What is Emergency contraception/I-pill /Unwanted 72?
You’ve had intercourse without using contraception, even though you don’t want to be pregnant. Or you think something could have gone wrong with your contraception – perhaps you forgot to take your pill, or a condom burst. What can you do?
If you really don’t want to get pregnant, all is not lost. If you act fast you can use emergency contraception. One possibility is to take an ECP or ‘morning after’ pill. You can also get an IUD fitted.
Emergency contraceptive pill
Emergency contraception pills (ECPs), also known as morning-after pills or e-pills, are drugs you can take when you have had unprotected sex but want to prevent pregnancy.
For the ECP’s to be effective, it is recommended that it’s taken as soon as possible after unprotected sexual intercourse, and at most within 5 days or 120 hours since the unprotected sexual intercourse or failure of contraceptive method. However, the sooner it’s taken after sexual intercourse, the more effective it is in preventing pregnancy. In fact, they can prevent 95% of pregnancies if taken within 5 days of the sexual intercourse.
ECPs are available over the counter, which means you can go straight to the pharmacy and get it without a doctor’s prescription.
There are four methods of EC:
EC pills containing ulipristal acetate (UPA): taken as a single dose of 30 mg
EC pills containing levonorgestrel (LNG): taken as a single dose of 1.5 mg OR taken in two doses of 0.75 mg, 12 hours apart
Combined oral contraceptive pills (COCs): taken as a split dose – one dose of 100 μg of ethinyl estradiol + 0.50 mg of LNG, followed by a second dose of 100 μg of ethinyl estradiol + 0.50 mg of LNG 12 hours later (Also referred to as the Yuzpe method)
Copper-bearing intrauterine devices (IUDs): inserted into the uterus through vagina and cervix within 5 days of the unprotected sexual intercourse
Availability in India
There are two types of emergency contraception pills however only one is currently available in India. The available pill is progestogen-only (using the hormone levonorgestrel) generally called Ipill or Unwanted 72.
How do they work?
ECPs and COCs prevent or delay ovulation.
Copper bearing IUDs prevents fertilisation or pregnancy by causing a chemical change in sperm and egg before they meet.
ECPs prevent or delay ovulation. Emergency contraceptives do not end an already established pregnancy or cause an abortion. They also don’t harm a developing embryo.
To know how to terminate a pregnancy, check abortion.
Who can use the EC?
Any person with female biological reproductive organs (cis-women, trans-men*, non-binary people*) and of reproductive age can use an ECP to prevent a pregnancy after having unprotected sexual intercourse or failure of contraception. No age limits (as long as within the reproductive age) or other restrictions are applicable for use of EC methods, especially for progestin-only pills (single dose EC pill of 30 mg or pills that contain UPA)..
EC pills are safe to use even if one has never used any other form of hormonal contraception before. However, whenever in doubt, do not hesitate to consult your doctor. Self-medication without having informed knowledge about using ECs for one’s particular context is not advisable.
When to use an EC?
When no contraceptive has been used – unprotected sexual intercourse.
Sexual assault when the person was not protected by an effective contraceptive method.
When there is concern of possible contraceptive failure, from improper or incorrect use. It is important to consult with your doctor to know which form of emergency contraception is best to use in this case.
Helps prevent pregnancy in cases of failed or forgotten contraception, or rape
Gives peace of mind
Easy to get
Can change timing of next period (early or late)
No STD protection
Needs to be taken as soon as possible after unprotected sex
ECPs are not for regular contraception
There is no limit as to how many times you can use the emergency-pill in a year. However, the ECP does have short-term side effects. That means it should not be used as a normal form of contraception, but only in case of emergency. Look for a form of contraception that suits you: see types of birth control.
The ‘morning after’ IUD
Another kind of emergency contraception is the ‘morning after IUD’. You have to have it fitted by a doctor. This is possible upto five days after you’ve had unprotected sex. You can find more information here.
This is actually just the same as having an IUD fitted as a contraceptive. Once it’s in, you can just leave it in place to stop you getting pregnant in future. But you need to think whether it’s the right kind of contraception to suit you – see the section on birth control.
Is an ECP the same as an abortion pill?
ECPs are not abortion pills. The ECP works in various ways, but can’t do anything if an egg is already fertilized. If you are already pregnant and take the ECP, it will have no negative effects on your pregnancy.
How do I get an ECP?
