Emergency contraceptives: pills and other best remedies for women

Pregnancy pills after intercourse, so-called. Emergency or fire contraception can prevent pregnancy after unprotected sex or if the protection you are using has failed - for example, the condom has come off or broken, or you have missed a birth control pill. According to the latest WHO recommendations from 2021, indications for the use of “firefighting” agents will be:

1. unprotected sexual intercourse,
2. concerns about possible refusal of contraception,
3. improper use of contraception and
4. sexual violence if there was no contraception.

What is emergency contraception?

Emergency contraception refers to contraceptive methods that can be used to prevent pregnancy after sexual intercourse. Such methods are recommended to be used within five days after sexual intercourse, but their effectiveness is higher the earlier they are used.

Mechanism of action

Emergency contraceptive pills prevent pregnancy by preventing or delaying ovulation and do not cause abortion. Copper-containing IUDs prevent fertilization by causing chemical changes in the sperm and egg before they touch. Emergency contraception cannot terminate an existing pregnancy or harm the developing embryo.

When emergency contraception is needed

It is obvious from the name that emergency contraception is intended for emergency situations, and not for regular use.

Before such episodes occur:

• unplanned act without contraception;
• constantly not interrupting the articles of the act;
• tearing of the condom or squeezing in the air;
• disruption of the use of oral and combined contraceptives;
• sexual violence, if for a woman there is a risk of vagrancy.

Shmargovich Nadiya Stepanivna, doctor-gynecologist of the medical ]"ON Clinic Uzhgorod"[/anchor], confirms:

“Emergency contraception can be prescribed for all women of the reproductive age to control unwanted vaginity. If you want absolute contraindications, as there are no age-old restrictions on these conditions, please consult a gynecologist before taking EK Varto.”

In what cases can emergency contraception be used?

Emergency contraception can be used in some cases after sexual intercourse. These include:

• cases where no contraceptives were used;
• cases of sexual violence where the woman was not protected by an effective contraceptive method;
• cases when there is reason to believe that the contraceptives used are ineffective due to their unsuccessful or incorrect use, including for the following reasons:

• Condom rupture, slippage, or misuse;
• skipping combined oral contraceptive pills three or more times in a row;
• taking a progestogen-only pill (minipill) more than three hours after your usual dosing time, or more than 27 hours after your previous pill intake;
• taking a tablet containing desogestrel (0.75 mg) more than 12 hours after the usual time of administration, or more than 36 hours after taking the last tablet;
• a progestogen-only norethisterone enanthate (NET-EN) injection with a delay of more than two weeks;
• a progestogen-only depot medroxyprogesterone acetate (DMPA) injection more than four weeks late;
• introduction of a combined injectable contraceptive (CIC) more than seven days late;
• displacement, breakage, rupture, or premature removal of the diaphragm or cervical cap;
• a failed attempt to interrupt sexual intercourse (for example, ejaculation in the vagina or on the external genitalia);
• incomplete dissolution of the spermicidal tablet or film before sexual intercourse;
• when using methods based on fertility tracking: errors in calculating the abstinence period, failed abstinence or unsuccessful use of the barrier method on fertile days of the cycle;
• expulsion of an intrauterine contraceptive device (IUD) or hormonal contraceptive implant.

A woman may be provided with a supply of ECPs in advance so that she has them with her in case of need and can take them as soon as possible after unprotected intercourse.

• Code of practice for the use of contraception - in English

Transition to permanent contraception

After using ECPs, a woman or girl can return to or start using a permanent method of contraception. If a copper-containing IUD is used for emergency contraception, then additional contraceptive protection is not required.

After taking levonorgestrel-containing ECPs (LNG) or combined oral contraceptive pills (COCs), women or girls can resume their current method of contraception or start using a method, including a copper-containing IUD.

After using ECPs with ulipristal acetate (UPA), women or girls can continue or start using any progestogen-containing product (combined hormonal contraception or progestogen-only contraceptives) on the sixth day after taking UPA. They can immediately receive an IUD with LNG if it can be established that they are not pregnant. They can immediately receive a copper-containing IUD.

Side effects of emergency contraception

Emergency contraception may cause side effects. Shegeda Viktoria Olegivna, doctor-gynecologist at the medical ]"ON Clinic Dnipro"[/anchor] talks about them:

“The use of emergency contraception can lead to the appearance of symptoms such as fatigue, confusion, headache, increased nausea, or blood vessels in the lower abdomen, sore breasts, and menstrual bleeding. Allow the symptoms to go away over a few days, unless they seem to go away on their own, and you will continue to feel very sick, which will eventually lead to a trip to the doctor.”

