Emergency Contraceptive Pills (ECP) - Safety and Indications

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.

Caution:

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).

Effectiveness:

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.

Conclusion:

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

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