Emergency Contraception

What is emergency contraception?
What is Plan B emergency contraceptive?
What is the Day After Pill?
Is there any pill approved for FDA emergency contraception?
Is it safe to use emergency contraception as birth control?
Is there a free emergency contraceptive?
When is emergency contraception sometimes called the Morning After Pill?

What is emergency contraception?

Emergency Contraception (EC) provides women with a safe means of preventing pregnancy following unprotected intercourse or failure of the contraceptive method used. The use of alternative terms that mean the same as Emergency Contraception include “morning after pill, morning after contraception, or day after pill, post-coital contraception and Plan B. The problem is that Emergency Contraception does not just come in a pill form and the alternative terms can be confusing. The most effective time to use Emergency Contraceptive Pills (ECPs) is less than 24 hours after unprotected intercourse has occurred. Emergency Contraception can be used immediately or up to five days after unprotected intercourse if you were forced to have sex, you did not use contraception, or the birth control failed.

Emergency Contraception does not prevent pregnancy 100% of the time though it makes it much less likely that pregnancy will occur. The use of Emergency Contraception is not as effective as using birth control pills or condoms. Emergency Contraception is not meant to be used as a primary form of birth control as 40% of patients who use combined birth control pills and 20% of patients who use levonorgestrel will become pregnant within a year of using these two methods as their primary means of birth control.

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The most frequently used methods of Emergency Contraception worldwide are the following:

A. Emergency Contraceptive Pills (ECPs) or “morning after pill”, or “day after pill”, or “post-coital contraception pill” or “morning after contraception” include:

1. Levonorgestrel (Plan B, or Next Choice). It contains the hormone progestin and is the only medication approved specifically for emergency contraception in the United States. Levonorgestrel taken in less than 24 hours after unprotected intercourse is about 95% effective. If taken between 48 to 72 hours it is 84% effective, and greater than 72 and less than 120 hours it is 50 to 63% effective. No studies have been done if greater than 120 hours after intercourse.

2. Several different types of combined estrogen and progestin birth control pills. Combined birth control pills have been used for Emergency contraception, morning after pill, day after pill since 1974. There are over 20 different combined birth control pills that can be used in the US to prevent unwanted pregnancy. The side effects are higher than taking the levonorgestrel (Plan B), and it reduces the incidence, in essence, the chance of pregnancy is reduced from reduced to 2 out of 8 chances in becoming pregnant versus only 1 in 8 becoming pregnant with the use of levonorgestrel.

3. RU486 (mifepristone or Mifeprex) is used in China in small doses for emergency contraception and has been found to be more effective than levonorgestrel in preventing pregnancy. RU486 is not currently used in the U.S. for EC.

4. Ella (Ulipristal Acetate or Ellaone) was approved in the US in 2010 and in Europe in 2009 as an Emergency Contraceptive for up to 5 days after unprotected intercourse. In a recent study, there were no pregnancies that occurred between 72 and 120 hours after unprotected intercourse whereas there were 3 patients who got pregnant in the levonorgestrel group. For patients between 24 and 48 hours after intercourse, the same study showed the incidence of pregnancy was half that of the levonorgestrel group.

5. Non-Steroidal Anti-inflammatories (NSAID) medications. Particularly Cyclooxygenase COX-2 blockers (Meloxicam, Indocin) prevent ovulation from taking place even after the LH Surge has occurred. Levonorgestrel nor Combined estrogen and progesterone tablets are able to prevent ovulation after the LH Surge has occurred. Thus, there is the potential that COX-2 blockers are more effective in preventing pregnancy than levonorgestrel. Not only are prostaglandins important for ovulation, but they are crucial for egg fertilization, implantation, and decidualization (development of stromal tissue and glands in the endometrium that are important for the pregnancy to grow)

6. Histamine Blockers H2 (Ranitadine). Histamine is known to be important in the implantation process of the embryo. If this process is blocked by a histamine blocker such as Ranitadine which is used to treat ulcers and gastritis, implantation of fertilized egg can also be prevented. H2 blockers are not currently used in the U.S. for EC.

B. Copper T Intrauterine Device (IUD).
The Copper T IUD when inserted into the intrauterine cavity within 5 days of unprotected intercourse is greater than 99% effective in preventing pregnancy. It is also a permanent form of contraception that is now approved for 12 continuous years of use.

None of the forms of Emergency Contraception mentioned above protect against being exposed or getting a Sexually Transmitted Disease (STD) including HIV as only condoms are able to do.

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What is Plan B Emergency Contraceptive?

