It’s 2018, and you’d think that people know that the morning-after pill exists. Not so. So here’s the 101 on emergency contraceptives and what you really need to know about how it works.
Here’s a scenario: You’ve just been over to your boyfriend’s place for dinner, and you guys had one drink too many. After wining and dining you get into the bedroom and … you guys were a little sloppy. You didn’t use a condom. You’re not on the Pill. He may or may not have pulled out in time. You were probably too in the moment?
Whatever your decisions are, you need to know that there is a Plan B. And that Plan B involves tiny pills that mean that you don’t fall pregnant — not that because you don’t want to, but it’s because it’s just not the right time yet.
In a small group we asked for some questions off the top off reader’s heads — and one of them even asked: “What is the morning-after pill?” This got us onto this straight away!
We spoke to an expert — Dr Ida Lilywaty, a Consultant Obstetrician & Gynaecologist at Pantai Hospital Cheras — and picked her brain on emergency contraception. Here’s everything you need to know so read carefully!
CLEO: Hi Dr Ida! Thank you for doing this. Some people don’t even realise what it’s for or what it is. Can you give a quick breakdown on what a morning after pill is?
Dr Ida: Emergency contraceptive pills (ECPs) are a way to prevent unintended pregnancies after unprotected sexual intercourse. It is also an option for women in the event of issues with barrier contraception (condom breaks or slips off) or for those who missed consumption of their birth control pills. The main effect of the ECPs is to delay ovulation or release of an egg during a woman’s menstrual cycle.
There are three types of ECPs available, namely combined estrogen and progestin pills (OCPs), progestin only, and the latest edition to the group, anti-progestin pills.
Contrary to popular belief, emergency contraception does not only come in the form of oral tablets but also can be an intrauterine device (IUCD) that can be inserted up to five days from the onset of sexual intercourse.
CLEO: What are they called usually?
Dr Ida: Often called the morning-after pill, other names for it include emergency hormonal contraception or emergency post-coital contraception.
“It is also an option for women in the event of issues with barrier contraception (condom breaks or slips off) or for those who missed consumption of their birth control pills.”
CLEO: How would someone go about obtaining it?
Dr Ida: Most ECPs are readily available as over-the-counter medication. That means one does not necessarily need a doctor’s prescription to obtain them. However, for women with medical issues, it is always advisable for them to see their doctors prior to taking the ECPs.
IUCD used for emergency contraception needs to be placed by doctors or specialised nurses after further assessment.
CLEO: How would the person take or consume it?
Dr Ida: The combined estrogen and progestin pills (OCPs) used to be available as a dedicated pill under certain brand names, but they were withdrawn after more effective progestin and anti-progestin pills were made available in the market. The regular OCP as emergency pills are also called ‘the Yuzpe regime’ in which they are taken in higher-than-usual doses (usually four tablets) 12 hourly apart, effective up to 72 hours after intercourse.
The progestin and anti-progestin pills as mentioned are available as dedicated emergency contraceptive pills under specific brand names. They are specifically packaged for their purpose as emergency pills, are sold over the counter and more preferred than the combined pills. This is because they are readily available, easier to be taken, have fewer side effects, and are generally more effective than OCPs.
The progestin pills contain levonorgestrel (LNG) either as a single tablet or as a split dose of two tablets taken 12 hourly apart, up to 72 hours after the onset of sexual intercourse. They are marketed in Malaysia under a few brand names like Postinor, Escapelle, and Plan B.
The anti-progestin Ulipristal acetate is available as micronised contraceptive tablets and it is one of the latest types of oral emergency contraception available in the market. One of the advantages of Ulipristal acetate is that it is effective up to 120 hours after the onset of sexual intercourse, making it preferable and more reliable and effective as compared to its other two counterparts. It is marketed in Malaysia under the brand name of EllaOne.
CLEO: Is there any chance at all that a person will fall pregnant after taking it?
Dr Ida: About one in 100 women who takes ECPs will become pregnant despite taking the pills within 72 hours after sex. As mentioned earlier, the ECPs work by preventing ovulation. Thus, if fertilisation between the sperm and the egg or the implantation has already happened, the ECPs will not be effective. That explains why the pills should preferably be taken as soon as possible as its effectiveness declines over time.
“Despite its name, one should not wait until the next morning to take ecps.”
ECPs are never recommended as a regular birth control method as they have a relatively high failure rate. The anti-progestin is more effective than the progestins that are more effective than the combined pills. ECPs do not prevent all pregnancies and for that reason, women who missed their menses despite taking the ECPs are advised to see their doctors for further assessment.
CLEO: Is there a time limit or time frame to take it?
Dr Ida: Despite its name, one should not wait until the next morning to take ECPs. It should be noted that the effectiveness of ECPs decreases the later the pills are taken from the onset of the sexual encounter. The OCPs and progestins are effective up to 72 hours from the time of intercourse. Ulipristal acetate has the longest window period, which is up to 120 hours following the sexual encounter.
For IUCDs, it can be inserted and be effective as an emergency contraception if inserted within five days from the onset of sexual intercourse.
CLEO: Is there a maximum amount of times you can use it?
Dr Ida: There is no maximum amount of times of usage for the ECPs. However, due to its lower effectiveness and high risk of failure, it is always advisable for women who want to avoid having an unintended pregnancy to get on more regular and reliable types of contraception.
This can either be in the form of oral hormonal, injectable hormones intrauterine devices, hormonal implants, and for those suitable, the non-reversible methods like tubal ligation or vasectomy for the males. It should be emphasised as well that emergency contraception does not protect women from sexually transmitted diseases.