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Contraception- Emergency Contraception ("Morning After Pill", IUD, "Plan B", "Ovral")

A friend recently used emergency contraception, but it did not work and she is still pregnant. Will there be anything wrong with her baby from the effects of the medication?

Emergency contraception is effective in preventing pregnancy the majority of the time, from 75-97%, depending on the method you use. There are no cases of birth defects as a result of using emergency contraception pills. Similarly, birth control pills which contain some of the same components as emergency contraception, have not been shown to cause birth defects. Intrauterine devices (IUDs) are even more effective for emergency contraception than the pills. They also are not associated with birth defects.

If the IUD is left inside the uterus once a pregnancy in diagnosed, there is an increased risk of miscarriage-which may also be associated with infection. When a pregnancy occurs despite the presence of an IUD, an ultrasound can ensure that the pregnancy is not in the fallopian tube (an ectopic pregnancy). If the IUD is in the uterus, the usual recommendation is for it to be removed if this can be done by pulling gently on the IUD strings.

Are there any contraindications to the use of emergency contraception?

Although there are no absolute contraindications to the use of emergency contraception, the Yuzpe method should be avoided in women with an absolute contraindication to estrogen use. The Yuzpe method and Plan B should also be avoided in women with acute porphyria or severe liver disease with abnormal function tests. The intrauterine contraceptive device (IUCD) should preferably only be inserted in women who would otherwise be suitable candidates for the IUCD. If this is not possible screening for sexually transmitted diseases (STD) should be performed and antibiotic treatment given as appropriate.

How does hormonal emergency contraception work?

Multiple mechanisms have been proposed including induction of endometrial asynchrony, altered endometrial receptors, suppression or delay of the LH surge, and ovarian steroid changes through pituitary suppression with subsequent corpus luteum disruption. Most of these mechanisms are felt to either suppress ovulation or prevent fertilization. The mechanism may also be through blocking implantation. Women should be aware of the possible mechanisms of emergency contraception because for some women this may not be an ethically acceptable option.

How effective is hormonal emergency contraception?

This depends on how quickly the woman obtains emergency post coital contraception. If Plan B is given within the first 24 hours 95% of pregnancies that would have resulted are prevented and between 48 to 72 hours 58% are prevented. The Yuzpe method, however, prevents 77% of the potential conceptions in the first 24 hours but only 31% from 48 to 72 hours. The average risk of pregnancy after a single act of intercourse is about eight percent (range 0-30%). Both Plan B and the Yuzpe method reduce the average risk of pregnancy from eight to less than four percent depending on the time between unprotected intercourse and treatment.

How is hormonal emergency contraception administered?

1. The Yuzpe method can be used within 72 hours of a single unprotected act of intercourse. In this method, two tablets of Ovral , each containing 50ug of ethinyl estradiol and .25 mg of levonorgestrel, are administered at once, followed by two tablets 12 hours later. Ideally the first dose should be given before noon or after eight p.m., in order to increase adherence with the second dose twelve hours later. The dosage must be repeated if vomiting occurs within one hour of ingestion of the tablets. An anti-nauseant, for example 50 mg of dimenhydrinate (Gravol) given orally, may reduce the risk of vomiting. If Ovral is not obtainable, four low-dose (35 ug ethinyl estradiol) oral contraceptive pills can be used in place of two Ovral tablets.

2. Plan B can also be used within 72 hours of a single unprotected act of intercourse. In this method one tablet of .75mg levonorgestrel is administered initially, followed by a second tablet 12 hours later. Since this method does not involve administration of estrogen it has a lower incidence of nausea. Success rates with this approach are slightly better than those reported for the Yuzpe method but the cost is slightly higher.

I had unprotected sex with my boyfriend and got a prescription for Emergency Contraception from my doctor. I took the first pill at 5 p.m. but then I slept in and didnt take my second pill until 9 a.m. Will it still work?

Yes, the emergency contraception will still work. Emergency contraception used to be called the morning-after pill, and it is sold in Canada under the brand name Plan B. It consists of two doses of the progestin levonorgestrel which is also used in some birth control pills. Usually one pill is taken right away (the sooner after unprotected sex the better) and the second one is taken 12 hours later. Taken within 3 days (72 hours) of unprotected sex, it reduces your risk of pregnancy by 85%. Its effectiveness is decreased after that, but it can still be used for up to 5 days after unprotected intercourse.

Studies have shown that emergency contraception has the same effectiveness as long as the second dose is taken within 24 hours of the first. Researchers have also found out that taking both pills at the same time right away (instead of waiting 12 hours to take the second pill) is just as effective as taking them 12 hours apart. This might be a good idea for someone like yourself whose second dose falls in the middle of the night. No need to set your alarm for 3 a.m. just take both pills at the same time!

I have just taken emergency contraception after an episode of unplanned intercourse. How and when can I restart a regular form of birth control?

This is a very important question. There are two groups of women that can benefit from using Emergency Contraception (EC). The first group of women has not been using contraception regularly and now wants to begin. The second group of women using EC has had a failure in their chosen form of contraception i.e., they missed pills or a condom broke and would like to continue with that method or start a new one.

If you are starting a form of birth control for the first time, or are changing to a new form of birth control, there are two options:

1. Quick start method. You start the new contraceptive method the day after you have taken EC. This works well for birth control pills, patches, or rings. You may have some spotting but dont stop taking your pills the bleeding usually improves with the next cycle of pills. Tips for this method:


  • Take the entire pack of 21 or 28 pills, regardless of any bleeding you may have.


