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All you need to know about ECP

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  • Who can use ECP?
    Any woman within the reproductive years (after puberty/menarche and before menopause), irrespective of age and marital status, can use emergency contraceptive pill (ECP) if it is confirmed that she is not pregnant. Reference: Guidelines for Administration of Emergency Contraceptive Pills by Health Care Providers, Ministry of Health and Family Welfare, India
  • Who can not use ECP or should consult a doctor before using it?
    You must NOT use emergency contraceptive pill (ECP), or consult a doctor before using it, if: you've not had your first menstruation or period yet you had unprotected sex more than 72 hours (3 days) ago your period is more than 7 days late or if you have unusual bleeding when your next period is due you suspect that you might be pregnant (feeling sick, vomiting, breast tenderness etc.) if you are allergic (hypersensitive) to levonorgestrel or to any of the other ingredients of Duly ECP you have a disease of your small bowel (such as Crohn’s disease) that interferes with the digestion of your food you have severe liver problems you have ever had an ectopic pregnancy (where the baby develops outside the womb) you have ever had salpingitis (inflammation of the fallopian tubes) you are taking any of the medicines listed below, as these may prevent the ECP from working properly: barbiturates and other medicines used to treat epilepsy (for example, primidone, phenytoin, and carbamazepine); medicines used to treat tuberculosis (for example, rifampicin, rifabutin); a treatment for HIV infection (for example, ritonavir); a medicine used to treat fungal infections (for example, griseofulvin); herbal remedies containing St John’s wort (Hypericum perforatum); ciclosporin, a medicine used to suppress the immune system If any of the above apply to you, talk to a doctor before taking ECP, as it may not be suitable for you. Reference: Levonorgestrel 1.5mg tablets, Recommended Patient Information, WHO
  • Can I use ECP if I'm pregnant?
    No. You should not take emergency contraceptive pill (ECP) if you are already pregnant. If you had unprotected sex more than 72 hours (3 days) ago, you may already be pregnant, and the ECP will not work. If your last period is more than 5 days late or was unusually light or unusually heavy or you suspect that you might be pregnant (feeling sick, vomiting, breast tenderness etc.), you should consult your doctor immediately and take a pregnancy test to confirm that you are not already pregnant. Reference: Levonorgestrel 1.5mg tablets, Recommended Patient Information, WHO
  • Can I use ECP if I’m unsure whether I’m pregnant?
    Emergency contraceptive pill (ECP) may be used if you are unsure whether you are pregnant and you have not taken a pregnancy test, as there is no evidence suggesting that an ECP will harm you or an existing pregnancy. However, it's important to know that if you are already pregnant, an ECP will not be effective. Reference: Guidelines for Administration of Emergency Contraceptive Pills by Health Care Providers, Ministry of Health and Family Welfare, India
  • Can I use ECP if I’m breastfeeding?
    Yes. But... If it has been less than six months since delivery, you are exclusively breastfeeding, and you have not had a menstrual period since delivery, you are not likely to ovulate and, therefore, may not need an emergency contraceptive pill (ECP). However, if you are providing supplementary breastfeeding (along with other sources of nutrition) to your infant, or have had menstrual period since delivery, even a single time, you may be at risk of pregnancy. An ECP is unlikely to have a serious effect on the quantity and quality of milk you produce. Very small amounts of the active ingredient in the ECP may get absorbed into the breast milk, but it is unlikely to affect the infant adversely. Existing data shows that progestin-only contraceptives like levonorgestrel ECP do not have any adverse effect on the newborns after 6 weeks of birth as their liver is capable of metabolizing the hormones efficiently. But if you are worried, you can take the tablet immediately after breastfeeding. In this way, you are taking the tablet well before the next feed and reducing the amount of active ingredient your baby may take in with the breast milk. Reference: Levonorgestrel 1.5mg tablets, Recommended Patient Information, WHO Guidelines for Administration of Emergency Contraceptive Pills by Health Care Providers, Ministry of Health and Family Welfare, India
  • Can ECP be used before puberty or menarche (i.e. first period)?
