When is emergency contraception indicated?

When is there a contraception emergency?
Who is able to use emergency contraception?
Is there a time in pregnancy where there is no risk of pregnancy when having unprotected intercourse?
When is emergency contraception needed for missing one or more birth control pills?
My condom broke – What am I supposed to do now?
When is emergency contraception needed when an Intrauterine Contraceptive Device is used?

When is there a Contraception Emergency?

More Frequently Asked Questions

Emergency Contraception (morning after pill, day after contraception, post coital contraception, or Day After Pill) may be required in multiple clinical situations where unprotected intercourse occurred through a sexual assault, a mistake in using oral contraception, when using the withdrawal method and ejaculation occurs near or onto the external genitalia, a condom splits or breaks, and is dislodged or incorrectly used, or a diaphragm or cervical cap is not properly inserted or it is damaged, dislodged, or removed within 6 hours of sexual intercourse. Potential contraceptive failures and indications for EC are the following:

  1. If missed two of more combined contraceptive pills where the ethinyl estradiol (EE) is in the 30-35ug dosage or two or more 20 ug are missed in the first week of pill taking.
  2. One or more Progestin only Pill are missed or taken >3 hours late and unprotected sex occurred in the 2 days following this
  3. Started pack of birth control pills more than 5 days late
  4. IUD. If complete or partial expulsion or mid-cycle removal is necessary and unprotected intercourse occurred in the last 7 days
  5. Depo-Provera. If contraceptive injection is greater than 14 weeks from the previous injection
  6. Barrier Methods (male and female condoms, diaphragm, cervical cap, etc.) fail.
  7. Liver Enzyme inducers (St. John’s Wart, Rifampin, Warfarin). EC indicated for patients using oral contraceptives,(combined and progesterone only), progesterone implants, and contraceptive patch
  8. Forced to have sex and no method of contraception was used. This happens more often than people think. It is reported to be as high as 20%

With whatever reason Emergency Contraception (morning after pill, day after pill, post coital contraception, or Day After Contraception) is necessary, the chance of getting pregnant is dramatically reduced if it is used immediately and no more than 5 days after unprotected intercourse. The American College of Obstetrics and Gynecology recommend that all patients of reproductive age who do not want to become pregnant have Emergency Contraceptive Pills available before they may be needed due to the fact that it may take time to purchase them over the counter at a pharmacy, or get in contact with a Physician or Family Planning Clinic that can either prescribe it or have it available at the office. This delay could be the difference in the Emergency Contraception effectively working and failure.

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Who Is Able to Use Emergency Contraception?

There are no contraindications to women using Emergency Contraception Pills to prevent an unwanted pregnancy after unprotected sex. The majority of women know very little about Emergency Contraception which at times is called “morning after pill”, “Day After Pill”, “Post Coital Contraception”, or “Day After Contraception”. The majority of Physicians or other medical health personnel do not discuss with their patients about emergency contraception during their appointments for their yearly exams for Pap Smears and refill on birth control pills. So when the time comes where the woman has sex without contraception, raped, or the method of contraception fails, the majority of women do not use Emergency Contraception.

It is our hope that through this website and our discussion with patients who come to the Women’s Center are being educated on the safe and effectiveness of birth control.

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Is There A Time In Pregnancy When There Is No Risk Of Pregnancy When Having Unprotected Intercourse?

There is actually no time in the menstrual cycle when there is absolutely no risk of pregnancy following unprotected intercourse. This is particularly true when the menstrual cycle is irregular or if there is uncertainty about the date of the last period. There are studies that show that women are only 30% accurate about the most 6 fertile days of their cycle. The probability of pregnancy in the first 3 days of a woman’s cycle is negligible but it has occurred.

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When Is Emergency Contraception needed for missing one or more birth control pills?

The decision to take Emergency Contraception (“morning after pill”, “day after pill”, “post-coital coital contraception”, or “Day After Contraception” after missing one or more contraception depends on several factors: 1) which week of pills the patient is on, 2) the type of pills being used, or 3) how many pills were not taken.

The highest chance of becoming pregnant is during the first or third week of taking the active hormonal pills. If you miss one pill, you should take it as soon as you remember. If you miss three or more, then you should take additional steps to protect yourself from becoming pregnant such as 1) abstinence for the remainder of the menstrual cycle, 2) use condoms the remainder of the present cycle, or 3) use some form of Emergency Contraception. If use the contraceptive pills for 7 days in a row, then ovulation does not take place from that point and you may resume intercourse without fear of becoming pregnant.

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For 30 -35ug ethinylestradiol pills:

Missed 1 or 2 active hormone pills in a row or started your new pill pack 1 or 2 days late.

