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Emergency contraception options

What options are there after unprotected sex?

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We all know that having unprotected sex is a poor decision to make on several levels! Not only do you risk becoming pregnant but you also risk becoming infected with a large selection of sexually transmitted diseases, some of which can cause permanent long term issues.

The need for emergency contraception may be as a result of not having used any other form of contraception or condom breaking. What you need to realise is that even if you were using other forms of contraception, under some circumstances, you may still be at risk of becoming pregnant and these include:

  • You did not take some of your pills
  • You forgot to put the contraceptive patch on
  • Your contraceptive implant is overdue for replacement

Lecture over, these things happen and the priority is to find out what the options are regarding an unwanted pregnancy.

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Types of emergency contraception

There are two main categories of emergency contraception, the morning after pill or emergency contraceptive pill or the intrauterine device, otherwise known as an IUD or copper coil.

The morning after pill

The morning after pill prevents a fertilised egg from implanting into the wall of the uterus. This is what defines it as a form of contraception as it is preventing the pregnancy from the beginning rather than, as some people think, causing the termination of an established pregnancy. There are two types of morning after pill which contain different active ingredients:

  • Levonelle - the active ingredient in Levonelle is levonorgestrel. This is a synthetic hormone of progesterone which is a natural hormone produced in the ovaries. The action of levonorgestrel is to prevent or delay ovulation (the release of an egg from the ovaries). Levonelle must be taken within 72 hours of having unprotected sex and the earlier it is taken the more effective it is
  • ellaOne - the active ingredient in ellaOne is ulipristal acetate which interferes with the normal action of progesterone; as a result, it prevents or delays the release of an egg during ovulation. The advantage of ellaOne is that it is effective for a longer period and it can be taken up to one hundred and twenty hours (five days) after having unprotected sex

Neither type of pill can protect against becoming pregnant should you have unprotected sex again. They are not designed to be used as a regular form of contraception, however, it is possible to repeat the use of either pill within a single menstrual cycle.

For the sake of speed and if you feel that you may have unprotected sex in the future, it may be an option to hold a morning after pill in stock; it is advisable to seek advice from your GP.

The intrauterine device

The IUD is a small ‘T’ shaped copper and plastic device that is inserted into the uterus by a medical professional. It releases copper and this prevents a fertilised egg from becoming implanted in the wall of the uterus.

The IUD can be implanted up to five days after intercourse or five days after the earliest date that ovulation may have occurred. The IUD is the most effective form of emergency contraception.

Which emergency contraception would suit you best?

As with any form of medication or device, suitability may be restricted for some individuals:

  • In the case of the morning after pill, it is suitable for most women to take. There are a number of reasons however that this may not be the case:
  • If you are allergic to any of the ingredients in the pills
  • If you have severe asthma
  • If you take medication to treat epilepsy
  • If you are taking medication to treat epilepsy
  • If you take the herbal remedy St John’s Wort
  • If you are taking some medicines to treat stomach acid such as omeprazole
  • If you are taking some less common antibiotics such as rifampicin or rifabutin

ellaOne cannot be used with any of this medication but Levonelle will still be effective although the dose may need to be increased.

Levonelle is also considered to be safe if a woman is breastfeeding but there is not sufficient data surrounding the safety of ellaOne so if a woman chooses to use this, it is recommended to stop breastfeeding for one week after taking the pill.

The IUD is also suitable for use by most women. Again, it may not be suitable for use by some women for the following reasons:

  • You have an untreated sexually transmitted infection or a pelvic infection
  • There are any problems with the uterus or cervix
  • You have unexplained periods of bleeding between each menstrual period or after sexual intercourse

It is safe to use an IUD if you are breastfeeding but not if you may be pregnant.

Side effects of emergency contraception

In the case of the morning after pill, side effects are not serious or long lasting but may include:

Headache

Abdominal pain Your next period may be later than expected or more painful
If you are actually vomiting within two hours of taking Levonelle or three hours of taking ellaOne then it will be necessary to seek medical attention as you will either need to repeat the dose or have an IUD fitted

If the symptoms persist for more than a few days you may need to seek medical attention:

  • You think you may be pregnant
  • Your next period is more than a week late
  • Your period is shorter or lighter than usual
  • You have sudden abdominal pain in which case a fertilised egg may have implanted outside the uterus, also known as an ectopic pregnancy

In the case of the IUD, complications of having them fitted are rare but may include:

  • Pain
  • Infection
  • Damage to the uterus
  • Expelling the IUD
  • Heavier, longer and more painful periods

Where can you obtain emergency contraception?

An IUD has to be fitted by a healthcare profession either at a sexual health clinic, GP surgery or contraception clinic. This service is free of charge on the NHS.
In the case of the morning after pill there are a number of places where Leonelle and ellaOne can be obtained for free. They include:

  • Contraception clinics
  • Brook centres
  • Some pharmacies
  • Most sexual health or genitourinary medicine clinics
  • Most NHS walk in centres and minor injuries units
  • Most GP surgeries
  • Some hospital A&E departments

It is also possible to buy the morning after pills from most pharmacies, high street and online as well as organisations such as British Pregnancy Advisory Service and Marie Stopes.

The price of Levonelle can vary hugely and can vary anywhere from £13 to £25. However, if you are under sixteen years old you will need to get a prescription from a doctor
If you are under sixteen years old you can buy ellaOne without a prescription and the cost will be anywhere between £20 and £35.

Conclusion

Emergency contraception is freely available in the UK and is also available free of charge on the NHS. There is no reason for any woman to proceed with a pregnancy that is truly not wanted and this has changed the lives of many women in this country.

A prescription is only necessary if you are under sixteen years old and specifically want to use Levonelle.

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