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Patient education: Emergency contraception (The Basics)

Patient education: Emergency contraception (The Basics)

What is emergency contraception? — Emergency contraception is a way to try to prevent pregnancy if you recently had sex. "Contraception" is another word for birth control.

You might use emergency contraception if:

You forgot to take your birth control pills.

The condom broke or slipped off during sex.

You have a problem with your birth control (for example, your skin patch came off or your vaginal ring fell out).

You had sex without using birth control.

Emergency contraception can also be used after sexual assault, if a person was forced to have unprotected sex against their will.

Emergency contraception lowers the risk of pregnancy. It does not end a pregnancy that has already started.

Are there different types of emergency contraception? — Yes. There are 2 types of emergency contraception:

An intrauterine device ("IUD") is inserted into your uterus. One type of IUD contains copper, and the other type releases the hormone progestin.

Pills that you take by mouth

Which type of emergency contraception should I choose? — This is a personal decision. To help you choose, think about:

How easy it is to get – An IUD requires a visit to a doctor or clinic, and the cost depends on your insurance coverage. Some pills require a prescription, while others do not. But not all pharmacies carry every type.

How well it works to prevent pregnancy – IUDs are the most effective form of emergency contraception. Pills are less effective, but might be more convenient in other ways.

Whether you want ongoing birth control, and what type – A copper IUD can stay in your body and provide birth control for at least 10 years. The progestin-releasing IUD can stay in for up to 8 years. An IUD is a good choice for people who do not have regular periods and do not know when they ovulate. Some people prefer to start a different form of birth control instead, like the pill or the skin patch.

Your body weight – If you weigh 165 pounds (75 kilograms) or more, you might want to consider an IUD instead of pills. Both types of IUDs work very well to prevent pregnancy no matter how much you weigh.

When, and how many times, you had unprotected sex – You might have different options depending on how recently you last had sex.

All of these issues are discussed more below.

How do I get emergency contraception? — It depends on what type you choose.

If you want an IUD, a doctor or nurse needs to put it in within 5 days of when you last had unprotected sex. The IUD works as both emergency contraception and as ongoing birth control. It prevents pregnancy as long as it is in place.

If you choose pills rather than an IUD, you might or might not need a prescription. There are several different pills that can be used for emergency contraception. They include:

A pill containing "ulipristal" (brand name: Ella) – This pill can be used up to 120 hours (5 days) after unprotected sex. You might need a prescription, particularly in the US. If you weigh 165 pounds (75 kilograms) or more and prefer pills over an IUD, ulipristal might be more effective than the other pill options.

Pills containing a hormone called "levonorgestrel" (sample brand names: Plan B One-Step, Next Choice One Dose) – This is another option. It can be used up to 72 hours (3 days) after unprotected sex, but might work for up to 120 hours (5 days). Depending on the brand and dose, you might need to take 1 pill or 2. Levonorgestrel is available without a prescription at many pharmacies and at clinics like Planned Parenthood.

A pill containing a medicine called "mifepristone" – This is available for emergency contraception in some countries, although not the US.

Birth control pills – Regular birth control pills can also be used as emergency contraception. This does not work as well as the other methods, and is more likely to cause nausea, but might be a good option in some situations.

For emergency contraception, you have to take more than 1 birth control pill at a time, and a second dose 12 hours after the first. The table tells you which birth control pills you can use for emergency contraception, which color pills to take, and how many (table 1). Birth control pills require a prescription in the US. Talk to your doctor or nurse to make sure that you are taking the correct pills and dose.

How well does emergency contraception work? — The IUD is the most effective form of emergency contraception. It prevents more than 99 percent of pregnancies when inserted within 5 days after unprotected sex.

If you choose pills, several different things can affect how well they work. These include how soon you take the pills after sex, where you are in your menstrual cycle, how many times you had unprotected sex, and how much you weigh. In general, the sooner you take them after unprotected sex, the better they work. When used within 3 days (72 hours) of unprotected sex:

Ulipristal – After taking ulipristal (brand name: Ella), the risk of pregnancy is 1 to 2 percent. That means that 1 to 2 people out of 100 who use this type will get pregnant anyway.

Levonorgestrel – After taking levonorgestrel (sample brand names: Plan B One-Step, Next Choice One Dose), the risk of pregnancy ranges from 1 to 7 percent. That means that 1 to 7 people out of 100 who use this type will get pregnant anyway.

Mifepristone – There is not as much information available for this method. But mifepristone probably works a bit better than levonorgestrel to prevent pregnancy.

Birth control pills – Taking a combination of birth control pills will lower the risk of pregnancy, but it is less effective than other methods.

What if I vomit? — Emergency contraception pills can make some people vomit. If you vomit less than 1 hour after taking birth control pills for emergency contraception, you need to take them again. Before doing this, you can take a medicine called "meclizine" that helps keep you from vomiting. You can get meclizine from a pharmacy without a prescription (sample brand names: Antivert, Bonine, Dramamine).

Ulipristal and levonorgestrel are less likely than birth control pills to make you vomit. If this does happen, read the label on the package to find out what to do. If you vomit within 3 hours of taking ulipristal, or 2 hours of taking levonorgestrel, call your doctor or nurse. They can tell you if you should take another pill.

What happens after I take emergency contraception? — You should get your period within a week of when you would normally expect it. If you took ulipristal, don't be surprised if your period is a few days late. That's normal. But if you do not have a normal period within 3 or 4 weeks, no matter which form of emergency contraception you took, you should take a pregnancy test. If emergency contraception did not work, and you are pregnant, talk to your doctor or nurse about your options and what to do next. If you are bleeding more than a normal period or have pain in your belly, you should also see a doctor or nurse.

If you took ulipristal and you normally use birth control pills, wait at least 5 days before starting your regular pills again. That's because ulipristal can cause problems with the way that birth control pills work. Even after you start taking your pills again, you should still use a condom every time you have sex until you get your period again.

If you have sex again after you take emergency contraception pills, you can still get pregnant. Use a condom or another type of birth control. Talk to your doctor or nurse if you have any questions about your birth control options.

Should I get emergency contraception before I need it? — If you choose not to get an IUD or another long-term form of birth control, this might be a good idea. Even though some types of emergency contraception pills are sold without a prescription, it is not always easy to find. You might want to buy some to keep at home, even if you don't need it now. That way, you will have it in the future, just in case.

More on this topic

Patient education: Choosing birth control (The Basics)
Patient education: Barrier methods of birth control (The Basics)
Patient education: Intrauterine devices (IUDs) (The Basics)
Patient education: IUD insertion (The Basics)
Patient education: IUD removal (The Basics)

Patient education: Emergency contraception (Beyond the Basics)

This topic retrieved from UpToDate on: Feb 02, 2024.
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