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Emergency Contraceptive Pills (ECP) - Safety and Indications

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Emergency Contraceptive Pills (ECP) - Safety and Indications

4 min read


Emergency pills are one of the emergency contraceptives used to prevent unwanted pregnancy. It is not an abortion pill, but still, it is not recommended for regular use because it has its own side effects.

Medically reviewed by

iCliniq medical review team

Published At July 18, 2017
Reviewed AtDecember 16, 2022

What Are The Safety and Indications for Emergency Contraception?

Nearly half of the pregnancies are unplanned, and this is particularly true for teenagers worldwide. Unsafe abortions are the significant cause of maternal mortality in some countries, accounting for approximately 8% of maternal deaths. As science has improved, there have been considerable improvements in contraceptive choices for both women and men. But, this information should be spread clearly among the public in general. As an end-user, it is essential for the public to understand the drug's utility, safety, and side effects, as some medicines are available over-the-counter like I-pill, Unwanted 72, or Plan B. Three methods of emergency contraception are recommended by WHO (World Health Organization), which include:

  1. High doses of progestogen-only pills containing Levonorgestrel (LNG).
  2. High doses of a combined oral contraceptive containing Ethinyl estradiol and Levonorgestrel (Yuzpe regimen).
  3. Copper-bearing intrauterine devices (IUD).

Copper-Bearing Intrauterine Devices (IUD): The copper-bearing intrauterine device is a small, flexible silicone frame with copper sleeves or wires around it. A specifically trained health care provider will usually insert it into a woman's uterus through the vagina and cervix. Most types of IUDs have one or two strings, or threads, tied to them. Safety: A copper-bearing IUD is a safe form of emergency contraception. It has been estimated that there may be less than two cases of Pelvic Inflammatory Disease (PID) per 1000 users and the risks of expulsion or perforation are also minimal.

What Are ECPs (Emergency Contraceptive Pills)?

Emergency contraception pills are the pills used to prevent pregnancy after sexual intercourse. As the name suggests, these pills can be used only in an emergency and offer 95% protection from unwanted pregnancy. These pills have to be used within 72 hours after unprotected sex; the earlier the drug is taken, the higher is the effect. For instance, it is used in conditions like breakage or slip of a condom, missing oral contraceptive pills, or mistaking the safe days. Likewise, ECP can also help to prevent pregnancy after a rape or undesirable sex. Never use ECP as a choice of regular contraception or conception prevention technique. Emergency oral contraceptive pills primarily contain Levonorgestrel, which is a progestogen (a synthetic form of progesterone). Taking these pills within 72 hours of unprotected sex can minimize the chances of pregnancy.

When to Use Emergency Contraceptive Pills?

  1. When no barrier contraceptive has been used.
  2. Sexual assault.
  3. Condom breakage, slippage, or incorrect use.
  4. Three or more consecutive missed oral contraceptive pills.
  5. Missed Progestin-only birth control pill by more than three hours from the usual time of intake.
  6. Missed Desogestrel pill by more than 12 hours.
  7. Late by four weeks in taking injection Depo-Provera (Medroxyprogesterone acetate).
  8. More than seven days late for combined contraceptive injection.
  9. Tearing or dislodgement of the cervical cap.
  10. Failed withdrawal during ejaculation.
  11. Failure to calculate the safe period days.
  12. Spermicidal jelly or tablet was unable to melt before the contact.


  1. Restart your birth control pills as soon as possible.
  2. Do not take emergency contraceptive pills more than two times a month.
  3. Emergency contraceptive pills should not be used as a substitute for oral contraceptive pills.
  4. If you vomit immediately after taking the ECP, you should repeat the dose immediately.

What Are The Types of ECP (Emergency Contraceptive Pills)?

  • ECP Containing Progestin-Only (Levonorgestrel): Plan B and I-pill are one-step pills containing 1.5 mg Levonorgestrel. Next Choice, One-Dose, and My Way are other names of the same drug.
  • Two Pills Regime: Levonorgestrel 1.5 mg in the form of two pills of 0.75 mg each is available. It can be taken as a single dose of 1.5 mg (both pills may be taken at once) or one pill (0.75 mg) followed by the second pill (0.75 mg) 12 hours later.
  • ECP which contains UPA (Ulipristal Acetate).
  • Combined oral contraceptive pills in two doses (Yuzpe method).


A pregnancy rate of 1.2 to 2.1 % has been reported with Emergency Contraceptive Pills.

What Can Be The Side Effects of Emergency Contraceptive Pills?

It can disrupt the menstrual cycles and can cause menstrual irregularities, which are usually not severe.

  • There can be spotting and mild to moderate bleeding, depending on how frequently it is used in a cycle.
  • Repeated use can also lead to ovarian failure.
  • Breast tenderness, lower abdominal pain, and cramps are common problems.
  • Headaches can also occur, and those with migraines should consult their doctor before using them.
  • In teenagers whose menarche has recently set in, it could cause more disturbances in cycles.
  • These pills cause nausea, vomiting, dizziness, and fatigue.
  • Decreased appetite with bloating can also be present.

