Emergency contraception (birth control after sexual intercourse) is the use of a drug or device to prevent pregnancy after unprotected

sexual intercourse. or emergency postcoital contraception Emergency contraception can be used when a condom breaks, if a diaphragm or cervical cap slips out of place during intercourse, after a sexual assault, or any time unprotected intercourse occurs. Emergency contraceptive pills are sometimes called the morning-after pill, but they are usually effective if taken within !" hours of unprotected sexual intercourse. #orms of E$ include%

Emergency contraceptive pills (E$&s)'sometimes simply referred to as emergency contraceptives (E$s) or the (morning-after pill('are drugs that act both to prevent ovulation or fertili)ation and possibly post-fertili)ation implantation of a blastocyst (embryo). E$&s are distinct from medical abortion methods that act after implantation.*+,

-ntrauterine devices (-./s)'usually used as a primary contraception method, but sometimes used as emergency contraception.

Emergency contraceptive measures can be taken within the first !" hours after unprotected sexual intercourse to reduce the possibility of pregnancy. 0 woman is most likely to become pregnant if sexual intercourse occurs in the few days before or after ovulation (release of an egg from the ovary).
Since EC methods act before implantation, they are medically and legally considered forms of contraception.

Emergency Contraceptive Pills

Emergency contraception pills contain high doses of the same hormones that are in birth control pills. 1he high dose of hormones is short lived. 1hese pills are not designed to terminate an existing pregnancy and should not be confused with 2ifeprex, also referred to as 3.-456, which is used to terminate (abort) an existing pregnancy. Emergency contraceptive pills are taken in " doses, +" hours apart. 1he &reven plan consists of " doses of pills, each containing a combination of estrogen and progestin, taken +" hours apart.

1he first dose should be taken within the first !" hours after unprotected intercourse. 7ome studies show they are effective if taken after that time (up to +"8 hours), but they are most effective in the first !" hours. 0ccording to the 3eproductive 9ealth 1echnologies &ro:ect, &reven reduces the chance of pregnancy by !;< when used as directed. &lan = is a progestin-only emergency contraceptive. &lan = should be used within !" hours of unprotected intercourse. 1he first dose should be taken as soon as possible after unprotected intercourse, and the second dose is taken +" hours later. 1he sooner it is used, the more effective it is. 0ccording to the 3eproductive 9ealth 1echnologies &ro:ect, &lan = reduces the chance of pregnancy by 5>< when used as directed. 1he sooner after intercourse that emergency contraceptive pills are taken, the more effective they are. Emergency contraception pills are currently available by prescription only. Examination, history may be re?uired. -@/-0 A i-pill is available B1$. $ontact your health care provider or see the contact information in #or 2ore -nformation if you are seeking emergency contraception. $ost depends on the health care facility, and may be provided on a sliding scale based on income. &rices for emergency contraceptive pills generally range from C5 to C;8.

Types of ECPs
1he progestin-only method uses the progestin levonorgestrel in a dose of +.; mg, either as two !;8 Dg doses +" hours apart, or more recently as a single dose. 1he combined or Eu)pe regimen uses large doses of both estrogen and progestin, taken as two doses at a +"-hour interval. 1his method is now believed to be less effective and less well-tolerated than the progestin-only method.*4, -t is possible to obtain the same dosage of hormones, and therefore the same effect, by taking several regular combined oral contraceptive pills. 1he drug mifepristone may be used either as an E$& or as an abortifacient, depending on whether it is used before or after implantation.

Existing pregnancy is not a contraindication in terms of safety, as there is no known harm to the woman, the course of her pregnancy, or the fetus if progestin-only or combined emergency contraception pills are accidentally used, but E$ is not indicated for a woman with a known or suspected pregnancy because it is not effective in women who are already pregnant. 1he Forld 9ealth Brgani)ation (F9B) lists no medical condition for which the risks of emergency contraceptive pills outweigh the benefits.

1he 0merican 0cademy of &ediatrics (00&) and experts on emergency contraception have concluded that progestin-only E$&s may be preferable to combined E$&s containing estrogen in women with a history of blood clots, stroke, or migraine. 1he 00&, 0merican $ollege of Bbstetricians and Gynecologists (0$BG), ..7. #ood and /rug 0dministration, F9B, 3oyal $ollege of Bbstetricians and Gynaecologists, and other experts on emergency contraception state that there are no medical conditions in which progestin-only E$&s are contraindicated. 1he herbal preparation of 7t HohnIs wort and some en)yme-inducing drugs (e.g. anticonvulsants or rifampicin) may reduce the effectiveness of E$&, and a larger dose may be re?uired.*JJ,*J4, 1he 00&, 0$BG, #/0, F9B, 3$BG, and experts on emergency contraception have concluded that E$&s, like all other contraceptives, reduce the absolute risk of ectopic pregnancy by preventing pregnancies, and that the best available evidence, obtained from over !,588 women in randomi)ed controlled trials, indicates there is no increase in the relative risk of ectopic pregnancy in women who become pregnant after using progestin-only E$&s.*"4,*"6,*"!,*"5,*">,*J8,*J+,*J",*JJ,*J;,