    No. An emergency contraceptive pill (ECP) is not approved for use before menarche (start of menstruation) or first menstrual period. Reference: Levonorgestrel 1.5mg tablets, Recommended Patient Information, WHO
  • Can ECP be used by children?
    No. An emergency contraceptive pill (ECP) is not recommended for use in children. It must not be used before the first menstruation or menstrual period has occurred. Reference: Levonorgestrel 1.5mg tablets, Recommended Patient Information, WHO
  • Can I use ECP if I have a problem in the legs like varicose veins?
    Yes. As the dose of hormones in an emergency contraceptive pill (ECP) is relatively low, the short exposure to estrogen and/or progestogen does not appear to alter blood-clotting mechanisms. Reference: Guidelines for Administration of Emergency Contraceptive Pills by Health Care Providers, Ministry of Health and Family Welfare, India
  • When can I use ECP?
    You can use emergency contraceptive pill (ECP) as soon as possible within 72 hours (3 days) after unprotected sex. For instance, after: voluntary sex without contraceptive protection incorrect or inconsistent use of regular contraceptive methods, for example, oral contraceptive pills missed for more than 2 days, being late for contraceptive injection, etc. contraceptive failure or mishap, for example, expulsion of an intrauterine device (IUD), slippage/leakage/breakage of condom during sex, etc. sexual assault or coercion The calculation of 72 hours or 3 days should start from the first unprotected penetrative vaginal sex in the current menstrual cycle. ECP is not a regular contraceptive method, and should be used only in case of an emergency.
  • How often can I use ECP?
    An emergency contraceptive pill (ECP) is not intended for repeated use. You should use ECP only in case of an emergency and not as a regular method of contraception. If it is used more than once in a menstrual cycle, it is more likely to upset your periods and menstrual cycle. Additionally, an ECP doesn’t work as well as regular methods of contraception. If you need to use an ECP repeatedly, you should consider regular methods of contraception instead. Reference: Levonorgestrel 1.5mg tablets, Recommended Patient Information, WHO
  • How many times can I take ECP in a month?
    An emergency contraceptive pill (ECP) is not intended for repeated use. It should be used only as a backup option in a contraceptive emergency. As ECP is less effective than regular contraceptives. To avoid it’s repeated use, it’s important to use a regular and more reliable contraceptive method of choice, and avoid contraceptive failure. Reference: Guidelines for Administration of Emergency Contraceptive Pills by Health Care Providers, Ministry of Health and Family Welfare, India
  • Should I use ECP as a continuing method of contraception?
    Relying on emergency contraceptive pill (ECP) as an ongoing method is not advisable. It is not certain that an ECP, taken every time after sex, would be as effective as regular, continuing methods of contraception. Also, if you take an ECP often, you may have more side effects. Repeated use of ECPs poses no known health risks. However, if you take ECPs often, consult a doctor who will screen for health conditions that limit use of hormonal contraceptives. Reference: Family Planning: A Global Handbook for Providers, WHO
  • Should I use ECP during the “infertile period” of the menstrual cycle?
    In practice, it is often difficult to determine with certainty whether a specific act of sex occurred on a fertile or infertile day of the menstrual cycle. Therefore, an emergency contraceptive pill (ECP) should be used within 72 hours if unprotected sex occurred on any day of the cycle. Reference: Guidelines for Administration of Emergency Contraceptive Pills by Health Care Providers, Ministry of Health and Family Welfare, India
  • Can I use ECP before sex?
    No, you should not use an emergency contraceptive pill (ECP) before sex. Presumably, an ECP taken immediately before sex is as effective as an ECP taken immediately afterwards. However, there is no data available on how long the contraceptive effect of an ECP persists after it has been taken. Therefore, if you have the opportunity to plan using a contraceptive method before sex, it is recommended that you use a regular and more reliable contraceptive method. Reference: Guidelines for Administration of Emergency Contraceptive Pills by Health Care Providers, Ministry of Health and Family Welfare, India
  • Can I use ECP after more than one acts of unprotected sex within 72 hours?
