Emergency Contraception (EC)

Emergency contraception consists of various ways that women may use to prevent pregnancy following an unprotected sexual intercourse. This may be in the form of hormonal or non-hormonal methods. There are three common methods, which include copper Intra-Uterine Device (Paraguard IUD), ulipristal acetate (Ella), levonorgestrel (as a single), 2 split doses of levonorgestrel, 2 doses of combined estrogen and progestin (Yuzpe treatment regimen) --usually at high doses (uncommon).


There are various reasons women seek emergency contraception such as from missed doses of regular hormonal contraception, a break in physical barrier methods like condoms or diaphragm, following a sexual assault, or from poor understanding of birth controls and safe sex practice. Some women may choose to use emergency contraception as their form or birth control (not the most effective approach and often not recommended) if they only have occasional sexual activity.


Due to the earlier mentioned reasons, it is very important for women to know when and how to use any of these methods of emergency contraception (EC).




The prescribing information for most combined oral contraceptive and the patch, recommend considering the use of emergency contraception if 2 or more consecutive doses or pills have been missed for 2 days or more, especially during the first week or 2 of the menstrual cycle. The unprotected sexual activity must have happened within the prior 3 to 5 days. Click chat now to be connected with one of our pharmacists.


Vagina ring contraceptives are often preferred by some women. They are placed in the vagina for 3 to 4 weeks before being replaced by a new ring. When the vaginal contraceptive ring become displaced or out of the vagina for more than 3 hours, during the first couple of weeks of placement (week 1 or 2 of the cycle), it is suggested to consider the use of an emergency contraception.


Other candidates of women who may seek emergency contraception include those who may have missed their depot shot, or accidentally removed transdermal hormonal patch for a duration longer than 1 hour.



According to the United states Centers for Disease Control and Prevention, and American College of Obstetricians and Gynecologists, Copper IUD is the most effective form or method of emergency contraception if inserted within 5 days of having unprotected intercourse. It works by weakening or immobilizing the sperm, thus making it less effective or preventing it from fertilizing any available egg. In addition, copper IUD is a very effective form of birth-control and may be used for long-term contraception for up to 10 years. However, it has to be inserted at the doctor's office.


Ulipristal Acetate (Ella) may also be used within 5 days of having unprotected intercourse. It also quite effective when used as directed, but not as effective as the copper IUD. It is a selective progesterone receptor modulator. Basically, it affects how the body responds to progesterone, a key hormone involved in fertilization and pregnancy. Ella is thought to postpone follicular rupture, thereby delaying ovulation. Its effects diminishes over time, thus it is important to use as soon as possible when needed.


Levonorgestrel (Plan-B, morning-after pill) One-Step is a synthetic progestin-only formulation that comes as one 1.5 mg tablet of levonorgestrel. When taken as directed within 72 hours of unprotected coitus, it is thought to delay ovulation via a negative feedback mechanism-consequently preventing fertilization and pregnancy. It has been shown to be less effective than Ella, particularly if used after 3 days of unprotected coitus. In the United States, this medication is available for purchase over-the-counter without a prescription. Some states may require seeing a form of identification for age verification during or before purchase.


Levonorgestrel also comes in 0.75mg (Generic). This is a 2 dose formulation with the option of taking the second dose 12 hours after the first. This may be beneficial if the first dose was vomited after ingestion. Both pills may also be taken at the same time. Keep in mind this formulation may require a prescription from the doctor. This medication works the same way as the aforementioned formulation. It may also help thicken the cervical mucus, further preventing fertilization and pregnancy.


Combined hormonal contraceptive given in high doses has lost its place in emergency contraception use, partly because it is not readily available in most places, it also involves multiple doses taken about 12 to 24 hours apart. There is also risk of increased side effect with the high doses of synthetic hormones in these formulations.



What should I do if I vomit the plan-b pill soon after ingesting?


Most patients are able to tolerate this formulation and Ella better than the Yupze regimen. If you vomit the medication within 3 hours of ingesting, it is usually recommended to take another dose. The routine use of anti-nausea medication before or after taking EC is not usually recommended. However, it may be considered in some women based on certain risk factors. Click let's chat to be connected with a pharmacist.


When can I resume my regular contraception after EC use?


Due to limited data on this topic, the recommendation on when a woman can resume their regular contraception method following the use of an EC depends on the kind of EC that was used. In the case of the progestin-only formulation as contained in plan-B, women may resume within 72 hours and must abstain from sexual intercourse or use an additional barrier method for at least 7 days. For Ulipristal (Ella), it is suggested that women resume their regular birth control after 5 days of use. Like the levonorgestrel formulation, women should abstain from sexual intercourse or use an additional barrier method for at least 7 days.


Please note that it is important to contact your healthcare provider or a pharmacist if you do not have a regular form of birth control. Due to efficacy and side-effect issues, it is generally not recommended to use EC as a long-term birth control method.

If your next period or menstruation is delayed for more than one week, you should take a pregnancy test. Any abnormal pain in the lower abdomen or irregular bleeding should be reported to your doctor.

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C. 2020


References:

1) Ella-Ulipristal Acetate Tablets [prescribing information]. Charleston, NC: Afaxys Pharma LLC; August, 2020

2) Emergency Contraception. American College of Obstetricians and Gynecologists. Assessed August, 2020

3) Plan B One-Step- levonorgestrel tablet [prescribing information]. Cincinnati, OH: Teva Women's Health Inc; August, 2020

4) Types of Emergency Contraception: Emergency Contraception. Centers for Disease Control and Prevention. Assessed August, 2020







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