Emergency contraceptive pills (ECPs) and combined oral contraceptive pills (COCs)

For emergency contraception, WHO recommends using one of the following drugs:

• ECP with UPA, taken in a single dose of 30 mg;
• ECP with LNG is given as a single dose of 1.5 mg or, alternatively, LNG is given in two doses of 0.75 mg each, 12 hours apart.
• COCs are taken in two doses: one dose of 100 mcg ethinyl estradiol plus 0.50 mg LNG, then 12 hours later a second dose of 100 mcg ethinyl estradiol plus 0.50 mg LNG (Yuzpe method).

Efficiency

A meta-analysis of two studies found that among women using ECPs with UPA, the pregnancy rate was 1.2 percent. Studies have found that pregnancy rates with LNG TKA range from 1.2 to 2.1 percent (1) (2).

Ideally, ECPs with UPA, ECPs with LNG or COCs should be taken as soon as possible after unprotected intercourse, no later than 120 hours. ECPs with UPA, unlike other ECPs, are more effective in the range from 72 to 120 hours after unprotected sexual intercourse.

Safety

Side effects of ECP use are similar to those caused by oral contraceptive pills and include nausea and vomiting, minor, irregular vaginal bleeding, and fatigue. Side effects occur infrequently, are mild and usually resolve without any additional drug treatment.

If vomiting occurs within two hours after taking a dose of the drug, the dose should be repeated. ECPs with LNG or UPA are preferable to COCs because they cause less nausea and vomiting. Intentional use of antiemetics before taking ECPs is not recommended.

The drugs used for emergency contraception do not harm future fertility. After taking ECPs, there is no delay in the restoration of fertility.

Medical eligibility criteria

There are no medical contraindications regarding who can use ECPs.

However, some women use ECPs intermittently or as their primary method of contraception for the reasons mentioned above. In such cases, they should be further counseled about what other more permanent contraceptive options may be more suitable and effective for them.

Frequent and intermittent use of ECPs may cause harm to women with conditions classified in categories 2, 3, or 4 of the medical eligibility criteria for use of combined hormonal contraceptives and progesterone-only contraceptives. Frequent use of emergency contraception may increase side effects such as menstrual irregularities, although occasional use does not pose any health risks.

Emergency contraceptive pills have been found to be less effective for obese women (with a body mass index over 30 kg/m2), although there are no safety concerns. Obese women should not be denied access to emergency contraception when they need it.

When counseling on the use of emergency contraceptive pills, it is necessary to talk about options for using permanent contraceptive methods, and in case of their alleged ineffectiveness, explain the correct procedure for emergency actions.

Is it possible to get pregnant... and how to avoid it?

✅ Is it possible to get pregnant during your period?

According to surveys, about 40% of couples practice intimate relations (vaginal sex with ejaculation inside) more or less regularly on menstrual periods. Do you think you can’t get pregnant if you have sex during your period and “finish” the act in the vagina? This is a wrong opinion, and this misconception occurs not only among most men, but also among many women. To understand whether you can get pregnant on the last day of your period or the first time bleeding starts, you need to have an understanding of the menstrual cycle. It is divided into several phases, characterized by the production of certain hormones. Conception of a child occurs at the moment of ovulation or within a few days after it. If the egg is not fertilized in a given cycle, then the release of some hormones is replaced by others and another menstruation occurs. It would be logical to assume that it is impossible to get pregnant during menstruation, if not for one important nuance. Not every girl can know for sure when she will ovulate.

Most girls and women of middle reproductive age (18 - 40 years) have a relatively regular monthly cycle, but its duration may vary under the influence of internal and external factors. A standard cycle lasts an average of 28 days and ovulation (egg release) occurs on days 13-15. This is in theory. In practice, under the influence of stress, physical overload, climate change, illness, etc. ovulation may shift in time. And, as you know, male reproductive cells are able to survive in the female body for quite a long time. The favorable microflora of the vagina and the consistency of the discharge allow sperm to “stay alive” and wait in the wings for up to a week. Consequently, sexual intercourse occurred on the 5th day of menstruation and ovulation occurred in the girl on the 7th day, i.e. 48-72 hours after unprotected intercourse give a huge chance of unplanned conception.

Other partners prefer to change vaginal sex to anal or oral sex on THESE days, which also makes it impossible to get pregnant during menstruation and eliminates the need to take a birth control pill for emergency contraception.