Side effects
1he most common side effect reported by users of emergency contraceptive pills was nausea (;8.;< of >!> Eu)pe regimen users and "J.+< of >!! levonorgestrel-only users in the +>>5 F9B trialK +4.J< of ",!"8 levonorgestrel-only users in the "88" F9B trial)K vomiting is much less common and unusual with levonorgestrel-only E$&s (+5.5< of >!> Eu)pe regimen users and ;.6< of levonorgestrel-only users in the +>>5 F9B trialK +.4< of ",!"8 levonorgestrel-only users in the "88" F9B trial).*4,*+>,*JJ, 0nti-emetics are not routinely recommended with levonorgestrel-only E$&s.*JJ,*J6, -f a woman vomits within " hours of taking a levonorgestrel-only E$&, she should take a further dose as soon as possible.*JJ,*J!, Bther common side effects (each reported by less than "8< of levonorgestrel-only users in both the +>>5 and "88" F9B trials) were abdominal pain, fatigue, headache, di))iness, and breast tenderness.*4,*+>,*JJ, 7ide effects usually do not occur for more than a few days after treatment, and they generally resolve within "4 hours.*"4, 1emporary disruption of the menstrual cycle is also commonly experienced. -f taken before ovulation, the high doses of progestogen in levonorgestrel treatments may induce progestogen withdrawal bleeding a few days after the pills are taken. Bne study found that about half of women who used levonorgestrel E$&s experienced bleeding within ! days of taking the pills.*J5, -f levonorgestrel is taken after ovulation, it may increase the length of the luteal phase, thus delaying menstruation by a few days.*J>, 2ifepristone, if taken before ovulation, may delay ovulation by JA4 days.*48, (/elayed ovulation may result in a delayed menstruation.)

1hese disruptions only occur in the cycle in which E$&s were takenK subse?uent cycle length is not significantly affected.*J5, -f a womanIs menstrual period is delayed by a week or more, it is advised that she take a pregnancy test.*4+, (Earlier testing may not give accurate results.)

Emergency Intrauterine Device

1he -./ used for emergency contraception is the $opper 1 J580 -./ (&araGard). -t can be inserted up to ; days after unprotected sexual intercourse but should be inserted as soon as possible. 1he -./ can be removed after your next menstrual period, when it is confirmed that you are not pregnant. Eou can use the -./ for long-term birth control. 1he copper -./ can be left in place for up to +8 years for contraception, and it is a reversible form of birth control. &lanned &arenthood cites emergency -./ insertion as being >>.>< effective. -./s should only be inserted and removed by health care professionals. 1his type of -./ can be left in place for up to +8 years.

How Emergency Contraception Wor s

Emergency contraception prevents pregnancy by stopping or delaying release of an egg (ovulation), blocking fertili)ation by affecting the egg or sperm, or preventing implantation by making the lining of the uterus inhospitable for pregnancy. &regnancy is defined by the medical community as implantation of a fertili)ed egg in the lining of a womanLs uterus, so emergency contraception works before pregnancy has occurred. 0 pregnancy test is not useful because emergency contraception is used to prevent pregnancy rather than to abort an existing pregnancy. 0 woman who uses emergency contraception will never know if a pregnancy would have otherwise occurred. #ertility returns with the next cycle unless a birth control method is continued. -n order for emergency contraceptive pills to be effective, they must be taken as directed.

Mechanism of action
1he .nited 7tates #/0 states that progestin-only E$&s like &lan = work by preventing ovulation. -t also says (it is possible( that progestin-only E$&s may interfere with the embryo implanting in the uterine lining, and that they have no effect on pregnancies if taken after implantation.*+8!,*+85, 0 number of studies in the +>!8s and 58s concluded that emergency contraception could cause changes in the endometrium*+8>, that would prevent implantation of an early-stage embryo in the uterus. 1his research led many pro-life advocates, who believe that pregnancy begins at fertili)ation, to oppose E$&s as an abortifacient. Fhen used as a regular method of contraception, -./s have been proven to act primarily through spermicidal and ovicidal mechanisms, but it is considered possible that these same mechanisms are also harmful to embryos that have not yet implanted.*++;, 9ormonal progestin-only and combined estrogen-progestin emergency contraceptives such as Eu)pe regimen or &lan = differ from the anti-hormonal drug mifepristone (also known as 2ifeprex and 3.-456). Eu)pe and progestin-only emergency contraception will have no effect if taken after implantation, whereas mifepristone can induce abortion if taken after implantation.

