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Emergency Contraception Q&A

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    Is it true that women who use emergency contraception are at increased risk of ectopic pregnancy?  I’ve heard some anti-choice people make the claim, but it doesn’t sound reasonable.

    No, there is no evidence that emergency contraception (EC) increases the risk of ectopic pregnancy — pregnancy outside of the uterus.  One study of only 201 women in the U.K. suggested this possibility, but subsequent studies of thousands of women worldwide demonstrate no increased risk. 

    EC works by stopping ovulation or fertilization.  In theory, it could interfere with the implantation of a fertilized egg, but there is no scientific proof that this happens.  EC, however, does not affect an established pregnancy.  So if EC fails to prevent a pregnancy or a woman who uses EC is already pregnant, her pregnancy — ectopic or uterine — will continue to develop.  That’s why women who do not have a normal period following the use of EC should take a pregnancy test and follow up with their health care providers.

    Ectopic pregnancy is more likely for women who have had a previous ectopic pregnancy, for women who have had surgery involving the fallopian tubes, and for women who have had sexually transmitted infections.  Left untreated with medication or surgery, ectopic pregnancy is a very dangerous, life threatening condition.

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    Is it true that emergency contraception causes abortion? What about other hormonal methods of birth control?

    No. Abortion ends a pregnancy. Emergency contraception (EC) cannot end a pregnancy. EC works before a pregnancy begins. Pregnancy begins with the implantation of the developing fertilized egg in a woman's uterus.

    EC can be started within five days of unprotected intercourse. It prevents ovulation — the release of the egg. Or it prevents fertilization — the joining of the sperm and the egg — which usually occurs within six days of intercourse. In theory, it's possible for EC to prevent implantation, but implantation doesn't occur until five to seven days after fertilization.

    The same is true for the pill, the shot, the patch, and the ring. They also prevent ovulation and fertilization, but not implantation. It is very unlikely that an egg would be released or fertilized while a woman is using them.

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    I'm reading that some pharmacists are saying they won't sell emergency contraception because it causes abortion. Does it? What about other hormonal methods of birth control?

    No, emergency contraception (EC) cannot end a pregnancy. EC works before a pregnancy begins, which is when the developing egg implants in a woman's uterus. EC therefore does not cause abortion.

    EC can be started within five days of unprotected intercourse. It prevents ovulation (the release of the egg), which prevents fertilization (the joining of the sperm and the egg). Other ways that EC can prevent fertilization is by thickening the cervical mucus so the sperm does not reach the egg or by interrupting the delicate timing of events required for fertilization to occur. In theory, it's possible for the hormones in EC to prevent implantation, but recent research indicates that this does not appear to happen.

    Other hormonal contraception, such as the pill, the shot, the patch, and the ring, also work to prevent fertilization through a number of ways. Theoretically, they, too, could interfere with implantation, but the primary way they work is so effective that fertilization rarely takes place.

    It is troubling that pharmacists in many states nationwide have refused to sell EC and other birth control pills. That's why Planned Parenthood is organizing nationally and locally to put a stop to this outrageous situation.

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    If I took emergency contraception and, weeks later, I find out that I'm pregnant, will the EC have affected the fetus in any way?

    Emergency contraception (EC) will not harm a fetus. Still, you should not use EC if you are pregnant.

    EC can reduce the risk of pregnancy if started within 120 hours (five days) of unprotected intercourse. The sooner it is started, the better.

    The U.S. Food and Drug Administration recently approved over-the-counter (OTC) sale of Plan B — a brand of EC — to women 18 and older. Plan B and other forms of EC will continue to be available by prescription for women of all ages.

    EC is currently available at Planned Parenthood health centers, pharmacies, as well as college, public, and women's health centers; from private doctors; and in hospital emergency rooms — unless they are affiliated with religions that oppose the use of birth control.

    Some clinics and health care providers will prescribe EC over the phone and call the prescription in to a pharmacy for women younger than 18. EC by prescription is also available directly from some pharmacists in a small but increasing number of states. If you would like to get EC through the Planned Parenthood health center nearest you, call 1-800-230-PLAN.

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    How much time do I have to start emergency contraception after having sex? Can I use it more than once?

    Five days! Of course, the sooner you start, the better. According to the most recent studies, starting emergency contraception (EC) within 120 hours of unprotected intercourse can significantly reduce the risk of pregnancy. Earlier studies showed that starting EC within 72 hours reduces the risk by 75-89 percent. We don't have exact numbers yet for 120 hours, but studies show that EC will still help within that time.