✅ Is it possible to get pregnant from lubricant?

What is the likelihood and whether it is possible to get pregnant from male lubricant - these questions concern both couples who have stable sexual relationships with vaginal penetration, and girls who wish not to lose their virginity and allow imitation of sexual intercourse by movements of the partner’s penis in the area of ​​the vaginal vestibule.

Theoretically, when released, male lubricant in its pure form does not contain sperm, since it is produced by a different gland. However, if sexual intercourse took place some time ago, and sperm can live in the urethra for up to 7 days and, therefore, it will be enough for them to mix with lubricant during any subsequent unprotected sexual intercourse for the woman to become pregnant. That is, if in this case the sperm meets an egg on its way, then the probability of getting pregnant from male lubricant is enormous.

What is the probability of getting pregnant from lubricant, depending on the phase of the menstrual cycle? The greatest chance of pregnancy from lubricant discharge occurs when a woman ovulates and in the coming days after it. You can avoid conception if you remember in the next 72 hours, or better yet 24 or 48, that emergency contraception is available. Modern gynecology offers several of the best contraceptives for “firefighting” purposes, which will be discussed below.

✅ Is it possible to get pregnant without protection?

Agree, this is a rather strange question. The likelihood of fertilization occurring at the end of sexual intercourse in the female vagina is maximum if neither partner uses contraception (condoms, hormonal contraceptives, IUDs, etc.). Of course, as elsewhere, in this case there are several conditions that significantly affect the possibility and success of pregnancy, such as:

1. Suitable phase of the menstrual cycle;
2. The condition of a woman's reproductive tract;
3. No gynecological problems;
4. Characteristics of male ejaculate, its usefulness;
5. General health of M and F;
6. The presence of bad habits and pathological addictions.

Thus, in some cases it is possible to become pregnant if you do not take protection, with a high degree of probability, but in others, even with the maximum possible combination of circumstances favorable to successful conception, it is not possible to have a child. The specialists of our clinic in Moscow will help you understand the reasons for the latter and provide effective treatment for infertility in women.

✅ Can a virgin get pregnant?

To find out whether it is possible to conceive a child and be pregnant while being a virgin, let’s make some clarifications. This may come as a surprise to some young people or girls, but a pregnant virgin is a reality, albeit not as common, but still. How do virgins get an appointment with gynecologists to register or have an abortion? Let's try to solve this equation with several unknowns...

✔ If the task has the following input data:

a) the girl has a intact, intact hymen; b) the girl is an actual virgin, i.e. does not have any intimate relationships (direct or indirect contact with the genitals of a representative of the opposite sex), then in this case we can say with confidence that such a virgin cannot be pregnant!

✔ If you make some changes to the original conditions of the problem and formulate them as follows:

a) the girl has a intact, intact hymen; b) the girl is a formal virgin, i.e. having a whole hymen, he practices various forms of sexual relations without penetration of the penis into the vagina (anal intercourse, surrogate imitation sex with ejaculation on the labia or in the vestibule of the vagina, various forms of mutual self-satisfaction, etc.). Such a virgin can become pregnant from both sperm and lubricant, even without a man’s penetration inside.

Now that we have learned about the main ways how you can get pregnant with a virgin, right away and the first time, we will behave more carefully, not rely on a lucky chance, and take care of choosing a method of contraception. Please consult our gynecologists. Competent and timely selection of a contraceptive will help you preserve your innocence and have the desired intimate relationship without the fear of ending up in an “interesting” position after it!

✅ Is it possible to get pregnant the first time?

How to avoid getting pregnant during sex for the first time, what can you do? Firstly, under no circumstances should you be fooled by the assurances of young people that a virgin does not become pregnant during her first sexual intercourse! Allegedly, the hymen prevents sperm from penetrating the uterus, so you can “tear” it without fear of undesirable consequences. A very popular scam among a certain category of guys. Usually these fables are told by people who want to persuade a partner to have sex without obligation, and they are to blame for many tragic situations among young girls.

The practical option that a gynecologist and common sense would recommend is using a condom. It almost completely eliminates the possibility of conception, and also protects the girl from unwanted diseases. Moreover, it will be very reasonable if they are in your purse directly, and not always with the guy. If there were no means of contraception, and the first sexual intercourse occurred, you can get pregnant very easily, especially on the days of ovulation.

Gynecologists are well aware that some virgins do not “get pregnant” due to “female” health problems, which are discovered only years later. There is also an element of “luck” and a psychological factor. All this led to the creation of a widespread myth that a virgin can have unprotected sex for the first time.

