Safety of Emergency Contraception

How safe is emergency contraception?
Is there a limit to the number of times emergency contraceptive pills can be used?
Can emergency contraception be used in people who have contraindications to using birth control pills on a daily basis?
Are emergency contraceptive pills safe to use when breastfeeding?
Do emergency contraceptive pills increase risk of an ectopic pregnancy (that’s when the pregnancy is outside the uterus)?
Does the Intrauterine Device (IUD) increase the risk of ectopic pregnancies?
Can emergency contraceptive pills cause birth defects?
Can the Intrauterine Device cause birth defects when used as an emergency contraceptive?

How safe is emergency contraception?

More Frequently Asked Questions

The safety of Emergency Contraception (morning after pill, day after pill, post coital contraception, day after contraception) has been evaluated since the early when hormones were first used to decrease the incidence of unwanted pregnancies after unprotected intercourse. No deaths have been reported or linked with the use of emergency contraceptive pills and there is no incidence where the risks outweigh the benefits of preventing an unintended pregnancy. Medical experts agree that taking progestin only Emergency Contraceptive pills (levonorgestrel or Plan B, or Next choice), or combined estrogen and progestin birth control pills used for Emergency Contraception, do not carry the same risks associated with taking oral contraceptives on a daily basis. Patients at high risk for stroke, blood clots, pulmonary emboli, cardiovascular problems, or heart disease are not candidates for long term use of oral contraceptives. There are no contraindications with using Emergency Contraceptive pills.

If a Physician or other health care provider wants a patient to avoid taking estrogen altogether, then progestin only pills (levonorgestrel, Plan B, or Next Choice), or the Copper T IUD are able to be used. The Copper T IUD should be offered to all patients as the first method of Emergency Contraception not only because it is safe, but due to it having the lowest incidence of pregnancy if inserted within 5 days of unprotected intercourse (over 99%).
The side effects that are associated with the use of Emergency Contraceptive pills are nausea (50% in use with combined oral contraceptives and 14% in patients who use progestin only tablets), vomiting (20 % in patients who use combined oral contraceptives, 1 to 6% in patients that use progestin-only tablets [levonorgestrel, Plan B, Next Choice] ). If patients vomit within 2 hours of taking the emergency contraceptive pills, it is recommended that the dose should be repeated. Meclizine (Dramamine) 2 twenty-five milligram tablets taken an hour before taking the Emergency Contraceptive Pills, reduce the incidence of nausea by 27% and vomiting by 64%. Drowsiness is a common side effect after taking meclizine. For those rare patients that vomiting is continuous, IUD insertion should be strongly advised. Headaches, fatigue, dizziness, breast tenderness, abdominal pain, ankle swelling, early or delayed menses can occur as well. Intermenstrual bleeding occurs in approximately 15% of patients. The following menstrual period occurs early or late. Progestin-only pills (plan b, next choice, levonorgstrel) have less side effects and are more effective than combined contraceptive pills at reducing the incidence of pregnancy (89% vs 75%) when taken within 72 hours of unprotected intercourse.

There is a small but higher incidence of pelvic infection that can occur during the first 20 days after insertion of the IUD. After that time, the incidence of pelvic infection goes down to the incidence in the general population. Stronger cramps and heavier menstrual bleeding can occur for the first several months after insertion of the copper IUD. The incidence of complete expulsion of the IUD is higher in the first few months after insertion. Rare complications include rupture of the uterus, migration of the IUD into the uterine wall.

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Is there a limit to the number of times emergency contraceptive pills can be used?

There is no limit to the number of times that Emergency Contraceptive Pills (morning after pill, day after pill, post coital contraception, or day after pills) can be used. Even in the same cycle Plan B (Next Choice, levonorgestrel) can be used more than once. Emergency Contraceptives should be taken again if unprotected intercourse happens after 12 hours of taking the Emergency Contraceptive pill. There are no contraindications in using Emergency Contraceptive Pills. Emergency Contraceptive pills are not as effective as using long term contraceptive methods (i.e., birth control pills, hormone injection, Intrauterine Device, condoms, diaphragm, or cervical cap to name a few. The side effects of taking Emergency Contraceptive Pills are much higher than using daily contraceptive methods as well which include nausea, vomiting, headaches, breast tenderness, leg swelling, abdominal pain, bloating, dizziness, fatigue and intermenstrual bleeding. They are not as effective as using a birth control method before or during sex, like the pill or condoms. Combined birth control pills used for Emergency Contraception is 75% effective and Plan B (Next Choice, levonorgestrel) is 89% effective in reducing the incidence of unwanted pregnancies. Birth control pills are over 99% effective in pregnancy prevention.

Emergency Contraception should not be used as a primary means of birth control as 40 percent of patients using combined birth control pills and 20 percent of patients using Plan B as their primary form of birth control will become pregnant within a year. (condom and withdrawal methods have higher rates of success over a one year period of time in preventing pregnancy).

The Copper T Intrauterine Device (IUD) should be offered as first choice for Emergency Contraception due to not only is it the most effective method of preventing a unwanted pregnancy (over 99%) if inserted within 5 days of having unprotected intercourse, but can be used for reversible contraception that is effective and approved for up to 12 years.

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Can emergency contraception be used in people who have contraindications to using birth control pills on a daily basis?

There are no contraindications to using Emergency Contraceptive Pills (morning after pill, day after pill, post coital contraception, day after contraception, Plan B). When used as emergency contraception, the estrogen and progesterone do not carry the same risks as taking birth control on a daily basis. There are no long term risks or side effects when using Emergency Contraceptive Pills though short term minor side effects can occur for 1 or 2 days after taking them which include nausea, vomiting, headache, breast tenderness, abdominal pain, low back pain, cramps, intermenstrual spotting and bleeding, ankle swelling, dizziness, and fatigue.