    You should use an emergency contraceptive pill (ECP) as soon as possible within 72 hours (3 days) after the first act of unprotected sex, rather than wait until a series of episodes of unprotected sex. As the interval between unprotected sex and ECP use lengthens, the effectiveness of ECP will be lower. Only one ECP should be taken at a time, regardless of the number of prior episodes of unprotected sex. One ECP is only effective for any and all acts of unprotected sex which have occurred within 72 hours prior to taking it. Reference: Guidelines for Administration of Emergency Contraceptive Pills by Health Care Providers, Ministry of Health and Family Welfare, India
  • Can I use ECP more than 72 hours after unprotected sex?
    Studies show that the effectiveness of an emergency contraceptive pill (ECP) declines with time. However, experts suggest that an ECP probably retains some limited effectiveness even after the 72-hour time period (Ellertson et al. 2000; Piaggio et al. 1999). Since an ECP poses no danger either to the woman or to the embryo, it is reasonable to use an ECP even after 72 hours, even though it may fail. It's important to note that there is a possibility of pregnancy if the ECP fails. Reference: Guidelines for Administration of Emergency Contraceptive Pills by Health Care Providers, Ministry of Health and Family Welfare, India
  • Can I use ECP while I’m breastfeeding?
    If you have delivered a baby in the last six months, are exclusively breastfeeding, and have not had a menstrual period/bleeding since delivery, then you are unlikely to ovulate and may not need an emergency contraceptive pill (ECP). However, if you are providing supplementary feeding to the baby (that is, the baby is partially breastfeeding), or you have had a period since delivery even once, then you may be at risk of pregnancy. An ECP is unlikely to have a serious effect on the quantity and quality of breastmilk. Some hormones may get absorbed into the breastmilk but they are unlikely to affect the infant adversely. Existing data shows that progestin-only contraceptives, such as levonorgestrel-only ECPs, do not have any adverse effect on the newborn after 6 weeks of birth as their liver is capable of metabolizing the hormones efficiently. Reference: Guidelines for Administration of Emergency Contraceptive Pills by Health Care Providers, Ministry of Health and Family Welfare, India
  • Do I need a doctor's prescription to purchase ECP?
    No, you don't need a doctor's prescription to purchase emergency contraceptive pill (ECP). Reference: Guidelines for Administration of Emergency Contraceptive Pills by Health Care Providers, Ministry of Health and Family Welfare, India
  • Where can I purchase Duly's ECP in India?
    Duly's emergency contraceptive pill (ECP) can be purchased from most pharmacies and e-pharmacies in India. However, if you notice that it is not available at your favourite pharmacy or e-pharmacy, then drop us a line at hello@dulycare.in, with the name and location/domain of the pharmacy or e-pharmacy, and we will do our best to make it available there. Your convenience is important to us.
  • Can I use ECP along with other medications?
    If you are taking any of the following medications, you should know that the effectiveness of emergency contraceptive pill (ECP) may be reduced: barbiturates and other medicines used to treat epilepsy (for example, primidone, phenytoin, and carbamazepine); medicines used to treat tuberculosis (for example, rifampicin, rifabutin); a treatment for HIV infection (for example, ritonavir); a medicine used to treat fungal infections (for example, griseofulvin); herbal remedies containing St John’s wort (Hypericum perforatum); ciclosporin, a medicine used to suppress the immune system If you are currently taking, have recently taken, or might take any supplements or medicines, especially those listed above, consult a doctor before using ECP. Reference: Levonorgestrel 1.5mg tablets, Recommended Patient Information, WHO
  • Does ECP protect against sexually transmitted infections (STIs)?
    No. An emergency contraceptive pill (ECP) does not protect against STIs. Male latex condoms are proven to protect against STIs. If you feel you are at risk of transmitting an STI, always use a condom during sex, and consult a doctor for advice. Reference: Guidelines for Administration of Emergency Contraceptive Pills by Health Care Providers, Ministry of Health and Family Welfare, India
  • How to use Duly's ECP?
