Understanding contraception, including emergency contraception, is an important part of sexual wellbeing. This article will focus on emergency contraception in particular, and explore what it is, what your options are, and how it works.

What is emergency contraception?

Emergency contraception refers to the options available to decrease the risk of pregnancy following intercourse when no contraception was used (unprotected intercourse) or when the method of contraception was used imperfectly (ex. missed birth control pill, or broken condom). Most importantly, these options do not work once pregnancy has occurred, which means that there is a specific timeframe that must be met in order to use emergency contraceptives. They do not cause abortion. Determining what to do when faced with a confirmed pregnancy is a separate conversation.

Morning after pills & the copper IUD

Emergency contraceptive options include: “morning after pills”, the copper IUD, and some birth control pills when taken in a specific way. There are two types of “morning after pills”: ulipristal acetate (UPA) and levonorgestrel (LNG). UPA (ex. Ella) requires a prescription, can be used up to up to 5 days following unprotected intercourse, and is the most effective pill option. LNG (ex. Plan B) can be purchased over the counter at a pharmacy, but is most effective when taken within 3 days of unprotected intercourse. The copper IUD is the most effective of all of the options, but does require insertion by a healthcare provider within 7 days of unprotected intercourse. To determine whether your birth control pill can be used for emergency contraception, you should talk to a healthcare provider who can guide you about the dose you would need to take to have the pill work as an emergency contraceptive. This would be an off label use of the birth control pill, and tends to have more side effects, like nausea and vomiting, compared to the other options. No matter which option, if you have not started your period within 3 weeks of taking emergency contraception, you should complete a pregnancy test.  

Hormones, the menstrual cycle, & emergency contraception

Before getting in to how the menstrual cycle is effected, I want to quickly review ovulation. Ovulation refers to the release of an egg from an ovary, where it can travel to the uterus, and potentially be fertilized by a sperm, resulting in pregnancy. The purpose of emergency contraception is to prevent this from occurring, because as I said earlier, once pregnancy has occurred these options will not work. Ovulation occurs approximately mid-way through the menstrual cycle (ex. day 14 in a 28 day cycle), and is a result of hormonal shifts, like the surge of a hormone known as luteinizing hormone (LH). Rising levels of LH stimulate the release of an egg. LNG works by delaying the LH surge, thereby delaying egg release. If the LH surge has already started, LNG will likely not work. UPA also delays the LH surge, and can still work when LH levels have begun to rise, which is possibly why it is more effective compared to LNG. Neither of these pills will prevent implantation of a fertilized egg in the uterine wall (pregnancy), and will not work if the LH surge has already occurred.

The way the copper IUD works is less well understood. It is not affecting hormone levels or ovulation, rather, the copper ions are likely disrupting fertilization, and may also be preventing implantation of a fertilized egg in the uterine wall. In addition, the copper IUD can remain in place long-term, providing ongoing contraception. Both UPA and LNG are meant as back up, in case of emergency, and not as the primary method of birth control.  

On that note, another very important point about emergency contraception is that you are not protected for the rest of your cycle, unless you had the copper IUD inserted. Delaying ovulation just means that you will not ovulate when you were supposed to, which means that the “morning after pill” may have worked the first time you had unprotected intercourse, but won’t work if you have unprotected intercourse again in that same cycle. Therefore, avoid intercourse until your period, use a barrier method (ex. condoms), or use hormonal birth control (ex. birth control pills). If you decide that you want to use hormonal birth control, and used UPA, you should wait 5 days after taking UPA to start hormonal birth control.

Do emergency contraceptives have long-term effects?  

Both UPA and LNG may cause spotting and a change in menstrual bleeding pattern, but that should subside in subsequent menstrual cycles. Both options are associated with other possible side effects, like nausea, fatigue, and abdominal pain, but these should also subside. Importantly, there is no evidence to suggest that taking emergency contraceptive pills will have a negative effect on future fertility or hormone balance. The copper IUD can cause some cramping and bleeding following insertion, but this should resolve. With that said, the copper IUD can worsen menstrual cramping and cause heavier bleeding, so it may not be a good long-term option if you already struggle with these symptoms.  

If you are wondering about either long-term or emergency contraception, consider booking an appointment with a trusted healthcare provider to determine what option is best for you.

To book an appointment with a Naturopath at Juniper Family Health, please contact the clinic at 778-265-8340 or info@juniperfamilyhealth.com or click here to book online.

References

Healthwise Staff. Emergency contraception. HealthLinkBC, 2019.

Turok D. Emergency contraception. UpToDate, 2020.