Plan B Emergency Contraceptive is a progestin-only pill composed of levonorgestrel in a dose of 1.5 milligrams. It was first approved by the FDA in 1999 where it was taken as .75 mg 12 hours apart. It was later found to be just as effective with no difference in side effects or efficiency when taken as a single pill which improves patient compliance. Progestin is one of two hormones found in birth control pills that prevents ovulation (release of eggs from ovary) and causes cervical mucus thickening (prevent sperm migration) and thinning of the lining of the uterus (endometrium). Plan B provides women with a safe means of preventing pregnancy following unprotected sexual intercourse or potential contraceptive failure (i.e. condom breakage or slippage, forgot to take several birth control pills, removed barrier methods untimely, displacement of barrier methods, dislodgement of Intrauterine Device) Alternative terms such as “the day after pill”, “morning after pill”, “post coital contraception”, and “day after contraception” can be confusing to the general population. Especially when Emergency Contraception comes in many forms of combined contraceptive pills (estrogen and progesterone), copper bearing Intrauterine Device (IUD), or levonorgestrel (progestin-only, Plan B, Next Choice).

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What is the Day After Pill?

The Day After Pill is the same as “Emergency Contraceptive Pill”, “Morning After Pill”, “Post Coital Contraception”, “Day After Contraception”, or “Plan B”. It may include combined estrogen and progestin hormones found in oral contraceptive pills or progestin only pill that is called Plan B or Next Choice. The name “Day After Pill” can be confusing as it can be taken the same day or up to 5 days after unprotected intercourse and still be effective in preventing pregnancy. The most effective time in preventing pregnancy is to take the pill for emergency contraception less than 24 hours after the incidence of unprotected intercourse where there is greater than 95% chance of preventing pregnancy. Between 73 and 120 hours, the incidence of pregnancy decrease to between 50 to 63% reduction in pregnancy rate. No studies have been performed to determine effectiveness of the “Day After Pill” after 120 hours (5 days) of unprotected intercourse.

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Is there any pill approved for FDA Emergency Contraception?

Yes. Preven which was a progestin-only pill was initially approved by the FDA for emergency contraception in 1994. It was removed from the market after several years. Plan B (Next Choice, levonorgestrel) was approved by the FDA in 2004. One .75 mg tablet was taken 12 hours apart. Plan B one step was then approved by the FDA in June 2009 that contains 1.5 mg levonorgestrel to be taken as a single pill for Emergency Contraception. The incidence of pregnancy after unprotected intercourse is reduced by up to 89% if taken less than 72 hours, and 63% if taken between 73 and 120 hours after unprotected intercourse.

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Is it safe to use Emergency Contraception as birth control?

Oral Contraceptives which are combined progesterone and estrogen pills and levonorgestrel (Plan B, Next Choice) which is progestin-only pill have minimal side effects and are safe to use as birth control. Taking Emergency Contraceptive Pills as the sole source of contraceptive is not highly effective in preventing pregnancy over a one year period of time. There is approximately a 40% chance of becoming pregnant with a combined progestin and estrogen birth control and a 20% chance of becoming pregnant by using Plan B (levonorgestrel, Next Choice). This is due to multiple reasons:

  1. The patient does not take the pills properly after having unprotected intercourse
  2. The patient does not take the pills at all
  3. The patient had several episodes of unprotected intercourse in the same menstrual cycle which reduces the effectiveness of the Emergency Contraceptive Pill

It is important to discuss with all patients who present for Emergency Contraception to discuss long term reversible methods of birth control which include abstinence, masturbation, Intrauterine Device (Copper T or Mirena), progesterone-only birth control pills, combined estrogen and progestin birth control pills, diaphragm, cervical cap, nuva ring, Depo-Provera injection, male and female condoms. Please look under our section of birth control to read about the different types of long term reversible birth control methods that are available and how effective they are in reducing pregnancy when taken and used properly. For example; IUD, Depo-Provera injection, progesterone pellets that are inserted under the skin are over 99% effective in reducing the incidence of pregnancy.

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Is there a Free Emergency Contraceptive?

Unfortunately there are no free Emergency Contraceptives that we know of. Plan B which can be purchased over the counter costs between $35.00 to $70.00. If you have a pack of birth control pills, you may be able to call your Physician who prescribed them and he/she may be able to tell you how to take them as Emergency Contraception to reduce the incidence of an unintended or unwanted pregnancy. If you have medical insurance, it will help to reduce the upfront cost of insertion of an Intrauterine Device which can work as an Emergency Contraceptive Method and a long term reversible contraceptive method up to 12 years. Non-Steroidal Anti-Inflammatories (NSAID) are available over the counter but though they are effective in preventing ovulation, have not had extensive studies done to determine proper dosages for Emergency Contraception. RU486 in dosages as low as 10 mgs can be used as an Emergency Contraceptive, but not in the U.S. for this purpose.

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Why is Emergency Contraception Sometimes Called the Morning After Pill?

Many people call Emergency Contraception the “morning after pill” although the name can be confusing because it can be taken immediately up to 120 hours (5 days) after unprotected intercourse to reduce the incidence of an unwanted or unintended pregnancy. This is the reason why the term Emergency Contraception is more accurate than the “morning after pill. Here we use the term Emergency Contraception and “morning after pill” to mean any kind of pills that can be taken after intercourse to prevent pregnancy.

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