    Take Duly's emergency contraceptive pill (ECP) as soon as possible within 72 hours (3 days), after the first episode of unprotected sex in the current menstrual cycle. Do not delay taking the tablet, it works better the sooner you take it after unprotected sex. Swallow the tablet whole, with water if necessary, before or after food. If you are unsure whether you should use or how to use, consult a doctor immediately. Reference: Levonorgestrel 1.5mg tablets, Recommended Patient Information, WHO
  • How can my partner help if I need to use an ECP?
    We love that your partner wants to help. Here are some ways: Support your decision to use an ECP Understand and support your need to choose and use a regular contraceptive method Help to make sure you have an ECP on hand in case you need it again If you need an ECP because of a mistake with a method, understand and support correct use of the method or discuss using a different method
  • Why should I keep an ECP on hand before I need it?
    Studies of women having an emergency contraceptive pill (ECP) on hand report these findings: Women did not have unprotected sex more often. Women continued to use other contraceptive methods as they did before obtaining an ECP in advance. Women who had an ECP on hand took it sooner after having unprotected sex than women who had to seek out an ECP. Women who had an ECP on hand were more likely to use it when needed than women who had to go to a provider to get it. Progestin-only ECP (like levonorgestrel-only ECP) is more likely to be effective when taken sooner. Reference: Family Planning: A Global Handbook for Providers, WHO
  • What if I vomit after taking ECP?
    If you vomit within 2 hours of taking emergency contraceptive pill (ECP), you will need to take it again, as the medication may not be absorbed by your body. If you continue to vomit, consult a doctor immediately for advice. Reference: Guidelines for Administration of Emergency Contraceptive Pills by Health Care Providers, Ministry of Health and Family Welfare, India
  • What are the possible side effects of ECP?
    Overall an emergency contraceptive pill (ECP) is well tolerated. However, like all medicines, an ECP can cause some side effects too, but not everyone using it may experience these, and these generally do not last more than 1-2 days. Possible side effects of an ECP are similar to what women may face in the first weeks of starting on an oral contraceptive pill. Very common (may affect more than 1 in 10 people) side effects may include: feeling sick (nausea) having some irregular bleeding before the next period lower abdominal pain tiredness headache Common (may affect up to 1 in 10 people) side effects may include: being sick (vomiting) unusual period period later or earlier than normal irregular bleeding or spotting before the next period tender/sore breasts diarrhoea feeling dizzy Very rare (may affect up to 1 in 10,000 people) side effects may include: abdominal pain rash urticaria pruritus swelling of the face pelvic pain painful period If you experience any side effect that persists, or is worrying you, or is not mentioned above, consult your doctor immediately. Reference: Levonorgestrel 1.5mg tablets, Recommended Patient Information, WHO
  • How to manage possible side effects?
    If vomiting occurs within 2 hours of taking Duly emergency contraceptive pill (ECP), then repeat the dose. If your menstrual period is delayed by more than 7 days, take a pregnancy test to exclude the possibility of pregnancy. If you experience any breast tenderness/soreness, headache, dizziness, and fatigue, these generally do not last more than 24 hours. However, a Paracetamol or Aspirin or Ibuprofen can be safely taken for breast tenderness and headache. An ECP may change the amount, duration, and timing of the next period. These effects are usually minor and do not need any treatment. Some irregular bleeding or spotting after taking an ECP is also normal, however, it should not be confused with periods. Most women have their periods on time, or slightly early or later than the expected date. Reference: Guidelines for Administration of Emergency Contraceptive Pills by Health Care Providers, Ministry of Health and Family Welfare, India
  • What if there is a change in the timing of my next period after using ECP?
    It is normal for the period to start a few days earlier or later than expected after taking an ECP. However, if your period is more than 7 days later than expected, take a pregnancy test to exclude the possibility of a pregnancy. If the test is positive, consult a doctor immediately. Reference: Guidelines for Administration of Emergency Contraceptive Pills by Health Care Providers, Ministry of Health and Family Welfare, India
  • What if my period is delayed by more than 7 days?
