EMERGENCY CONTRACEPTION (1):

WHAT METHODS? WHAT SIDE EFFECTS? WHAT PRECAUTIONS?

Dr. Claude Allouche, Gynecologist 

Ahuza Clinic, Raanana 058 726 02 64

Emergency contraception, used within 3 to 5 days after unprotected or poorly protected sexual intercourse, involves hormonal emergency contraception (morning-after pill) or the insertion of a copper intrauterine device (IUD).

Its purpose is to prevent pregnancy after unprotected intercourse. These methods should be used within 5 days, but the sooner they are used, the more effective they are.

Two methods are available, each with a different mechanism of action:

  1. Hormonal emergency contraceptive pills, or "morning-after pills," which block or delay ovulation. Hormonal emergency contraception is a backup method and is not intended for regular use.

  2. Copper intrauterine devices (IUDs) prevent:

    • Fertilization through a toxic effect on sperm and the egg;

    • Implantation of a fertilized egg by causing inflammation of the uterine lining.

  • Emergency contraception does not terminate an existing pregnancy.

  • It is ineffective once the fertilized egg has implanted in the uterus and nidation has begun. In this case, it does not harm the developing embryo.

  • Therefore, emergency contraception is only effective within 3 to 5 days following a risky intercourse.

HOW DOES THE MENSTRUAL CYCLE WORK?

  • Ovulation timing is unpredictable within the menstrual cycle.

  • The onset of menstruation in young girls indicates that their reproductive system is mature, meaning they can become pregnant from their first period.

  • Women’s bodies follow a menstrual cycle that typically lasts 28 days but can vary between 23 and 35 days.

  • This cycle consists of two phases separated by ovulation:

    • From the end of menstruation to ovulation, the uterus prepares to receive a fertilized egg by thickening its inner lining (endometrium). This is the follicular phase. Around the 14th day, ovulation occurs, releasing an egg into one of the fallopian tubes.

    • From ovulation until the next period, the uterine lining strengthens in preparation for nidation. This is the luteal phase. If fertilization does not occur, nidation does not take place, and the superficial layer of the uterine lining is shed, leading to menstruation, marking the beginning of a new cycle.

  • This cycle repeats until menopause, which usually occurs around age 52.

  • Even in women with regular cycles, ovulation cannot be precisely predicted due to variations in the follicular phase duration.

  • An egg survives for 24 hours, while sperm can live for 3 to 5 days. Thus, the fertile window includes the days leading up to ovulation and the 24 hours after.

  • If sexual intercourse occurs during this period, the risk of fertilization and pregnancy is higher.

  • Only effective contraception can prevent pregnancy.

WHAT DOES THE MORNING-AFTER PILL LOOK LIKE?

  • Hormonal emergency contraception comes in the form of a single pill that can be taken at any time during the cycle, ideally within 12 hours after unprotected intercourse, and no later than:

    • 3 days for levonorgestrel (a progestin hormone), known as Norlevo in France, Postinor in Israel;

    • 5 days for ulipristal acetate (a medication that blocks progesterone), known as EllaOne in France, Ella in Israel.

WHAT IF YOU BECOME PREGNANT DESPITE EMERGENCY CONTRACEPTION? Pregnancy can be carried to term, as no increased risk of fetal malformation has been identified with ulipristal or levonorgestrel.

CAN IT BE USED WHILE BREASTFEEDING?

  • Once breastfeeding is no longer exclusive, contraception is necessary as pregnancy risk exists.

  • If using ulipristal or levonorgestrel for emergency hormonal contraception, the amount passed to the baby through breast milk is very low.

  • No particular adverse events have been reported in breastfed infants whose mothers have taken emergency contraception.

  • Suspension of breastfeeding is not required after taking emergency contraception.

  • Hormonal emergency contraception (morning-after pill) is covered by Health Insurance in France but not in Israel.

WHAT ARE THE SIDE EFFECTS?

Some side effects may occur after taking the pill:

  • Nausea

  • Headaches

  • Abdominal pain

  • Light bleeding (spotting)

These are rare and usually resolve quickly. Menstrual cycle irregularities, such as early or delayed periods, may also occur.

However, hormonal emergency contraception does not increase the risk of future infertility, spontaneous miscarriage, or ectopic pregnancy.

SOME PRECAUTIONS FOR USING HORMONAL EMERGENCY CONTRACEPTION

  • It is not recommended to use the morning-after pill more than once in the same cycle (between two menstrual periods).

  • If vomiting occurs within 3 hours of taking the pill, another pill should be taken.

  • In certain medical conditions (severe liver disease, severe asthma, history of gynecological infections or ectopic pregnancy), a medical consultation is necessary before taking emergency hormonal contraception.

  • Some medications, such as those for epilepsy, tuberculosis, HIV, or St. John’s Wort, may reduce its effectiveness.

  • Until the next period, local contraception (e.g., condoms) should be used for each intercourse, as emergency contraception only protects against intercourse that occurred before taking the pill.

  • The use of hormonal emergency contraception should remain exceptional. It is not 100% effective and cannot replace regular contraception combined with medical follow-up.

Want to know more? Visit my website at https://claude-allouche.com

Source: https://www.ameli.fr

Contraception urgence 1 engl