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Emergency Contraception

WHAT IS EMERGENCY CONTRACEPTION? 

Emergency contraception (EC) is contraception which is used as soon as possible after unprotected sexual intercourse to reduce the risk of unplanned pregnancy. 

Unprotected sexual intercourse may happen for many reasons including:

  • sexual intercourse where no contraception was used
  • a condom broke or slipped off 
  • a diaphragm dislodged during intercourse 
  • you missed one or more of your contraceptive pills 
  • sexual assault

There are three types of emergency contraception available in Australia:

  • Levonorgestrel EC (an oral pill) 
  • Ulipristal acetate EC (EllaOne) (an oral pill)
  • The copper IUD

Emergency contraception is used after unprotected intercourse and the oral pills will not prevent pregnancy from intercourse that occurs after emergency contraception has been used.

HOW DOES EMERGENCY CONTRACEPTION WORK?

The oral pills work by stopping or delaying ovulation (the release of an egg from the ovaries). If an egg is already fertilized or implanted in the womb and a pregnancy has begun, they will have no effect.  They do not cause an abortion and will not harm an existing pregnancy.

The Copper IUD is a small plastic device containing copper that is inserted into the uterus(womb). It works mainly by interfering with sperm and egg function and movement and prevents fertilisation.

It can also work by preventing the implantation of a fertilised egg.  

The copper IUD needs to be inserted within five days of unprotected sexual intercourse. It does not cause an abortion. It can be used as ongoing contraception and is effective as a contraceptive for five to ten years depending on the model used.

HOW EFFECTIVE IS EMERGENCY CONTRACEPTION? 

The emergency contraceptive pills are around 85% effective in preventing pregnancy. The earlier they are taken the more effective they are. Ulipristal acetate-EC has been shown to be more effective in preventing pregnancy than Levonorgestrel-EC. 

The copper IUD is the most effective emergency contraception and is highly effective in preventing pregnancy if used within 5 days of unprotected intercourse (over 99%).

WHEN DO I TAKE THE EMERGENCY CONTRACEPTIVE PILL?

The emergency contraceptive pill should be taken as soon as possible after unprotected sex, the sooner you take it the more effective it is.

Ulipristal acetate–EC needs to be taken within 120 hours (five days) of unprotected sex. The sooner it is taken the more effective it is.

If you are using the combined oral contraceptive pill or progestogen-only pill (mini pill) you will need to stop taking it for five days after using Ulipristal acetate-EC because other hormone contraception can make the Ulipristal acetate less effective as emergency contraception. When you restart your previous contraceptive method, you will need to use condoms for seven days.

If you are breastfeeding, you will need to stop feeding your baby for seven days after using Ulipristal acetate -EC and discard any milk expressed during this period. You may resume breastfeeding after the initial seven days. 

Levonorgestrel-EC needs to be taken within 72 hours (three days) after unprotected sex, although it may have some effect up to 96 hours (four days) afterwards. The sooner Levonorgestrel-EC is taken the more effective it is. It can be used more than once in the same cycle. When you take Levonorgestrel-EC it is important to continue with any regular contraception that you are using.  Levonorgestrel-EC is safe to use if you are breastfeeding. 

Oral EC can be repeated in one cycle if you use the same type. You should not use the Levonorgestrel-EC in the same cycle as Ulipristal acetate-EC because Levonorgestrel can cause the Ulipristal to be less effective as emergency contraception.

WHEN SHOULD I EXPECT MY PERIOD AFTER I HAVE TAKEN THE EMERGENCY CONTRACEPTIVE PILL? 

Most people will have their period at the usual time after taking the emergency contraceptive pill. However, it may be a bit early or delayed. Whether your period comes on time or not, you should always do a pregnancy test three weeks after the last unprotected intercourse to ensure that you are not pregnant and to ensure that the EC has worked. 

HOW SOON AFTER UNPROTECTED SEX SHOULD I HAVE THE COPPER IUD? 

The Copper IUD needs to be inserted within five days after the unprotected sexual intercourse you are worried about. You can then use it as ongoing contraception or you can have it removed a short while later if you wish.

DOES EMERGENCY CONTRACEPTION HAVE ANY SIDE EFFECTS?

The emergency contraceptive pills are considered very safe to take. Most people do not experience side effects, but if they do occur, they may include nausea, headache, and possible changes to your menstrual cycle in the month that you take it. 

Although vomiting is very rare, if you vomit within three hours of taking the emergency contraceptive pill you will need a second dose. 

There are some medications that may interfere with the emergency contraceptive pills so it’s important to tell your doctor, nurse, or pharmacist about any medications or herbal preparations that you are taking.

The copper IUD may have some minor side effects such as discomfort at the time of insertion. If you plan to use it for ongoing contraception, please see SHFPACT’s Copper IUD information brochure for more details and discuss it with your doctor. It has no effect on breastfeeding.

WHERE CAN I GET EMERGENCY CONTRACEPTION?

Levonorgestrel-EC is available over the counter at most pharmacies for around $20.

It is also available at the SHFPACT clinic for a small cost and for free at the Walk-in Centres, the Junction Youth Health Centre (if you are under 25), and Canberra Sexual Health Centre.

Ulipristal acetate-EC is available as EllaOne over the counter at most pharmacies for around $30-$40. Not all pharmacies stock it so you may wish to call ahead to make sure they have it available.

The copper IUD - you will need to have the copper IUD inserted by a specially trained doctor within the correct timeframe once you have been assessed for suitability. If you are considering the copper IUD as an emergency contraceptive, please contact SHFPACT during businesses hours on 02 6247 3077 or see your GP.

For more detailed information about the copper IUD see SHFPACT’s copper IUD information brochure.

References:

  • Contraception: An Australian clinical practice handbook 4th Edition
  • Faculty of Sexual & Reproductive Healthcare UK 
  • Emergency Contraception Fact Sheet/ Family Planning NSW

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