Emergency Contraception at a Glance

Emergency contraception at a glance

At present there are two methods and three forms of emergency contraception; the copper coil IUD, ellaOne pill and Levonelle pill. All have advantages and disadvantages. The best form in terms of percentage of pregnancies prevented is the copper intrauterine device.
An emergency IUD can be fitted up to five days (120 hours) after unprotected sex or within five days of ovulation (in a 28 days cycle up to day 19) whichever comes later. Patients should be warned that they may get some light bleeding and period type pain following insertion. There is a small risk of uterine perforation as well as a risk of infection. The women should get her next period as expected following insertion of the IUD.
All women should see the GP after 3-4 weeks following insertion of the IUD to check that they are not pregnant and to discuss long term contraceptives. The IUD can of course be used as the LARC and would therefore protect the women against future pregnancies for the next five years.
The Levonelle has been around longer than the ellaOne. It is a pill containing progesterone thatch be used up to 72 hours post unprotected sexual intercourse. There can be some spotting or irregular bleeding from taking the levonelle and the women's next period. The period may it self come a little early or late. Levonelle is less effective than IUD, it can fail however the safety profile in terms of effect on a fetus is better known than the ellaOne. It does not protect the women from future pregnancies and if the women has unprotected sex again she would need a further dose of Levonelle. In terms of additional contraceptive women should be asked to take their regular contraceptive pill (i.e. COCP) within 12 hours of taking Levonelle and to use additional contraception for 9 days (two days for POP). Levonelle can be bought over the counter in the pharmacy.
EllaOne is a tablet that contains ulipristal acetate which is selective progesterone receptor modulator that delays or inhibits ovulation. It is effective for 120 hours post unprotected sex. Its use is cautioned in patients who have liver disease or severe asthma (women should also be told to avoid breastfeeding for up to 36 hours post pill ingestion). Side effects include period pain, mood swings and muscle and back pain. It is not effective if the women vomits with THREE hours of ingestion of the tablet. Unlike the Levonelle if the women has further unprotected sex during cycle then they can NOT HAVE A FURTHER dose of ellaOne (or have it in a cycle where Levonelle has been taken) so the only option remaining to the women would be the IUD.
EllaOne has to be prescribed and is NOT available over the counter.
In terms of the regular contraception the women should be advised that they should take their regular form of contraception within 12 hours of taking the ellaOne. Additional contraception should be used for 14 days with the COCP (16 days for Qlaira) or for 9 days with the POP.
Women who take the Levonelle or the ellaOne should see the GP for a pregnancy txt of their period is more than seven days late, is shorter or lighter than usual, or they have acute lower abdominal pain.