If your Physician or other health care provider refuses to give combined oral contraceptives due to health risks and wants the individual to avoid estrogen exposure, then levornorgestrel (Plan B or Next Choice) or the Copper T IUD are available for usage. The IUD should be offered as the first choice for Emergency Contraception because of being highly safe and the most effective method in prevention of an unwanted pregnancy (over 99%). It can also be used as a continuous form of birth control for up to 12 years.

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Are emergency contraceptive pills safe to use when breastfeeding?

The use of Emergency Contraceptive Pills (morning after pills, day after pills, post coital contraception, day after contraception, Plan B) once will probably not affect either the quantity or quality of the milk as the taking of regular combined birth control pills do. Progestin-only birth control pills or Depo-Provera shots have been used in women breastfeeding for many decades. There are hormones that may be passed on through breast milk there are no observations or studies that show harm or contraindicate their use when breastfeeding children.

Regular breastfeeding without additional food or drink supplementation is a very effective contraceptive method on its own. The first 6 months to a year of breastfeeding and no menses is generally associated with no ovulation occurring which in turn means the patient is not able to get pregnant. One cannot 100% rely on this method of preventing pregnancy even if not having menstrual cycles. Patients are at higher risk of becoming pregnant if they are feeding their child food or infant formula, the infant is more than 6 months to a year old, or menses is occurring.

There is no contraindication to using the Copper T Intrauterine Device (IUD) in patients who are Breastfeeding. The IUD is the most common form of reversible contraception used worldwide. It is very safe and highly effective method of preventing pregnancy. The use as an Emergency Contraceptive where it is placed up to 120 hours after unprotected intercourse is over 99% effective in preventing an unwanted pregnancy.

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Do emergency contraceptive pills increase risk of an ectopic pregnancy (that’s when the pregnancy is outside the uterus)?

There are no studies or other evidence that show emergency contraceptive pills (morning after pill, day after pills, post coital contraception, or Plan b) increase the risk of having an ectopic pregnancy. The data shows the incidence of ectopic pregnancies actually decrease with the use of Emergency Contraception due to the reduction in the total number of pregnancies that occur. Combined data from several clinical trials involving nearly 6000 women showed the actual rate of ectopic pregnancies in women who had used Plan B to be 1.02%, which is slightly lower than overall national ectopic pregnancy rates (1.24%-1.97%). This does not show that Plan B prevents normal movement of the fertilized ova through the fallopian tube.

Ectopic pregnancies do occur after women use emergency contraceptive pills. Symptoms of ectopic pregnancy include abdominal pain and vaginal bleeding. These can be seen after taking emergency contraceptive pills so it is important that patients are able to be evaluated rather quickly if there is concern.

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Does the Intrauterine Device (IUD) increase the risk of ectopic pregnancies?

Ectopic pregnancies are increased in women with previous ectopic pregnancies, previous history of Pelvic Inflammatory Disease, previous history of Sexually Transmitted Disease (STD), previous abdominal surgery, or cigarette smoking.

Several studies show that the IUD does not increase the incidence of ectopic pregnancy but actually lowers it. Ectopic pregnancies occur in IUD users in less than 1 percent of cases. The national average of ectopic pregnancies is 1.24% to 1.97%. If pregnancies do occur the incidence of ectopic pregnancy can be as high as 3 to 4%. If pregnancy does occur, the IUD should be removed because of the increased incidence of infection, miscarriage, or premature delivery. IUDs are not associated with birth defects. IUDs do not protect against Sexually Transmitted Diseases (STD) or Pelvic Inflammatory Disease (PID).

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Can emergency contraceptive pills cause birth defects?

Birth Control Pills have been used for over 40 years and there has never been any evidence that progestin only or combined birth control pills cause any type of birth defect. These observations were made over many years when women continued to take their birth control pills and found to be pregnant for weeks to months. Emergency contraceptive pills (morning after pills, day after pill, post coital contraception, day after contraception, Plan B) have never been associated with or caused birth defects.

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Can the Intrauterine Device cause birth defects when used as an emergency contraceptive?

There are no studies or evidence indicating Intrauterine Devices (IUDs) are associated with birth defects when used as Emergency Contraception or long term as a reversible and highly effective contraceptive. The chance of pregnancy for women using the IUD for emergency contraception when inserted within 5 days of unprotected intercourse is less than 1%. When used as a contraceptive method over the long term, the incidence of pregnancy is 3 to 8 per 1000 women become pregnant in the first year which then decreases to 1 to 2 per 1000 women who become pregnant after the second year of continuous usage. The reason for the higher incidence of pregnancy the first year is probably due to expulsion of the IUD which has a higher occurrence in younger women and women who have never been pregnant or had children. Women who have painful menses or have abnormally large menstrual flows have a higher incidence of expelling their IUDs. Expulsion rates vary from 1 to 7 per 100 in the first year of usage. Most expulsions occur in the first year and particularly in the first 3 months after insertion which is the reason that all patients need to be evaluated 3 to 6 weeks after insertion of the IUD.

There is approximately a 40 to 50% incidence of spontaneous miscarriages in women who become pregnant with an IUD in place. There was a higher incidence of septic abortion with the Dalkon Shield IUD which was only on the market in the U.S. from 1970 to 1974. The IUD is associated with a higher incident of premature deliveries.

Whenever an IUD is noted to be in place in the presence of an intrauterine pregnancy, it should be removed immediately to prevent the complications described above.

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