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12 questions about emergency contraception: is it too late?


This article is co-written by Carrie Noriega, MD. Dr. Noriega is a certified obstetrician-gynecologist from Colorado. She graduated from the residency of the University of Missouri in Kansas City in 2005.

The number of sources used in this article is 18. You will find a list of them at the bottom of the page.

Emergency contraception is a great option to prevent pregnancy if your usual birth control measures haven’t worked or if you have unprotected sex for some reason. There are two main types of tablets for emergency contraception, as well as such an option as an IUD (intrauterine device). All of them are simple enough to use and very effective in preventing an unwanted pregnancy.

Can I get pregnant if a condom breaks?

The answer to this question depends on what day of the cycle an unplanned sexual intercourse occurred:

  • Intimacy in the first 7 days of the cycle is unlikely to lead to an unwanted pregnancy. During this period, the uterine mucosa is rejected, and there is monthly bleeding. Follicular maturation has not yet begun, and sperm live in the genital tract of women for no more than 7 days. With a standard 28-day cycle, the risks are minimal. The shorter the total duration of the cycle (21-27 days), the higher the likelihood of conception of a child with intimacy these days.
  • Sex in terms close to ovulation (7-14 days), with a high degree of probability will lead to the conception of a child. During this period, follicular maturation and ovulation occurs. An egg released from the ovary has every chance of meeting a sperm, and fertilization will occur.
  • Sexual intercourse in the second phase of the menstrual cycle (14-28 days) does not threaten the unwanted conception of the child. The egg dies 24 hours after leaving the ovary. After the death of the egg, a corpus luteum forms. Conception of a child during this period is impossible.

Does this mean that after unprotected sex in the second phase of the cycle, you can not drink pills for emergency contraception and not worry about a possible pregnancy? Yes, but only if the woman is exactly sure: ovulation has already been, and since then more than 24 hours have passed. Surely, the date of ovulation of a woman who uses natural methods of contraception (a method for recognizing fertility) is known. In other situations, it is rather difficult to catch the moment of the egg's exit from the ovary. Any failure of the cycle can lead to the fact that ovulation is postponed indefinitely, and all calculations on the calendar will be incorrect.

If in doubt, it is better to take a pill for emergency contraception than to have an abortion in the event of a confirmed pregnancy.

How often can I take pills for emergency contraception?

The instructions for drugs for postcoital contraception indicate that you can take such drugs no more than once a month. Practicing gynecologists indicate that such recommendations are incorrect. Emergency contraception is an ambulance in case of emergency, and not a routine method of protection against unwanted pregnancy. Experienced doctors do not advise their patients to get involved in similar drugs that cause significant harm to reproductive health.

One gynecologist with the question “How often can I take postcoital tablets?” Answered categorically: “Once in a lifetime!”. There is some truth in this, because the more often a woman drinks such drugs, the higher the risk of complications in the form of menstrual irregularities.

When should I take drugs for emergency contraception?

According to WHO recommendations, tablets for postcoital contraception are used in the following situations:

  • Unprotected intercourse when contraceptives have not been used at all.
  • Cases of sexual violence when a woman was unable to protect herself from an unwanted pregnancy.
  • Situations in which there is reason to believe that the contraceptives used were ineffective.

According to the last point, they are especially distinguished:

  • Skipping combined oral contraceptives more than two times in a row.
  • Pass mini-drank for more than 3 hours.
  • Delayed injection of contraceptive (timing depends on the specific drug).
  • Prolapse of the intrauterine device or vaginal ring NovaRing.
  • Displacement or damage to the diaphragm or cap on the cervix.
  • Tearing or slipping a condom.
  • Attempted interrupted intercourse, ending in ejaculation in the vagina or on the external genitalia.
  • Incomplete dissolution of spermicide before intercourse.
  • Incorrect definition of safe days when using natural methods of contraception.

When is it not too late?

