnancy. The bleeding is generally lighter than their normal menses. Most bleeding occurs approximately 5 days after implantation with only one case of bleeding noted on the day of implantation out of 151 pregnancies studied.

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After taking Emergency Contraception, can pregnancy still occur during the same menstrual cycle if unprotected sex occurs again?

Emergency Contraceptive pills (morning after pills, day after pills, post coital contraception, day after contraception, Plan B) reduce the incidence of pregnancy only after one episode of unprotected intercourse. Exposure to multiple episodes of unprotected intercourse during the same menstrual cycle increases the chance of pregnancy. For each episode of unprotected intercourse, the Emergency Contraceptive Pill should be repeated if it has been more than 12 hours of taking the previous one. If patients find themselves using Emergency Contraceptive Pills frequently, a long term contraceptive method should be started as there is between a 20 to 40% chance of becoming pregnant using them over a year period of time.

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Once emergency contraception is taken, when can regular contraceptive use be started to prevent unintended or unwanted pregnancy?

Emergency Contraceptive Pills are only meant to be taken once per unprotected intercourse in a menstrual cycle. The remainder of the cycle the patient should abstain from intercourse or use condoms as the incidence of pregnancy significantly increase with each episode of unprotected intercourse. This is the reason that the Women’s Center highly suggests a long term reversible form of birth control with the first choice being the Intrauterine Device (IUD). If inserted within 5 to 7 days of having unprotected intercourse, the IUD can prevent unwanted or unintended pregnancy greater than 99%. Birth control pills should be started within 12 to 24 hours after using Emergency Contraception if it is pretty certain that the patient is not pregnant. Either the patient must abstain or use a barrier method (male or female condoms, cervical sponge) for a week after starting birth control pills.

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