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EMERGENCY CONTRACEPTION

Emergency contraception refers to a back-up form of contraception that works to prevent pregnancy after intercourse in the following situations:

 

  • You didn’t use any birth control

  • Your condom came off or broke

  • You missed one or more birth control pills

  • You were late starting your pill pack

  • You were late getting your Depo-Provera shot

  • You were sexually assaulted and/or raped

  • You didn’t have intercourse, but semen came near the vagina

  • You miscalculated your non-fertile days and didn’t use contraception

The closer to the intercourse that emergency contraception is used, the more effective it will be in preventing pregnancy, so do not delay in seeking treatment. Emergency contraception does not provide protection from any STIs.

 

There are currently two types of contraception that can be used as emergency contraception:

  • Emergency Contraceptive Pills (ECP)

  • Copper IUD

NO PRESCRIPTION IS REQUIRED FOR ECP

Emergency Contraceptive Pills (aka "the morning after pill" are available over the counter (without a health card) at any local pharmacy, usually for about $40.

EMERGENCY CONTRACEPTIVE PILLS (ECP)

Emergency Contraceptive Pills (ECP) are most commonly referred to as the “morning-after pill.” There are currently three types of emergency contraceptive pills available in Canada: the levonorgestrel progestin-only method (Plan B®), the ulipristal acetate method (Ella®), and a method that involves using birth control pills that both estrogen and progestin in a special dosing pattern (Yuzpe).

 

The Yuzpe method does not work as well as the dedicated ECP products ( Plan B® or Ella®); this method involves taking combined oral contraceptive pills that contain ethinyl estradiol and progestin; they must be taken in a dosing pattern that is very different from use as an oral contraceptive. Use of the Yuzpe method should be reserved for situations where people can obtain combined oral contraceptive pills but cannot obtain a dedicated ECP (Plan B® or Ella®) product within two to three days. Nausea and vomiting is more common with the Yuzpe method; it is also not appropriate for people who cannot safely take estrogen.

How Does ECP Prevent Pregnancy?

  • It can prevent the egg from leaving the ovary

  • It can prevent the sperm from meeting the egg

  • It can prevent the fertilized egg from attaching to the uterus

 

ECP must be used as soon as possible within 72 hours of unprotected sexual intercourse or known or suspected contraceptive failure. Treatment for emergency contraception should begin as soon as possible; however, treatment is still moderately effective if used within 5 days and should be made available to patients who may become pregnant up to 5 days after unprotected or inadequately protected intercourse. It may be used at any time during menstrual cycle and may be used more than once within the same cycle (ACOG 2015).

 

It does not cause disruption to the embryo once fertilization and implantation has occurred. In other words, ECP prevents pregnancy, but does not cause a miscarriage or abortion. 

Advantages of Using ECP

  • ECP is the only oral method of contraception used to prevent pregnancy after unprotected sex.

  • It works: Plan B® is 97.4 - 98.3% effective in preventing pregnancy when used within 72 - 120 hours of a single episode of unprotected intercourse; Ella® is 98.2 - 98.8% effective in preventing pregnancy when used within 72 - 120 hours of a single episode of unprotected intercourse

  • It is available without a prescription from pharmacies.
     

Disadvantages of Using ECP

  • ECP does not work if you are already pregnant

  • It must to be used within a limited time frame to be effective

  • It cannot be used as a regular method of birth control

  • Most people tolerate ECP; however it can cause minor side effects in some users such as fatigue, breast tenderness, headache, and abdominal pain. People rarely feel nauseated after taking Plan B® or Ella®. It may cause changes in the next menstrual period.

  • ECP works less well in overweight (BMI 25 to 29.9 kg/m2) and obese (BMI ≥30 kg/m2) individuals due to decreased concentrations of the medication in blood.

  • It does not offer protection against STIs

EMERGENCY (COPPER) IUD 

The emergency IUD is the same copper IUD that is used as a birth control method. The IUD can be used in an emergency to prevent pregnancy up to 7 days after the unprotected sex occurred.

How Does It Prevent Pregnancy?

  • The copper IUD prevents pregnancy by changing the environment of the endometrial cavity and altering sperm function. There are no hormones involved.

  • The copper IUD can be used as emergency contraception when used within 7 days after unprotected sex.

  • It is a very reliable method of contraception, with a failure rate of 1.26 per 100 patients-years (WY) and an ectopic pregnancy rate of 0.25 per 100 WY.

 

Advantages of Emergency IUD

  • It is more effective than emergency contraceptive pills (ECP), a greater number of hours beyond the unprotected sex.

  • Body weight does not impact the efficacy of the copper TCu380A IUD, which in part contributes to its overall high efficacy

  • The IUD can be kept in place and used as regular method of birth control for 3-10 years (depending on the device).
     

Disadvantages of Emergency IUD

  • It may cause cramping and some spotting during and/or after insertion.

  • The copper IUD requires an appointment with a doctor for a prescription and/or the insertion procedure.

  • Copper IUDs may be slightly more expensive than ECP (approximately $50 plus dispensing fee from the pharmacy), and sometimes are not covered by private insurance plans.​

FOLLOW-UP

You should get your period within 3 weeks of using emergency contraception.  If you do not have a period within three weeks of initiating either form of emergency contraception you should perform a pregnancy test. Seek medical attention if you experience heavy bleeding with abdominal pain (concerning for ectopic pregnancy); have a positive pregnancy test; or if you have any concerns regarding lack of return of menses, bleeding, or any other questions.