What Can Be The Disadvantages Of Emergency Contraceptive Pills?

The disadvantages of emergency contraceptive pills are:

  • It can be costly and inconvenient.
  • It may expose you to higher total levels of hormones.
  • It is not as effective as other birth control methods.
  • It can cause side effects, like irregular periods, breast tenderness, or nausea.

What Are The General Facts About Emergency Contraceptive Pills?

  • Emergency contraception can prevent up to 95% of pregnancies when taken within five days after intercourse.
  • It cannot protect an individual from HIV (Human Immunodeficiency Virus), chlamydia, gonorrhea, and other sexually transmitted diseases.
  • Patients with liver disease and under medications like antitubercular or antiepileptic drugs should consult the doctor before using contraceptive pills.
  • A few of the HIV drugs like Ritonavir can interact with Emergency Contraceptive Pills.
  • Emergency contraceptive pills should not be taken on an empty stomach.
  • EC can be used in the case of unprotected intercourse, contraceptive failure, incorrect use of contraceptives, and sexual assault without contraception.
  • Two methods of emergency contraception like copper-bearing intrauterine devices (IUDs) and emergency contraceptive pills (ECPs), can be used.
  • A copper-bearing IUD is a very effective form of emergency contraception.
  • The emergency contraceptive pill regimens recommended by WHO are Ulipristal acetate, Levonorgestrel, or a combination of oral contraceptives (COCs) containing Ethinyl estradiol and Levonorgestrel.


Even though emergency contraceptives are an essential aspect of contraception, people should use them with caution.

Frequently Asked Questions


Which Is the Best Emergency Contraceptive Pill?

A pill that contains Levonorgestrel or Ulipristal acetate is the best emergency contraceptive pill.


Is One Pill Sufficient To Stop Pregnancy?

Yes, one pill is sufficient to prevent pregnancy if it is taken within 72 hours of unprotected intercourse. But sometimes there are failures also. One tablet taken within the specified time is adequate to stop unwanted pregnancy, and doubling the dose will not increase the effectiveness but may cause increased side effects. Therefore, do not take more than one tablet without consulting a physician.


Will the Contraceptive Pill Be Effective If You Take It After 72 Hours?

The morning-after pills or emergency contraceptive pills work best when taken within 72 hours (3 days) after unprotected sex, but they can also be taken five days later. The sooner it is taken, the better they work. In women who are weighing more than 155 pounds, Levonorgestrel morning-after pills may not work.


When Should You Take the Emergency Pills?

Even though the emergency contraceptive pill is referred to as the morning-after pill, women do not have to wait until the morning to take the emergency contraceptive pill after unprotected sex. Instead, the emergency contraceptive pill is more effective when you take it as soon as possible after unprotected sex.


Can Emergency Pills Be Harmful?

Emergency contraceptive pills are not harmful and are very safe to be used. Side effects, even if they occur, are usually short-term and mild. Nausea has been reported in about 20% of women using Levonorgestrel emergency contraception, and vomiting can occur in about 4% of women. Cases of ovarian failure have also been reported when used repeatedly.


What Happens After Taking Emergency Contraceptive Pills?

After taking the emergency contraceptive pills, you should have a normal period within the next month. Sometimes, this emergency contraception can change the length of the monthly menstrual cycle, making the next period come as much as a week earlier or a week later than usual.


Will Emergency Contraceptive Pills Lead to Infertility?

Emergency contraceptive pills by themselves will not affect long-term fertility. However, improper and frequent use of the drug can cause hormonal imbalances.


How Does the Emergency Contraceptive Pill Work?

Levonorgestrel emergency contraceptive pills prevent pregnancy by delaying or preventing ovulation and preventing sperm from fertilizing the egg. However, it clearly states that Levonorgestrel emergency contraceptive pills will not be effective if the implantation process has already begun, and it will also not cause abortion.


How Many Pills Should You Take for Emergency Contraception?

It is necessary to take more than two birth control pills to function, like emergency contraception. Popping two birth control pills will not work as emergency contraceptive pills, but it is a reliable method to use if women have just missed a day of taking the pill.


Will Emergency Contraception Help To Prevent STDs?

Most of the birth control contraceptives pills are usually targeted for pregnancies, and very few can be used to prevent STDs.


Which Contraceptive Pill Is Safe During Breastfeeding?

The progesterone-only contraceptive pill, also called a mini-pill, is generally recommended during breastfeeding. However, it needs to be taken simultaneously every day continuously. A delay of more than 3 hours may mean contraceptive protection is lost.


Can an Emergency Contraceptive Pill Cause Bleeding After a Week?

Emergency contraceptives can sometimes change your monthly menstrual cycle length and make the next period come a week before or a week later than usual. Sometimes the hormones in the pills can also cause unexpected bleeding in women, but this is not a common or severe side effect.
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Dr. Sujata Mittal
Dr. Sujata Mittal

Obstetrics and Gynecology


emergency contraception
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