    You should take a pregnancy test to exclude the possibility of a pregnancy, and consult a doctor immediately in case the test is positive. Reference: Guidelines for Administration of Emergency Contraceptive Pills by Health Care Providers, Ministry of Health and Family Welfare, India
  • How will I know if the ECP worked?
    If your next period is more than 5 days late, or it is unusually light or unusually heavy, or if you continue to use a regular contraception method like an oral contraceptive pill and do not have a menstrual bleeding in your pill-free break, you should contact your doctor as soon as possible and take a pregnancy test. If you do become pregnant even after taking an emergency contraceptive pill (ECP), it is important that you consult your doctor immediately to discuss your options. Reference: Levonorgestrel 1.5mg tablets, Recommended Patient Information, WHO
  • What if the ECP fails?
    An emergency contraceptive pill (ECP) is not 100% effective. If you do become pregnant even after taking it, it is important that you see a doctor immediately. There is no evidence that an ECP will harm an unborn baby, but your doctor may want to check that the pregnancy is not ectopic (where the baby develops somewhere outside the womb). This is especially important if you develop severe abdominal pain or fainting after taking the ECP, or if you have previously had an ectopic pregnancy, fallopian tube surgery or pelvic inflammatory disease. Reference: Levonorgestrel 1.5mg tablets, Recommended Patient Information, WHO
  • Can ECP harm an existing pregnancy or a pregnancy caused by its failure?
    No. Studies show that an emergency contraceptive pill (ECP) does not have an adverse effect on pregnancy. Reference: Guidelines for Administration of Emergency Contraceptive Pills by Health Care Providers, Ministry of Health and Family Welfare, India
  • For how long can ECP prevent pregnancy?
    An emergency contraceptive pill (ECP) can only help prevent a possible pregnancy resulting from unprotected sex that occurred within 72 hours prior to taking it. It is possible to become pregnant the next time you have sex unless you start using another method of contraception. Because the ECP may delay ovulation in some women, you may be most fertile soon after taking the ECP. If you want ongoing protection from pregnancy, you can start using a barrier method like a condom till the beginning of your next menstrual period, and then start using a regular contraceptive method like an oral contraceptive pill, intrauterine device (IUD), contraceptive implant, etc. within the first 7 days of your next menstrual period. Reference: Family Planning: A Global Handbook for Providers, WHO Guidelines for Administration of Emergency Contraceptive Pills by Health Care Providers, Ministry of Health and Family Welfare, India
  • Will ECP protect me from unprotected sex in future?
    No, emergency contraceptive pill (ECP) that you took will not protect you from any unprotected sex in future. Reference: Guidelines for Administration of Emergency Contraceptive Pills by Health Care Providers, Ministry of Health and Family Welfare, India
  • What if I have sex again after using ECP?
    If you have sex after using an emergency contraceptive pill (ECP), and are not using a regular contraceptive method, you should use a barrier method like condoms. This is because an ECP won’t work if you have unprotected sex again. You should also consult a doctor to discuss regular contraceptive options which are more reliable in preventing an unintended pregnancy. Reference: Levonorgestrel 1.5mg tablets, Recommended Patient Information, WHO
  • Which contraceptive methods can I use after using ECP?
    You can use a regular contraceptive method, or return to the method that you were using earlier, or switch to a different method that is more suitable, whichever you prefer. You can continue or choose any of the following contraceptive method after using an emergency contraceptive pill (ECP): • Condom • Oral contraceptive pill • Intrauterine copper device (IUCD) (if not used as an emergency contraceptive already) • Injectable contraceptive like DMPA • Implant like Norplant • Sterilization Reference: Guidelines for Administration of Emergency Contraceptive Pills by Health Care Providers, Ministry of Health and Family Welfare, India
  • How soon after using Duly ECP should I use a regular contraceptive?