!enefits and Drawbac s

Effectiveness" 0ccording to &lanned &arenthood and the 3eproductive 9ealth 1echnologies &ro:ect, if taken within the first !" hours of unprotected intercourse, emergency contraceptive pills are !;-5>< effective in reducing the risk of pregnancy. 1he effectiveness rate of !;< does not mean a ";< failure rate. -nstead, when considering +88 women who have had unprotected intercourse during the middle " weeks of their cycle, about 5 became pregnant. -f those 5 had used emergency contraception, only " would have become pregnant. Emergency contraception pills work best when used as soon as possible after unprotected sexual intercourse. &lanned &arenthood cites emergency -./ insertion as being >>.>< effective. #dvantages" Emergency contraception is a safe form of backup birth control if your birth control fails or if you have unprotected sexual intercourse. -t is used after intercourse but before pregnancy has occurred. 0fter use, fertility returns to normal unless a form of birth control is continued. Disadvantages" $ommon side effects of emergency contraceptive pills are similar to those of birth control pills. 1hey include nausea, abdominal pain, fatigue, headache, and menstrual changes. =reast tenderness, fluid retention, and di))iness may also occur. 2any of these symptoms may be less severe with progestin-only or intrauterine forms of emergency contraception.

7erious risks include heart attack, blood clots, and strokes. Emergency contraceptive pills do not continue to protect against pregnancy during the rest of the cycle. Emergency contraception may not prevent tubal pregnancy. -f you experience severe abdominal pain, contact your health care provider immediately. 1ubal pregnancy can be life threatening. 7ide effects of -./s used for emergency contraception are the same as those for ongoing birth control -./s. Emergency contraception does not protect against sexually transmitted infections, nor does it treat existing infections. Emergency contraceptives should not be used as a contraceptive method in women who are sexually active or planning to become sexually active. 1hey are not as effective as any ongoing contraceptive method. $ases of deep vein thrombosis (blood clotting) have been reported in women using the emergency method.
As its name implies, EC is intended for occasional use, when primary means of contraception fail.

1he current (Bctober "88;) AAP Policy Statement on Emergency Contraception states% (1he concern that widespread emergency contraception use would encourage unprotected coitus in teens is not supported in the literature.(*"6, 1he current (/ecember "88;) ACOG Practice Bulletin on Emergency Contraception states% (0 prominent concern among both women and health care providers is that making emergency contraception more readily available could encourage irresponsible sexual behavior, which would increase the risks of both unintended pregnancy and sexually transmitted diseases. 9owever, numerous studies have shown that this concern is unfounded.(*"5, 1he latest (0pril "88!) review by emergency contraception experts 1russell and 3aymond *"4, states% (3eported evidence demonstrates that making E$&s more widely available does not increase risk-taking*5!,*55,*5>,*>8,*>+,*>",*>J,*>4,*>;,*>6,*>!, and that women who are the most diligent about ongoing contraceptive use are those most likely to seek emergency treatment.(*>5, 9owever, the availability of E$&s has not been shown to lower abortion rates. -n #rance, 7weden, and =ritain'where Eu)pe-regimen E$ had been available by prescription for more than a decade and progestin-only E$ has been available without a prescription for 5, 6, and " years respectively'the abortion rate was stable or higher during that time period.*>>, 0nother study concluded that distribution of free, advance supplies of E$ to large numbers of women in 7cotland did not reduce abortion rates.*+88, 0 randomi)ed controlled trial of "888 women in $hina compared women with advance access to E$ to women without access, and noted that

the pregnancy rate was the same between the two groups. 1he study observed that (...providing E$ in advance increases use, but there is no direct evidence that it reduces unintended pregnancy( and concluded that E$ may not lower abortion rates.*+8+,
Some scientists believe that EC may possibly act after fertilization (see Mechanism of action , a possibility that leads some to consider EC an abortifacient.

Women w$o s$ould not use emergency contraception" Fomen who are pregnant, those with undiagnosed vaginal bleeding, and women with an allergy to the product should not use emergency contraceptive pills. -./ use for emergency contraception is not recommended for women who are not in an established monogamous relationship and those who have been raped. Emergency contraception pills are not +88< effective in preventing pregnancy, even when taken within !" hours of intercourse. Eou still have a risk for pregnancy. Eou may need follow-up care if your normal menstrual cycle does not occur. $ontact your health care provider if you do not have your period within J weeks of using emergency contraception or have symptoms of pregnancy. $ontraceptive pills do not provide any protection against sexually transmitted diseases. $onsider testing for sexually transmitted infections if the unprotected intercourse may have put you at risk. Eou may need follow-up care in the next few weeks if you develop any symptoms of sexually transmitted infections, such as pain, itching, sores, or discharge. Emergency contraception is not as effective as ongoing birth control. -t should not be used routinely instead of birth control. -f you are sexually active and wish to avoid pregnancy, you may wish to consider using a consistent form of birth control.

!regnancy test re"uired if no period seen after # wee$s !eriods % EC! may disrupt ne&t menstrual period by couple days. '()s may ma$e menstruation heavier and more painful *enefits '()s may be subse"uently left in place for ongoing contraception +is$s As per methods