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Emergency contraceptive pills

Emergency contraceptive pills (sometimes known as the morning after pill) are hormone pills that can be used by a woman who has had unprotected sex, to prevent pregnancy. The earlier after unprotected sex they are used, the more effective they are. Emergency contraceptive pills are very effective if used less than 72 hours after unprotected sex, and usually effective if used within 120 hours (5 days).

What are emergency contraceptive pills (ECP)?

ECP are pills that provide a larger dose of hormone than the oral contraceptive pill. They can be used when a woman has had unprotected sex or when contraception has failed. This could include a condom breaking or slipping off, a forgotten pill, or forced intercourse (rape/sexual assault).

There are two types of Emergency Contraceptive Pills which contain progestogen only.

Combination pills, containing both progestogen and oestrogens ('Nordiol') have been used in the past, but are no longer available in Australia.

When can I use ECP?

The hormone pill (or pills) must be taken as soon as possible after unprotected sex, because they are most effective within 72 hours.  They are reasonably effective when started up to 120 hours (5 days) after unprotected sex.

You can take the ECP if you are taking the Oral Contraceptive Pill - see our topic Contraception. Check with your doctor to see if this is necessary.

Who can take ECP?

Most women can take Emergency Contraceptive Pills, even women who cannot take the Oral Contraceptive Pill, or who get side effects from the Pill such as migraine.

How effective are ECP?

The earlier the pills are taken in the 120 hour period after unprotected sexual intercourse, the more effective they are. The pills are 97 to 99% effective if taken within 1 day of unprotected sex, but only about 70% effective if taken after 72 hours.  They are not likely to be effective if taken more than 5 days after unprotected sex. They may be less effective if taken more than once in any one menstrual cycle.

How do they work?

This is not fully known. ECP may work by preventing the release of an egg from the ovary. (ovulation) They make mucous thicker which may block the sperm. The lining of the uterus is changed to stop a fertilised egg attaching itself to the wall of the uterus.

Emergency Contraceptive Pills do not cause an abortion.

What effect will they have on my body?

Nausea and vomiting may occur, but this is not common. If you do vomit within 2 hours of taking the pills, they will not work. You will need to take another dose. See a doctor for another dose, and for something to reduce the nausea. Taking them with a small amount of food or a drink of milk seems to help.

Other changes to your body because of the medication may include breast tenderness, headaches and dizziness and spot bleeding.

If the ECP fails there is no evidence to suggest that there is any risk to a developing baby or the pregnancy.

It is safe to use emergency contraception while breastfeeding. It will not decrease milk supply. Some progesterone may go through the milk to the baby but there is no evidence this causes any harm.

When will my next period come?

For most women the next period will occur on time, but it may be a few days earlier or later than expected. If your period does not start within four weeks of taking the pills (about two weeks after your period was due) have a pregnancy test. If you have any unexpected bleeding, or abdominal pain or cramping it is important to seek medical advice.

Sexually transmitted infections

The ECP does not protect anyone from sexually transmitted infections.

If you have had unprotected sex it would be a good idea to have a check for sexually transmitted infections. This is usually done 2 to 3 weeks after unprotected sex.

Where can I get ECP?

In Australia, Emergency Contraceptive Pills may be obtained from a pharmacist without a prescription, or be prescribed by a doctor. Some of the places that you can go to see a doctor for this include your local doctor, family planning clinics, emergency departments of public hospitals, youth health services.

A pharmacist will discuss your health, effects and side effects of the tablets and how to use them.

In South Australia, ShineSA (formerly known as Family Planning) and The Second Story Youth Health Service can help with emergency contraception.

The use of progestogen only pills is fairly new, and some doctors may not be familiar with using them. In South Australia you or your doctor can call the Sexual Health Hotline for more information 8364 0444.

Resources

South Australia

Australia

References

Shine SA, ‘Emergency contraceptive Pills (ECP)': www.shinesa.org.au

Foran T, 'In the case of emergency’, Australian Doctor, 10 May 2002.

Royal Australian College of General Practitioners. 'Independent Statement on Emergency Contraception', Australian Family Physician, Vol 32, No 10, October 2002.

von Hertzen, H. et al, 'Low dose mifepristone and two regimes of levonorgestrel for emergency contraception: a WHO multi-centre randomised trial.' The Lancet, Vol 360, No 9348, 7 December 2002, pp1803-1810: http://www.thelancet.com

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The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Youth Healthline on 1300 13 17 19 (local call cost from anywhere in South Australia).