    You can resume your current contraceptive method like condom or oral contraceptive pill immediately after using Duly emergency contraceptive pill (ECP). If you are not using any contraceptive method currently, you can start using condoms till the beginning of your next menstrual cycle/period, and then start using a regular contraceptive method like oral contraceptive pill, intrauterine device (IUD), contraceptive implant, etc. within the first 7 days of your next menstrual cycle/period. Reference: Guidelines for Administration of Emergency Contraceptive Pills by Health Care Providers, Ministry of Health and Family Welfare, India
  • What are the advantages of an ECP as a backup method for contraceptive emergencies?
    An emergency contraceptive pill (ECP) can be used by women to avoid an unintended or unwanted pregnancy, after unprotected sex (where contraceptive was forgotten or not used) or contraceptive failure (where the contraceptive method broke/ slipped during sex), if taken as soon as possible within 72 hours (3 days) after the first episode of unprotected sex or contraceptive failure. An emergency contraceptive pill (ECP): Is safe and effective Is easy to use and widely available Can be taken at any time during the monthly cycle Does not require a physical examination Is available without a prescription Can be used by women for whom use of oral contraceptive pill is contraindicated Can be used as needed, although it is not a substitute for regular contraception Doesn’t have serious medical complications reported Has relatively lesser hormones taken over time Doesn’t have metabolic effects due to the short exposure Is not associated with fetal malformations/congenital defects Does not increase the risk of ectopic pregnancy Reference: Guidelines for Administration of Emergency Contraceptive Pills by Health Care Providers, Ministry of Health and Family Welfare, India
  • Is an ECP safe?
    Yes. An emergency contraceptive pill (ECP) can be used by women who cannot use oral contraceptive pills regularly, such as those with a history of hypertension, or severe migraine. This is because an ECP is taken for a short span of time and, consequently, may not have any side effects that may develop due to long-term use. Reference: Guidelines for Administration of Emergency Contraceptive Pills by Health Care Providers, Ministry of Health and Family Welfare, India
  • Can an ECP increase the risk of an ectopic pregnancy?
    No, an emergency contraceptive pill (ECP) neither prevents nor increases the chance of an ectopic pregnancy (a pregnancy that develops outside the uterus but inside the fallopian tube/abdomen). Reference: Guidelines for Administration of Emergency Contraceptive Pills by Health Care Providers, Ministry of Health and Family Welfare, India
  • Can an ECP harm the fetus if I take it accidentally while I'm pregnant?
    No. There is no evidence to show that an emergency contraceptive pill (ECP) will cause birth defects or otherwise harm the fetus if you are already pregnant when you take an ECP or if the ECP fails to prevent pregnancy. Reference: Family Planning: A Global Handbook for Providers, WHO
  • Can an ECP affect fertility in future?
    No. You can become pregnant if you have unprotected sex again after taking an emergency contraceptive pill (ECP). An ECP prevents pregnancy only from acts of sex that took place in the 3 days prior. To stay protected from pregnancy, you must begin to use another contraceptive method. There is no data available on long term fertility after ECP use. Reference: Levonorgestrel 1.5mg tablets, Recommended Patient Information, WHO Family Planning: A Global Handbook for Providers, WHO
  • How effective is an ECP?
    It’s important to know that not every woman will become pregnant after unprotected sex, even if she does not take an emergency contraceptive pill (ECP). However, it’s also impossible to predict accurately who would become pregnant after unprotected sex and who would not. The probability of conception after a single act of sex is approximately 8%, and a normally fertile, sexually active couple not using contraception, has an average monthly chance of conceiving of 20-25% (counting pregnancies that result in live births). An ECP, if taken within 72 hours (3 days) after unprotected sex, is 85% effective. It is more effective if used within 12-24 hours after unprotected sex. A delay in taking the ECP decreases its effectiveness. Additionally, the closer a woman is to ovulation at the time of unprotected sex, the higher is the pregnancy risk and lower is the effectiveness of the ECP. Reference: Guidelines for Administration of Emergency Contraceptive Pills by Health Care Providers, Ministry of Health and Family Welfare, India
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