It is necessary to take funds for emergency contraception no later than 72 hours after unprotected sexual contact. The optimal effect is achieved if the tablet was taken on the first day after intimacy. There is evidence that postcoital contraceptives remain effective for 120 hours, but drug manufacturers do not guarantee the desired result.

To protect yourself from an unwanted pregnancy, you need to drink tablets strictly according to the instructions.

When can I take a postcoital pill again?

The application regimen depends on the chosen drug:

  • Postinor should be drunk twice. The second pill should be taken 12 hours after the first.
  • Escapel and Mifepristone are prescribed once. Repeated administration of the drug is not needed.
  • According to the Yuzpe method, COCs are used as an emergency contraception. The first dose is taken 72 hours after unprotected intercourse. The second dose is prescribed 12 hours after the first pill.

As for the interval between the reuse of emergency contraceptives, here the opinion of doctors is clear: the more, the better. At least a month should elapse between taking postcoital tablets.

Which emergency birth control pills are better?

All postcoital preparations are effective in their own way, if you take them on time and strictly follow the instructions for use. Recently, in gynecology, they have been moving away from Postinor, giving priority to new means - Escapel and Mifepriston. These drugs must be taken once, and thus eliminates the risk of insufficient effect from a forgotten second tablet.

All of these drugs have a large number of side effects, so it is rather difficult to distinguish among them safe.

Can I use COCs for emergency contraception?

Such a scheme was developed in 1977, but it is not very popular. According to the Yuzpe method, it follows:

  • Drink the first dose of the drug within 72 hours after intercourse.
  • Take the second dose 12 hours after the first.

For emergency contraception, immediately use 8 tablets of low-dose COC (containing 30-35 μg of ethinyl estradiol and levonorgestrel), taken in two doses (4 tablets of the drug). Such funds are suitable: Microginon, Rigevidon.

Such a scheme is not popular in Russia, as there are more convenient and affordable means.

Do emergency contraceptive pills protect against sexually transmitted infections?

No, such drugs only protect against pregnancy, but do not provide protection against infections. Pathogenic microorganisms easily penetrate the genital tract of women and cause dangerous diseases. The following remedies will help to slightly reduce the risk of infection:

  • Hexicon (candles).
  • Betadine (candles).
  • Miramistin (spray).

Antiseptics should be used in the first hours after unprotected intercourse. These drugs do not provide 100% protection and practically do not protect against the penetration of HIV infection and viral hepatitis.

What happens if you become pregnant on the background of emergency birth control pills?

Women using Mifepristone for postcoital contraception should know: if the effect has not occurred, you need to think about terminating the pregnancy. Against the background of the use of the drug, there is a high risk of the appearance of congenital malformations in the fetus.

Levonorgestrel-based products (Escapel and Postinor) are contraindicated during pregnancy, however, data on the adverse effects of drugs on the fetus have not been identified.

Can I use emergency contraception pills for nursing mothers?

According to the instructions, preparations for postcoital use penetrate into breast milk and are considered unsafe for the baby. Nursing mothers are not allowed to drink such drugs. If there is an urgent need to take a contraceptive, you need to interrupt breastfeeding:

  • for 24 hours for drugs based on levonorgesterl (Escapel, Postinor),
  • 14 days for Mifepristone.

Do emergency contraceptive pills have an abortive effect?

The answer to this question depends on when the drug was taken:

  • In the first phase of the cycle, means of postcoital contraception inhibit ovulation and interfere with the release of the egg. Conception in this case becomes impossible, and there is no talk about the abortive effect.
  • In the second phase of the cycle, the tablets prevent the implantation of the fetal egg into the uterine cavity. In this situation, a miscarriage occurs for up to 7 days. This is considered an abortive effect of the drug.

Important! After the onset of implantation, emergency contraception methods are not used.

The effectiveness of drugs used after unprotected intercourse is 85-95%. Despite all the possible shortcomings, such funds are considered the best alternative to abortion. Even if the drug leads to an abortion as a result of a violation of the implantation of the fetal egg, for a woman it will be a better outcome. In this situation, an abortion will occur at a very early stage and will pass with minimal consequences for reproductive health. Conversely, termination of pregnancy at a later date (after a delay of menstruation) threatens with serious health problems up to infertility.