You can get the ECP over the counter or from your healthcare provider. Because it is most effective the faster you take it, many health care providers even suggest getting an emergency pill and keeping it at home just in case. Studies have found that keeping an ECP at home doesn’t mean you are more likely to have unprotected sex.
What are the side-effects of ECPs?
Abdominal pain, nausea, vomiting
How safe are ECPs?
While frequent use of ECPs can lead to more side effects, these side effects are not harmful. The primary reason that ECPs are not recommended as regular contraception is that they may not be as effective.
There seem to be no long-term side-effects known for emergency-contraception pills.
There are some cases of deep vein thrombosis (DVTs) reported with the use of the ECPs.
Who shouldn’t use ECPs?
Because ECPs are not used daily, there are no restrictions on who can use them. Even women who cannot use on-going hormonal contraception can use ECPs safely. However, keep in mind the following:
Women with undiagnosed abnormal vaginal bleeding
Women with acute migraines
People with a Body Mass Index (BMI) higher than 25
What can stop ECPs from working properly?
If you vomit soon after taking the pill, it may be less effective. Talk to a healthcare provider as soon as possible to find out what your options are.
In both cases ( when yo have had unprotected sex and/or vomited after ECP), consider the Copper-T IUD as emergency contraception. The IUD can be inserted within 5 days after unprotected sex.
How does I-pill / Unwanted 72 work?
The progestogen-only pill stops ovulation while also releasing a hormone that makes it harder for sperm to travel up towards the egg. You get either two doses of 0.75 mg each that you have to take 12 hours apart, or one dose of 1.5mg.
If taken within 24 hours it is 95% effective. The longer you wait before taking ECPs, the less effective they are. They are most effective if taken between 12 and 24 hours after unprotected sex. If taken later, they can still be effective for 120 hours (5 days) after intercourse, but then your chances of getting pregnant are higher. If taken between 49-72 hours the pill is only 58% effective.
Progestogen-only pills work less well for women who are overweight. If you have a body mass index (BMI) of more than 25 then it is suggested to use the Copper IUD as emergency contraception.
Progestogen-only pills can even be used several times in one cycle if needed, though should not be used as a normal form of birth control. For more regular forms of birth control check out Birth Control Methods.
Privacy and ECP:
Given that emergency contraceptive is usually available over the counter and in the form of pills, it can be accessed directly or indirectly (via partner/friends) without having to compromise one’s privacy. Moreover, they can be taken in the privacy of any space you deem as “safe” and “private” and at a time convenient for you (but within 5 days of unprotected sexual intercourse or failure of contraceptive).
However, this is not the case if using a copper IUD as a form of emergency contraceptive. If using an IUD, you would need to access and interact with a healthcare provider (and health clinic staff and environment). Although a safer option, concerns around privacy may be an important aspect for you to consider depending on your context and situation.
When in doubt, remember to always consult a doctor!
Switching to regular contraception after using EC:
After using ECPs, a person can resume their prior contraceptive method or begin any contraceptive method immediately, including copper-bearing IUD. However, it is always important to consult your doctor to ensure you are using a form of regular contraception best suited for you.
If a copper IUD is used for emergency contraception, no additional contraceptive protection is needed.
Myths and Facts about ECPS:
Myth:EC harms future fertility
Fact: There is no delay in returning to fertility after use of ECs. There is also no known negative impact on future fertility after using ECs.
Myth: There is only one form of EC
Fact: There are four methods of EC (outlined above)
Myth: EC induces an abortion or terminates a pregnancy
Fact: ECs prevent a pregnancy. They do not end an already established pregnancy and do not harm a developing embryo.
Myth: Frequent and repeated use of ECs can pose health risks for the person taking them
Fact: Frequent use of emergency contraception can result in increased side-effects, such as menstrual irregularities, but their repeated use poses NO known health risks. However, it is recommended to always consult your doctor when in doubt.
Myth: Obese persons (women) should not take ECs
Fact: Any person with female biological reproductive organs (cis-women, trans-men, non-binary people) and of reproductive age can use an ECP to prevent a pregnancy after having unprotected sexual intercourse or failure of contraception. No age limits (as long as within the reproductive age) or other restrictions are applicable for use of EC methods, especially for progestin-only pills.
Myth: Access to EC should be restricted as much as possible. Only certain groups of people can use ECs
Facts: EC pills are safe to use even if one has never used any other form of hormonal contraception before.However, whenever in doubt, do not hesitate to consult your doctor. Self-medication without having informed knowledge about using ECs for one’s particular context is not advisable.