What is emergency contraception?
Emergency contraception is the use of certain methods after unprotected intercourse to prevent pregnancy.
How should ECPs be used?
a) Combined Pill Regimens
Regular combined oral contraceptive pills (COCs) can be used. The number of COCs taken for each dose will vary depending on the amount of hormones in each pill; however, each dose should contain at least 0.1 mg of ethinyl estradiol and 0.5 mg of levonorgestrel.
When "low-dose" COCs are used (containing 0.03 mg of ethinyl estradiol each):
- Take 4 pills within 120 hours after unprotected intercourse.
- Take another 4 pills 12 hours after the first dose.
When "high-dose" COCs are used (containing 0.05 mg of ethinyl estradiol each):
- Take 2 pills within 120 hours after unprotected intercourse.
- Take another 2 pills 12 hours after the first dose.
b) Progestin-Only Pill Regimens
- Take 2 pills containing 0.75 mg of levonorgestrel within 120 hours after unprotected intercourse.
--OR--
- Take one pill containing 0.75 mg of levonorgestrel within 120 hours after unprotected intercourse.
- Take another pill containing 0.75 mg of levonorgestrel 12 hours after the first pill.
Where prepackaged ECPs containing 0.75 mg of levonorgestrel are not available, the required amount of hormone for each dose could be obtained, for example, by taking 20 progestin-only pills containing 0.0375 mg of levonorgestrel each.
How do ECPs work (mechanism of action)?
Emergency contraceptive pills do not interrupt an established pregnancy. Depending on when taken during the menstrual cycle, emergency contraceptive pills may:
- Inhibit or delay ovulation
- Have effects after ovulation
When should ECPs be used? They should be started within 120 hours after intercourse, when:
- No contraception is used
- A contraceptive method fails (e.g., condom breaks or slips)
- A contraceptive method is used incorrectly (e.g., pills are missed)
- Coercive sex or rape takes place
Emergency contraceptive pills are more effective the sooner they are taken after unprotected intercourse.
Who can use ECPs? Any woman of reproductive age who has had unprotected intercourse and who:
- Does not want to become pregnant
- Does not have contraindications
Advantages
- Safe, effective and easy to use
- Can be used at any time during the menstrual cycle
- Pills used are widely available
- Can be provided without a prescription
- No office visit or physical exam required
Disadvantages
- Do not prevent STIs/HIV
- Have short-term side effects
Possible side effects
- Nausea
- Vomiting
- Headaches
- Dizziness
- Fatigue
- Breast tenderness
Side effects are much more common with combined pills than with progestin-only pills. They generally do not last more than 24 hours after the second dose.
Counseling
- Any symptom or concern of the client
- Common side effects
- Ongoing contraception
- Prevention of STDs and HIV
Dispelling myths regarding ECPs
ECPs:
- Do not cause abortion
- Will not harm a pregnancy