Author: doctor obstetrician-gynecologist Ekaterina Sibileva

Types of emergency contraception

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To prevent an unplanned pregnancy urgently in different countries, several methods are used:

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  • taking a combination of estrogen and progestogen (Yuzpe method),
  • the introduction of a copper-containing intrauterine device in a medical institution,
  • use of pills containing gestagen,
  • use of progesterone antagonists (mifepristone).

In Russia, the last two methods are most often used (about other types of contraception, you can read in the next article). However, the question of which emergency contraception is better, scientists of the World Health Organization answer that this is an intrauterine device contraceptive (spiral), installed over the next 5 days. It most effectively prevents pregnancy. However, this method is expensive, not available to all women, is not recommended for adolescents and nulliparous.

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As a result of numerous studies by scientists involved in evidence-based medicine, it was concluded that new-generation emergency contraception is the use of drugs containing 10 mg of mifepristone.

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The effect of drugs for oral administration

Emergency contraceptive pills have been studied for the past 30 years and have been shown to be effective and fairly well tolerated by women. These drugs are used to prevent pregnancy during unprotected sexual intercourse in the following cases:

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  • there were no means of planned contraception,
  • there was a rupture or displacement of the condom (one of the means of barrier contraception), the vaginal cap, diaphragm,
  • two or more oral contraceptives were missed in a row
  • a timely injection of long-acting contraceptives was not made,
  • interrupted intercourse ended with ejaculation in the vagina or on the skin of the external genitalia,
  • a pre-used spermicidal tablet did not completely dissolve,
  • an error in determining the "safe" days with the calendar method of protection,
  • rape.

In all these cases, you need to take a medication as soon as possible.

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Two types of drugs are used:

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  • drugs based on levonorgestrel (progestin),
  • a combination of ethinyl estradiol (estrogen) and levonorgestrel (progestin).

Monocomponent drugs can be taken once after sexual intercourse or in two doses with a break of 12 hours. Combined funds are accepted twice. This allows you to reduce a single dose and reduce the likelihood of adverse events. You should take the drug as soon as possible, because every hour of delay increases the likelihood of pregnancy. Nevertheless, effectiveness still persists for 120 hours after coition, and not 72 hours, as previously thought.

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How do tablet emergency contraceptives work:

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  • prevent or delay ovulation,
  • interfere with the fusion of the sperm and the egg,
  • complicate the introduction of a fertilized egg into the endometrium for further development (although this statement is not proven, and there is evidence that it is incorrect).

The effectiveness of levonorgestrel reaches 90%, combined drugs are less effective. Not a single drug for urgent contraception has such effectiveness as modern means for constant protection.

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Hormone safety

Possible unwanted symptoms:

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  • nausea and vomiting,
  • abdominal pain,
  • feeling of weakness
  • headache and dizziness,
  • breast tenderness
  • spotting from the vagina (not the nature of menstruation),
  • change in the date of the beginning of the next menstruation (usually a week earlier or later than expected).

If the period after emergency contraception is delayed for more than a week, it is necessary to exclude the onset of pregnancy by buying a test in a pharmacy or by contacting a doctor. Bleeding after administration is harmless and will stop on its own. Its likelihood increases with repeated use of tablets during one cycle. However, if it occurs in combination with delayed menstruation and abdominal pain, it is recommended to consult a doctor. This may be a sign of ectopic (ectopic) pregnancy. However, it has been proven that taking funds for postcoital contraception does not increase the likelihood of such an event. Women who have already had an ectopic pregnancy can also take these drugs.

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To reduce the risk of vomiting, the use of combination drugs should be minimized, since levonorgestrel rarely causes such a side effect. If vomiting occurs within two hours after applying the medicine, you need to repeat the reception. In case of intense vomiting, antiemetic drugs (metoclopramide, cerucal) can be used.

