Title: Types of emergency contraceptive methods
Course: Level 3 - Family Planning > Section: Emergency contraceptive

Emergency contraception is broadly divided into two categories:

- Hormonal pills, known as emergency contraceptive pills (ECPs)
- copper-bearing intrauterine contraceptive devices (IUCD)

Emergency Contraceptive Pills (ECPs)

ECPs are hormonal methods of contraception that can be used to prevent pregnancy following an unprotected act of sexual intercourse. ECPs are sometimes referred to as "morning after" or "postcoital" pills. These terms have been replaced by the term "emergency contraceptive pills" because they do not accurately convey the correct timing of use. ECPs can be used up to five days following unprotected intercourse (120 hours). ECPs should not be used as a regular or on-going method of contraception. They are intended for "emergency" use only.

There are two types of emergency contraceptive pills

- Pills containing a combination of a progestin and an estrogen
- Pills containing a progestin-only

How it works?:

The precise mechanism of action of ECPs is uncertain and may be related to the time it is used in a woman's cycle. ECPs are thought to prevent ovulation, fertilization, and/or implantation. ECPs are not effective once the process of implantation of a fertilized ovum has begun. ECPs will not cause an abortion and have no known adverse effects on (the growth and development of) an established pregnancy.

Effectiveness of ECP:

- The effectiveness of ECPs depends on how soon after unprotected intercourse they are taken.
- The sooner they are taken, the more effective they are. The use of combined oral contraceptives for emergency contraception reduces the risk of pregnancy by about 75%.
- The progestin-only regimen reduces the risk of pregnancy by about 85% after a single act of intercourse. This means, if 100 women had unprotected sex, about 8% would become pregnant compared to only 1% POP ECPs were taken.

Overall, ECPs are less effective than regular contraceptive methods. Because the ECP pregnancy rate is based on a one time use, it cannot be directly compared to failure rates of regular contraceptives, which represent the risk of failure during a full year of use. If ECPs were to be frequently used, the failure rate during a whole year of use would be higher than those of regular hormonal contraceptives. Therefore, ECPs are not recommended for regular use. Additional factors determining effectiveness are the timing of the two doses and exposure to repeated unprotected intercourse following ECP therapy before the return of menses.

Side effects (that are temporary and not dangerous):

Changes in bleeding patterns including:

- Light vaginal bleeding for 1-2 days after taking ECPs.
- Monthly bleeding that starts earlier or later than expected.

In the week after taking ECPs: nausea, abdominal pain, fatigue, headache, breast tenderness, dizziness and vomiting (less frequent with progestin-only formulations)

Who can use ECPs?:

All women can use ECPs safely and effectively, including women who cannot use ongoing hormonal contraceptive methods. Because of the short-term nature of their use, there are no medical conditions that make ECPs unsafe for any woman

When to use ECPs:

ECPs can be utilised any time a woman is worried that she might become pregnant within 5 days of unprotected sex. The sooner after unprotected sex that ECPs are taken, the more effective they are.

There are two types of ECP regimen in use:

1. Combined oral contraceptive pills: contain ethinylestradiol and levonorgestrel or comparable formulations.
  - When high-dose pills containing 50 μg (micrograms) of ethinyl estradiol and 0.25 mg of levonorgestrel are available, two tablets should be taken as the first dose as soon as convenient, but not later than five days (120 hours) after unprotected intercourse. The second two pills should follow 12 hours later.
  - When low-dose pills containing 30 μg ethinylestradiol and 0.15 mg of levonorgestrel are available, four pills should be taken as the first dose as soon as convenient but not later than five days (120 hours) after unprotected intercourse, to be followed by another four pills 12 hours later.
2. Progesterone-only pills:
  - When tablets containing 0.75 mg of levonorgestrel are available, one tablet should be taken as the first dose as soon as convenient, but not later than five days (120 hours) after unprotected intercourse, to be followed by another one pill 12 hours later.
  - When pills containing 0.03 mg of levonorgestrel are available, 20 tablets should be taken as the first dose as soon as convenient but not later than five days (120 hours) after unprotected intercourse, to be followed by another 20 pills 12 hours later.

Copper-Bearing Intrauterine Contraceptive Devices (IUCD)

A Copper-T IUD can also keep the egg from attaching to the womb wall. The IUD must be inserted by a specially trained health worker within 5 days after having unprotected sex. The IUD can be kept in and continue to protect a woman from pregnancy for up to 10 or 12 years. Or she can have the IUD removed after her next monthly bleeding when it is certain she is not pregnant.

Mechanism of action:

As emergency contraception, the copper-bearing IUD primarily prevents fertilisation by causing a chemical change that damages sperm and egg before they can meet.

Effectiveness:

IUCDs are highly effective as ECs. After unprotected sexual intercourse, less than 1% of women are reported to become pregnant if they use a copper-releasing IUCD as an EC. The client prefers using an IUCD for continuous, long-term contraception

Disadvantages:

- It does not work if women are already pregnant.
- It has a limited time frame of 5 days following unprotected intercourse.
- Women still have a small chance of getting pregnant.
- IUCD insertion requires a trained professional.
- It does not provide protection from sexually transmitted infections.