    EC can be a great consolation to women who forgot their pills, who had a condom slip off in the vagina, who were with a guy who didn't pull out in time, and, perhaps especially, women who were forced to have sex.

    Women should feel free to use EC whenever they think it's necessary. EC is not recommended for ongoing use because they are not as effective as the IUD or hormonal methods like the pill, the patch, the ring, or the shot. But there is no harm using them when you need to.

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    I recently took the morning after pill, and now my period is late. Is that because of the pills?

    It could be.  Irregular bleeding is a common side effect of taking emergency contraception (EC), sometimes called “the morning-after pill.” It is possible that the first menstrual period after taking EC may be early or late.  If a woman is not pregnant, her menstrual cycle should return to normal the following month.  Frequent use of EC may cause periods to become irregular and unpredictable.

    EC can reduce the risk of pregnancy if started within 120 hours — five days — after unprotected vaginal intercourse.  It works best when started within 72 hours — during this time they can reduce the risk of pregnancy by 75–89 percent.  The sooner, the better.

    EC is not as effective as the regular use of ongoing contraception —such as the IUD, the pill, the patch, the ring, the shot, or the implant.  EC does not continue to prevent pregnancy during the rest of the cycle — other methods of birth control must be used for continuous protection.

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    I know that women can use emergency contraception to protect themselves from pregnancy after unprotected intercourse, what about STIs?

    It is possible for women and men to protect themselves from certain sexually transmitted infections after unprotected intercourse, but before a complete diagnosis can be made. This kind of protective treatment is sometimes called "post-exposure prophylaxis." Prophylaxis is a prevention or protection against infection. (This is why the technical word for condoms is prophylactic.)

    Protective treatment may be recommended by a clinician when someone is quite likely to have been exposed to certain infections through recent sexual contact. It can be attempted only for certain sexually transmitted infections. In the case of probable exposure to hepatitis B and HIV, the medication may prevent infection. This would be a true "prophylaxis." "Prophylaxis" for hepatitis B and HIV must occur very quickly — in a few days — following exposure.

    In the case of chlamydia, gonorrhea, or syphilis, the medication is designed to treat an infection that may already be established, but before diagnosis is made. This is technically called "empiric" treatment. The use of antibiotics is effective at any time during the course of infection with chlamydia, gonorrhea, or primary syphilis.

    If you would like to inquire about post-exposure treatment and STI testing, contact your health care provider or call 1-800-230-PLAN to make an appointment with the Planned Parenthood health center nearest you.

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    I saw an advertisement on the bus for Plan B. What is that?

    Plan B® is the brand name for the progestin-only emergency contraception (EC) that has been approved by the U.S. Food and Drug Administration (FDA). The other FDA-approved forms of EC are increased doses of certain other oral contraceptives that contain both progestin and estrogen.

    Some women experience side effects with EC, including nausea, vomiting, fatigue, headache, dizziness, breast tenderness, and menstrual changes. However, these side effects occur less frequently with progestin-only pills, such as Plan B, than they do with other forms of EC.

    Emergency contraception, if started within 120 hours of unprotected intercourse, can significantly reduce the risk of pregnancy. Emergency contraception is the best way to reduce the risk of unintended pregnancy in cases of rape, incest, or contraceptive failure.

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    My health care practitioners all work at a Catholic hospital and cannot prescribe emergency contraception. My boyfriend and I were having sex, and the condom broke, and I do not want to get pregnant. I have some Yasmin pills ... can I take them at a higher dose as emergency contraception?

    No. Yasmin is not recommended for emergency contraception. While high doses of Yasmin might work well as emergency contraception, the exact dose needed has not been determined or studied. Besides Plan B, which is the brand especially designed for emergency contraception, certain other brands of oral contraceptives may be used in certain doses for emergency contraception.

    Plan B emergency contraception is now available over the counter for women 17 and older.  Plan B and other forms of contraception are also available by prescription for all women.  Contact your local Planned Parenthood at 1-800-230-PLAN to get EC or to get a prescription for EC if you are younger than 17.  You may also get EC at your local pharmacy if you are older than 17.

This column is for informational purposes only and is not intended to constitute medical advice, diagnosis, or treatment. If you have a medical problem, please call toll-free 1-800-230-PLAN for an appointment with the Planned Parenthood health center nearest you.

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