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Plan B: An Introduction to Emergency Contraception




Also known as the 'morning after pill' or 'plan B', emergency contraception is unlike other types of contraception. While most contraception, in the form of pills, condoms or other methods, are usually considered before or during sexual intercourse and tends to be used regularly or long term, emergency contraception are mostly used after having unprotected sexual intercourse.


Emergency contraception provides women with the means of preventing an unintended pregnancy. It mainly works by preventing or delaying ovulation, which is the release of an egg. Emergency contraception is intended for occasional emergency use and should not be considered as a substitute for regular contraception.


Pregnancy is theoretically possible after having unprotected sexual intercourse at any day of the menstrual cycle, although it is considered most likely during the 6 days before and including the day of ovulation (known as the fertile period). Predicting the most fertile period is not always precise, therefore it is recommended that women seek emergency contraception after having any unprotected sexual intercourse, to reduce chances of being pregnant. It is recommended to use emergency within 3- 5 days of having intercourse. However the sooner it is taken, the more effective it will be.


Many women are worried about taking emergency contraception whilst possibly being pregnant. However, they can be reassured that emergency contraception does not interrupt an established pregnancy or harm a developing embryo.



Types of emergency contraception


Despite being commonly known as the 'morning after pill', emergency contraception may not necessarily come as a pill. There are 3 types of emergency contraceptive choices currently available:

  • The oral progestogen-only pill (LNG- EC)

  • Oral Ulipristal acetate (UPA-EC or also known as Ella®)

  • The copper intra-uterine device (Copper IUD)


Why is emergency contraception required?


There are several reasons why women might need emergency contraception. They include if:

  • Another method of contraception has failed e.g. a condom has burst or ripped during intercourse.

  • You missed one or more pills or had a delay in starting a new pill pack. This also includes situations in which you may not be sure whether you have used your regular method of contraception correctly (i.e. changed your contraceptive patch or other methods on time).

  • You had unprotected sexual intercourse for any reason and have not been on any birth control.

It is important to know that none of the emergency contraceptive methods mentioned above protect against HIV or other sexually transmitted infections (STIs). Barrier methods such as male and female condoms are most effective in preventing STIs. If you are concerned about whether you may have an STI, you might want to discuss this with a doctor and consider being tested.



Are there any other precautions that are necessary with any method of emergency contraception?


Your periods may be later than your expected date, however if your period is 7 days late, it might be worth considering doing a pregnancy test. The general advice is to do a pregnancy test 3 weeks after taking the emergency contraception.



Is there anything I need to be aware of that requires immediate medical attention?


The following situations will require urgent medical attention:

  • If you have symptoms of a drug allergy which include a swollen face, lips or tongue, difficulty in breathing or a spreading rash, after taking an emergency contraceptive.

  • If you experience severe pain, bleeding and are generally unwell.

  • If the side effects are very bothersome.


 

References

  • https://www.healthhub.sg/a-z/medications/309/Levonorgestrel-prostinor-2

  • https://bestpractice.bmj.com/patient-leaflets/en-gb/pdf/3000186/Contraception%3A%20emergency%20contraception.pdf

  • https://www.healthhub.sg/a-z/medications/152/Ulipristal-Acetate-30mg

  • The Faculty of Sexual & Reproductive Healthcare of the Royal College of Obstetricians & Gynaecologists. (2017, Amended 2020). Emergency Contraception. Retrieved from https://www.fsrh.org/standards-and-guidance/documents/ceu-clinical-guidance-emergency-contraception-march-2017/

  • Bearak J, Popinchalk A, Alkema L, Sedgh G. Global, regional, and subregional trends in unintended pregnancy and its outcomes from 1990 to 2014: estimates from a Bayesian hierarchical model. The Lancet Global Health. 2018;6(4):e380-e9.



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