  • Use condoms for the first seven days


  • If you do not have a period at the end of the month (after finishing the pack of pills, or removing the ring or third patch), do a pregnancy test.



2. Start with next menses. Use a form of birth control such as condoms until you get your period, then start the contraceptive you have chosen. This works well with birth control pills, the patch, the ring, Depo Provera, or an IUD.

If you are going to keep using a previously used form of birth control (such as pills, patches or rings), you can continue to use them starting the day after taking the EC. This may be a good opportunity to review your contraceptive options with your health care provider. For example, if you needed the EC because you have trouble remembering to take your pills, the patch or ring might work better for you.

Finally, remember that a copper IUD can be used as a form of EC as well as for long-term contraception. If you and your health care provider decide this would be a good method for you, the IUD can be inserted up to five days after unprotected intercourse and serve both purposes. If you choose, the IUD can also be inserted after using the pill form of EC once you have a period.

Source: International Consortium for Emergency Contraception, 2004 ed.

Is there an alternative to the combined oral emergency contraceptive pill (ECP)?

Yes if a woman is fearful of the nausea and vomiting that the combined oral contraceptive form of ECP (Ovral) induces in many women -either because of what she has read or heard from friends or because of a bad experience with it in the past a new levonorgestrel (pure progestin) formulation of ECP (Plan B) is available. Plan B has a much lower frequency of nausea and vomiting. This may sufficiently reassure her.

The only proven alternative to oral ECP is placement of a copper intrauterine contraceptive device (IUCD). The IUCD is effective up to seven days after unprotected intercourse and may be the only effective method if ECP is needed in a cycle during which multiple ovulation has occurred (because the elevated estrogen of the stimulated cycle may prevent the constituents of the ECP from sufficiently disrupting the normal implantation process).

What are the most common side effects following administration of emergency contraception?

The most common side effects following hormonal contraception are nausea and vomiting. An anti-nauseant given before each dose may reduce this. If vomiting occurs within one hour of the administration of the medication, the dose should be repeated. It is reasonable to provide an additional dose, at the time of dispensing, to be used if vomiting occurs within one hour or in the future. Plan B has been associated with less nausea and vomiting than the Yuzpe method.

What factors should determine the type of emergency postcoital contraception chosen?

If less than 120 hours have passed since sexual intercourse occurred either one of the hormonal methods can be used. After 120 hours there is an increase in failure if the Yuzpe method or Plan B is used. This does not mean that hormonal methods are absolutely contraindicated after 120 hours. If the woman presents later than 120 hours but before seven days, and will not accept the intrauterine contraceptive device (IUCD), one of the hormonal mechanisms can be given provided that the woman is aware of the increased failure rate. After 5 days, however, the IUCD is the less likely to result in failure than the Yuzpe or Plan B method. If the IUCD is to be used the woman should be preferably an otherwise good candidate for the IUCD.(see question on patient selection for the IUCD).

What forms of emergency contraception exist?

In an emergency when contraception is required condoms are the best protection during intercourse. After inadvertent exposure to risk of pregnancy through condom breakage, slippage of a condom or diaphragm, or failure to use an effective contraceptive method there are two postcoital emergency contraceptive approaches. 1) Hormonal methods involve immediate (within 72 hrs) exposure to high doses of contraceptive steroids, and 2) Non Hormonal methods which require the insertion of a copper intra-uterine device up to 7 days after the episode of unprotected intercourse.

What pre-treatment assessment is needed prior to prescribing emergency contraception?

There is no need to do a full physical or pelvic exam before using a hormonal form of emergency contraception. Appropriate screening for sexually transmitted diseases (STD) and other contraindications to the methods (hormonal or intrauterine contraceptive device) should be considered when emergency contraception is sought.

When should a woman be seen in follow-up after receiving emergency contraception?

A defined follow-up visit is ideally set for three to four weeks post treatment. At this visit the results of the emergency contraception can be assessed and the woman can be provided with counselling for regular contraception. This is also a good time to discuss screening for and counselling about sexually transmitted disease (STD) prevention and condom use.

When should a woman expect her period after receiving emergency contraception?

In the majority of woman the next period occurs on time or earlier. If menstruation is delayed by more than one week a pregnancy test should be performed.

When should an intrauterine contraceptive device (IUCD) be used for emergency post coital contraception?

A copper IUCD can be offered to women who are unable to take hormones, who have no contra-indication to IUCD use, and in whom exposure to conception occurred less than seven days previously. This is the only option available to a woman who presents three to seven days following unprotected intercourse.

Where can I get emergency contraception (the "morning after pill")? Do I need a medical exam before getting emergency contraception? Can I use emergency contraception instead of a regular form of birth control?

Emergency contraception (EC) is available without a prescription in pharmacies across Canada. A from a wide range of health services also carry EC- a doctor, hospital emergency room, walk-in clinics, sexual health clinics, and birth control clinics but there is greater accessibility in pharmacies.

A medical exam, although suggested, is not required before getting the morning after pill.

Emergency contraception is not as effective as other methods of birth control that are used regularly. It does not replace the consistent use of a birth control method. Emergency contraception should be used only in emergency situations (unprotected intercourse, condom failure, diaphragm failure, missed birth control pill, sexual assault). Frequent use of emergency contraception is not recommended, although repeated use over time poses no health risks.

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