Emergency contraception is crucial in female reproductive health, providing a safeguard against unintended pregnancy after unprotected intercourse. Pharmacists play a vital role in educating patients about emergency contraceptives, offering guidance on their proper usage.
The World Health Organization (WHO) defines emergency contraception (EC) as methods used to prevent pregnancy after sexual activity. They are recommended within five days post-intercourse, with higher effectiveness the sooner they are taken. Situations warranting EC include contraceptive method failures like missed birth control pills, condom mishaps, or diaphragm displacement. It's also applicable when no contraception was used or in cases of sexual assault. Even if some form of contraception was used, EC reduces pregnancy risks.
TWO MAIN TYPES OF EMERGENCY CONTRACEPTION EXIST:
1. Emergency contraceptive pill (ECP)
There are two kinds of ECP:
- Levonorgestrel pill contains a synthetic form of progesterone and works by inhibiting or delaying ovulation. It doesn’t interfere with sperm function, embryo viability or endometrial receptivity. Due to a delay in ovulation, no fertilisation occurs. However, this type of EC is not effective if ovulation or fertilisation has already taken place. Levonorgestrel needs to be taken within 72 hours (three days) of sexual intercourse to prevent pregnancy.
- Ulipristal acetate pill contains the active ingredient ulipristal acetate which prevents progesterone form functioning effectively. It also works by stopping or delaying the release of an egg. Ulipristal can be taken up to 120 hours (five days) after sexual intercourse with no decrease in its effectiveness. When taken properly, ulipristal can be more effective in preventing pregnancy than a pill with levonorgestrel and is only available with a prescription.
2. Intrauterine device (IUD)
Copper IUDs can be inserted up to five days after ovulation to prevent pregnancy. They can also serve as long-term contraception for up to 12 years. Notably, IUDs aren't suitable for patients with active sexually transmitted infections due to the risk of pelvic infections leading to infertility.
While EC is effective, it's not a routine contraception method and doesn't protect against sexually transmitted infections. Some patients should avoid EC usage:
- Those allergic to its components.
- Individuals taking medications that diminish its effectiveness.
- Overweight or obese patients, as its efficacy might be reduced.
- Pregnant or breastfeeding patients, especially concerning ulipristal use.
EC may cause short-term side effects such as irregular bleeding, which usually resolves without treatment. Nausea and headaches are common with ulipristal acetate and levonorgestrel pills. If vomiting occurs within hours of consumption, a repeat dose might be necessary. Patients might also experience breast tenderness, abdominal pain, dizziness, and fatigue. The insertion of a copper IUD could lead to increased menstrual flow and discomfort.
While EC is effective, it shouldn't replace routine contraception, and it doesn't prevent sexually transmitted infections. Side effects, such as irregular bleeding and nausea, are generally short-term and manageable.
- The World Health Organization. (2018). ‘Emergency Contraception.’ Available from: https://www.who.int/news-room/fact-sheets/detail/emergency-contraception
- Michigan Medicine. (2019). ‘Emergency Contraception.’ Available from: https://www.uofmhealth.org/health-library/tb1838
- The International Planned Parenthood Federation (IPPF). (2018). ‘IMAP Statement on Emergency Contraception.’ Available from: https://www.ippf.org/sites/default/files/2018-04/IMAP%20Statement%20on%20Emergency%20Contraception.pdf
- (2018). ‘Emergency Contraception (Morning After Pill, IUD).’ Available from: https://www.nhs.uk/conditions/contraception/emergency-contraception/#:~:text=Emergency%20contraception%20can%20prevent%20pregnancy,the%20%22morning%20after%22%20pill)
- The American College of Obstetricians and Gynaecologists. (2019). ‘Emergency Contraception.’ Available from: https://www.acog.org/womens-health/faqs/emergency-contraception
- Trussell, J et al. (2017). ‘Emergency Contraception: A Last Chance to Prevent Unintended Pregnancy.’ Available from: https://www.paho.org/hq/dmdocuments/2017/violence-against-women-2017-03ws-emer-contracep-princenton-rev-2017.pdf
- (2020). ‘Morning-After Pill.’ Available from: https://www.mayoclinic.org/tests-procedures/morning-after-pill/about/pac-20394730
- Cleland, K et al. (2015). ‘Emergency Contraception Review: Evidence-Based Recommendations for Clinicians.’ Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4216625/
- The American College of Obstetricians and Gynaecologists. (2019). ‘Emergency Contraception.’ Available from: https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2015/09/emergency-contraception