  1. Take missed pill as soon as you can remember and take the remaining pills at your regular time each day from that point. If miss 2 pills, then take an additional pill for 2 days in a row.
  2. There is no need to use any emergency contraceptive, or barrier method required.
    Missed 3 or more active hormone pills in a row or started a new pack 3 or more days late.

Missed 3 or more active hormone pills in a row or started a new pill pack 3 or more days late:

  1. Whenever 3 or more active pills in a row are missed, condoms should be used or practice abstinence for 7 days in a row until active birth control pills are taken for that length of time.
  2. If miss pills in the first week of a new pack, emergency contraception is advised.
  3. If miss pills in the third week of your pack, then take the remainder of the active hormone and immediately start a new pack of pills. Do not take the last 7 inactive pills.
  4. Take an active hormone pill as soon as possible and if missed more than 3 days, one can double up on birth control pills every day until caught up.

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For 20 ug or less ethinyl estradiol:

  1. If miss 2 or more pills follow the above directions for missing 3 or more pills.
  2. If miss 1 pill, follow the directions above for missing 1 or 2 pills

There is a high chance of becoming pregnant by missing 3 or more of the 20 ug of ethinylestradiol tablets. It is very important to follow the above directions precisely.

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Progesterone only pills:

If one or more pills are missed or taken greater than 3 hours late and unprotected intercourse has occurred in the 2 days following.

Birth control pills not used appropriately lead to a very high incidence of unwanted or unintended pregnancy. If birth control pills do not seem to working because they are not taken, then another form of long term birth control is strongly advised such as Depo-Provera injections which are given every three months, or the Copper T Intrauterine Device which is approved for 12 years of protection against pregnancy.

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My Condom Broke. What am I supposed to do now?

Condoms that break (split, burst) happen frequently when having sexual intercourse. Condoms are tested for leakage and airbursts at the manufacturers who make them. If 4 out of 1000 leak water, then the entire batch of condoms are thrown away. For the air burst test, no more than one and a half percent of the condoms can fail this test of required pressure and volume. Condoms do not have to pass a friction test. Despite this, 2 – 5% of condoms tear during usage with most of them due to human error. There are numerous reasons that condoms fail:

  1. Failure to place the condom on appropriately where it is placed on the inside out,
  2. Tearing the condom open with your teeth or using sharp or dull objects to open the package can cause tears in the condom
  3. Not leaving a half inch empty space at the tip of the condom for collection of sperm
  4. Using expired condoms
  5. Not unrolling the condom to the base of the penis
  6. Not using condoms every time of a sexual counter
  7. Not using enough lubricant
  8. Either male or female have pierced genitals
  9. Not putting the condom on soon enough
  10. Creating tears with sex toys or fingernails
  11. Placing condoms in wallet or exposure to extreme heat or cold
  12. Using petroleum jelly on latex or lamb skin condoms
  13. Using the wrong size condom (too large or too small)
  14. Not holding onto the base of condom after ejaculation to prevent slippage and leakage of sperm into the vagina. The penis begins to lose its erection almost immediately after ejaculation in which the condom can slip off into the vagina. If you still have an erection after ejaculating and you want to continue having sex, then one should hold the base of the condom against the base of the penis.

As can be seen, the reason for condom breakage and failure are numerous so when it occurs, and a back-up birth control was not being used (birth control pills, Intrauterine Device (IUD), Depo-Provera Shot, Subcutaneous pellets of progesterone, or primary birth control failure (forgot to take birth control pills, missed starting new birth control pack), then the chance of a unwanted or unintended pregnancy can be as high as 20 to 30% depending on where the individual is in her menstrual cycle.

Thus the use of a method of Emergency Contraception (morning after pill, day after pill, post coital contraception, day after contraception, Plan B, or IUD) should be considered. The sooner a method is chosen, the higher the chance of success in reducing the incidence of an unwanted pregnancy. If Plan B is used 24 hours or less after unprotected intercourse, the incidence of pregnancy is reduced by 95%. If taken 72 hours or less, the incidence of pregnancy is reduced to 89%. If used 73 to 120 hours after unprotected intercourse, the incidence of pregnancy is reduced 63%. If an IUD is inserted 120 hours (5 days) or less after unprotected intercourse, the chance of pregnancy is less than 99%. All women should be given the choice of an IUD being inserted for Emergency Contraception and be retained as a continuous form of reversible birth control. The IUD is the most common form of reversible birth control being used around the world. It is highly effective and safe.

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When Is Emergency Contraception needed when an Intrauterine Contraceptive Device is being used?

Indications for Emergency Contraception (morning after pill, day after pill, post coital contraception, day after contraception) when a Intrauterine Device (IUD) is in place occurs when complete or partial expulsion is identified or mid cycle removal of an IUD is deemed necessary and unprotected intercourse has occurred in the last 7 days.

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