It is important to note that pregnancy does not only occur when the girl is already an adult. Even when you don't have your period, this can happen. In medical practice, it happens when 11-12 year old girls get pregnant.

How to avoid pregnancy for a girl who just lost her virginity? Do not panic, but make an appointment with a gynecologist for a consultation and discuss the need to take a contraceptive “pill after intercourse.” The main thing is to do it on time - emergency contraception is safe and effective no later than 48-72 hours after sex. It is a good idea to get tested for infections and carry out minimal prevention of inflammatory processes and STDs.

✅ Can masturbation get you pregnant?

It should be understood that for fertilization, the development of pregnancy and the birth of a child, certain requirements must be met. It is impossible without an egg and sperm, so getting pregnant during masturbation (on your own, without the participation of a man) will not work. If the process involves the participation of a man, then it is possible to become pregnant from masturbation with a finger if sperm gets on it. In the absence of even minimal contact of any kind with male semen, a girl will become pregnant, incl. virgins cannot.

Copper intrauterine devices

WHO recommends a copper IUD as an emergency contraceptive, to be inserted within five days after unprotected intercourse. This method is especially suitable for women who want to start using a highly effective and long-term reversible method of contraception.

Efficiency

When inserted within 120 hours of unprotected sex, a copper-containing IUD is more than 99 percent effective in preventing pregnancy. This is the most effective form of emergency contraception available. After its insertion, a woman can continue to use a copper-containing IUD as a permanent method of contraception or switch to another contraceptive method at her discretion.

Safety

A copper IUD is a safe form of emergency contraception. It is estimated that pelvic inflammatory disease (PID) may occur in fewer than two in 1000 users (3). (See Family Planning Guide). The risks of tissue perforation or coil expulsion are low.

Medical eligibility criteria

For emergency use of a copper-containing IUD, the same criteria apply as for permanent use. Women with medical conditions that fall within category 3 or 4 of the medical eligibility criteria for copper-containing IUDs (such as untreated pelvic inflammatory disease of infectious origin, puerperal sepsis, unexplained vaginal bleeding, cervical cancer, or severe thrombocytopenia) should not use them. for emergency purposes. In addition, a copper IUD should not be inserted for emergency contraception after sexual assault because the woman may be at significant risk for sexually transmitted infections such as chlamydia and gonorrhea. A copper-containing IUD should not be used for emergency contraception when a woman is already pregnant.

As noted in the Medical Eligibility Criteria for Contraceptive Use, insertion of an IUD may further increase the risk of PID among women at increased risk of sexually transmitted infections (STIs), although limited evidence suggests that this risk is low. Current algorithms for identifying increased risk of STIs have insufficient predictive value. The risk of STIs varies depending on individual behavior and the local prevalence of these infections. Thus, although many women who are at increased risk for STIs can generally have an IUD inserted, some women who are at increased risk for STIs should not have an IUD inserted until appropriate testing and treatment has been performed.

• Medical Eligibility Criteria for the Use of Contraceptive Methods - in English

WHO recommendations for the provision of emergency contraception

All women and girls at risk of unwanted pregnancy have the right to access emergency contraception methods, and these methods should be routinely included in all national family planning programmes. In addition, emergency contraception should be included in health services for populations most at risk of unprotected sex, including services and care for women and girls who have survived sexual violence and living in humanitarian emergencies.

• Ensuring human rights in contraception programs: analyzing existing quantitative indicators from a human rights perspective - in English

WHO reaffirms its commitment to carefully review emerging evidence through its Continuous Evidence Identification (CIRE) System and to regularly update its recommendations accordingly.

• (1) Can we identify women at risk of pregnancy despite using emergency contraception? Data from randomized trials of ulipristal acetate and levonorgestrel. Glasier A, Cameron ST, Blithe D, Scherrer B, Mathe H, Levy D, et al. Contraception. 2011 Oct;84(4):363-7. doi: 10.1016/j.contraception.2011.02.009. Epub 2011 Apr 2.
• (2) Effect of BMI and body weight on pregnancy rates with LNG as emergency contraception: analysis of four WHO HRP studies. Festin MP, Peregoudov A, Seuc A, Kiarie J, Temmerman M. Contraception. 2021 Jan;95(1):50-54. doi: 10.1016/j.contraception.2016.08.001. Epub 2021 Aug 12.
• (3) Family planning: a comprehensive guide for service providers Institute of Public Health. Johns Hopkins Bloomberg/Center for Information Programs and World Health Organization