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If there is a headache or discomfort in the mammary glands, you should use the usual pain medication (paracetamol and so on).

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Tableted emergency contraception drugs have no contraindications, as they are considered safe. They are not prescribed for existing pregnancy, because this makes no sense. However, if pregnancy is not yet diagnosed, taking levonorgestrel is harmless to the developing fetus. Levonorgestrel drugs are not able to terminate an already begun pregnancy, so their effect is not similar to medical abortion. Normal pregnancy after emergency contraception can occur in the next cycle.

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Serious adverse effects on a woman’s health have not yet been reported after prescribing levonorgestrel preparations for postcoital contraception. Therefore, they are allowed to use even without a doctor’s examination, including in many countries of the world they are sold without a prescription.

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The most common emergency contraceptives

The most common drugs for postcoital protection

Means containing levonorgestrel, and used for postcoital protection:

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  • Postinor
  • Escapel
  • Eskinor-F.

One tablet contains 750 mcg or 1500 mcg of the hormone levonorgestrel, depending on the dosage you need to take one or two tablets.

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Despite the fact that with a single dose, these drugs are safe, they should be used with caution in the following diseases:

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  • severe liver disease with its insufficiency (cirrhosis, hepatitis),
  • Crohn's disease,
  • lactose intolerance,
  • age to 16 years.

Combined estrogen-progestogen drugs:

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  • Microgynon,
  • Rigevidone
  • Regulon and others.

These are monophasic contraceptives, usually used for planned protection against pregnancy, but in emergency cases, they can also be used for postcoital contraception. Этот метод экстренной контрацепции признается самым опасным, поскольку эстрогены в составе препаратов имеют противопоказания и довольно много побочных эффектов, которые усиливаются из-за высокой дозировки гормонов: назначается по 4 таблетки два раза с перерывом в 12 часов. Использование этих препаратов особенно нежелательно в следующих ситуациях:

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  • тромбозы артерий и вен,
  • мигрень,
  • поражение сосудов при сахарном диабете, атеросклерозе, гипертонии,
  • тяжелые болезни печени и поджелудочной железы,
  • опухоли репродуктивных органов,
  • the period after injuries, operations, immobilization.

The main danger is an increase in blood coagulation and the threat of clogging of arteries or veins by blood clots.

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Non-hormonal postcoital contraception

Emergency non-hormonal contraception is carried out using funds containing mifepristone. This is a synthetic substance that blocks progesterone receptors in a woman's body. The mechanism of action of the drug includes:

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  • suppression of ovulation,
  • a change in the inner lining of the uterus - the endometrium, which prevents the introduction of a fertilized egg,
  • if egg implantation does occur, uterine contractility increases under the influence of mifepristone, and the fetal egg is rejected.

So, the main difference between mifepristone and levonorgestrel tablets for postcoital contraception is the ability to cause a “mini-abortion", death and secretion of an egg already implanted into the uterine wall. Indications for admission are the same as for hormonal drugs - unprotected sexual intercourse.

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Preparations containing mifepristone in a dose of 10 mg:

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  • Agesta
  • Ginepriston
  • Zhenale.

Emergency contraception with Genet is possible with confidence that the woman is not pregnant. In addition, mifepristone should be taken with great care in such cases:

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  • liver or kidney failure,
  • changes in the blood (anemia, coagulation disorders),
  • adrenal insufficiency or prolonged use of prednisone,
  • lactation, after taking the drug, you can not feed the baby with breast milk for 2 weeks,
  • pregnancy.

Mifepristone-based products can cause adverse effects:

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  • spotting from the vagina, pain in the lower abdomen,
  • exacerbation of chronic adnexitis, endocervicitis, endometritis,
  • dyspeptic disorders and diarrhea,
  • dizziness, headache,
  • weakness, fever, skin rash, and itching.

Mifepristone-based emergency contraceptives cannot be used every month. It is strongly recommended that you begin to use funds for planned contraception. If, despite taking the pill, pregnancy nevertheless has come, it is recommended to terminate it, since there is a risk of damage to the fetus.

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Mifepristone is a more powerful, but also more dangerous means to prevent unwanted pregnancy. It is recommended to be taken only after consulting a doctor. A prescription drug is released.

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Pill-free contraception

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Say right away, the effectiveness of the methods that will be discussed is low, and the application is inconvenient. However, women should be aware of such methods.

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In the first minute after ejaculation, while the sperm have not yet penetrated through the cervical canal into its cavity, douching can be done with clean water or with the addition of potassium permanganate, i.e. potassium permanganate. Then you should immediately enter the suppository with a spermicidal effect into the vagina.

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Of course, the effect of spermicides will be much better if you use them as expected - 10-15 minutes before coition. Such candles as Farmateks, Contraceptin T, Patenteks oval and others are used.

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Contraindications for local contraception:

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  • inflammation of the mucous membrane of the external genitalia (vaginitis, colpitis),
  • individual intolerance to the drug.

After using this method, it is recommended to use the drug levonorgestrel for 120 hours.

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Intrauterine contraception

Intrauterine device T Cu 380 A

It is recommended to use copper-containing spirals that secrete this metal into the uterine cavity. Copper has a spermicidal effect, and the presence of a foreign body in the uterine cavity prevents the implantation of an egg, if fertilization does occur.

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The most famous tools from this group:

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  • T Cu-380 A,
  • Multiload Cu-375.

The second model is preferable, since its soft shoulders do not injure the uterus from the inside, which reduces the risk of spontaneous removal of the spiral.

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The introduction of an intrauterine contraceptive is contraindicated in such cases:

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  • an existing pregnancy that the woman did not know about,
  • tumors and inflammatory processes of the reproductive organs,
  • an ectopic pregnancy
  • acquired immunodeficiency syndrome,
  • individual intolerance,
  • promiscuous sex life
  • adolescence (up to 18 years),
  • abnormalities of the development of the uterus, myoma and other cases when the internal form of the organ is changed.

So, the choice of funds for emergency contraception is quite large. Some of them are more effective, but have more restrictions on use, others are safe, but more often do not have the desired effect. In any case, postcoital contraception is preferable to terminating an unwanted pregnancy.

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After using any of the methods of emergency pregnancy prevention, you must consult a doctor and choose an acceptable option for planned protection. Emergency contraception should not be used regularly, including because of its low effectiveness.

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Emergency contraceptive methods

Unplanned pregnancy is a very common situation throughout the world. According to one of the latest data, only about 65.7% of pregnancies are planned. Most often, an unplanned pregnancy ends with its abortion. According to one of the studies conducted in Scotland at the Edinburgh Hospital, which consisted of questioning more than 3,500 pregnant women, both attending the gynecological department to monitor the course of pregnancy, and those who applied for an abortion, it was found that 89.7% pregnant women who decided to have an abortion called their pregnancy unplanned and only 8.6% of pregnant women who decided to maintain a pregnancy called it unplanned.

Researchers, during a survey of pregnant women, found that among those who had an abortion, 11.8% became pregnant as a result of the unsuccessful use of emergency contraceptives, and among those who decided to maintain a pregnancy, only 1% became pregnant as a result of failed emergency contraceptives.

Analyzing the data of a Scottish study, we can conclude that if, after taking an emergency contraceptive, a pregnancy does occur, it is almost 12 times more likely that this pregnancy will be interrupted rather than saved. No more than 1% of pregnancies resulting from the ineffectiveness of emergency contraceptives will be saved, therefore, 99% will be interrupted.

Given the above, it becomes obvious that in case of risk of an unplanned pregnancy as a result of unprotected sex, it is necessary to take measures for emergency contraception as soon as possible, as well as the fact that when choosing a method of emergency contraception, its effectiveness in preventing an unplanned pregnancy is one of the most important parameters .

Emergency contraceptive methods