Morning After Pill

About the morning after pill

The morning after pill is a form of emergency contraception. Unlike other forms of contraception, it is used after sexual intercourse to reduce the risk of pregnancy.

Also known as emergency contraceptive pills, the morning after pill is a contraceptive option for women who have had unprotected intercourse. Intercourse may be defined as unprotected when:

• No contraception was used.
• The contraceptive method failed (e.g., condom breaking, diaphragm slipping out of place).
• The contraceptive method was used incorrectly (e.g., birth control pills were not taken properly).

Emergency contraceptive pills contain the same hormones as birth control pills. Some versions contain a combination of the hormones estrogen and progestin (a synthetic form of progesterone). Others only contain progestin. These hormones prevent pregnancy by:

• Preventing ovulation (the release of an egg by an ovary)
• Preventing fertilization (the penetration of an egg by sperm)
• Preventing implantation (the embedding of a fertilized egg into the lining of the uterus)

Although emergency contraceptive pills contain the same hormones as birth control pills, the hormones are present in much higher doses. As a result, morning after pills should never be used on a regular basis.

According to the National Women’s Health Information Center (NWHIC), emergency contraceptive pills containing a combination of estrogen and progestin are approximately 75 percent effective in preventing pregnancy. Pills that only contain progestin are approximately 89 percent effective. The morning after pill is effective because human conception rarely occurs immediately after sexual intercourse. Instead it takes place after ovulation, which may occur as long as several days later. After intercourse, sperm may continue to travel in the fallopian tube until an egg is released. During this time the morning after pill can be taken, resulting in prevention of the pregnancy.

Emergency contraceptive pills, however, do not work if the woman is already pregnant. Unlike the “abortion pill” which causes the uterus to expel the egg and end the pregnancy, the morning after pill prevents pregnancy. It is important to remember that these drugs do not protect against the human immunodeficiency virus (HIV) or other sexually transmitted diseases (STDs).

The term “morning after pill” is misleading because emergency contraceptive pills are never taken in a single dose. Instead, two doses are required. The first dose should be taken as soon as possible after the act of unprotected intercourse, and no more than 72 hours (three days) after the act of unprotected intercourse. The second dose should be taken 12 hours after the initial dose. The number of pills taken in each dose depends on the brand. Women should take the pills exactly as instructed by their physician or healthcare professional.

After taking the first dose, women must use another form of contraception any time they have vaginal intercourse until their next menstrual period. A woman who regularly uses barrier methods of contraception, such as condoms, diaphragms and spermicides may use them immediately after taking the pills. Women who regularly use hormonal methods of contraception, including birth control pills, contraceptive injections, the contraceptive patch and the contraceptive ring, should consult with their physician about when they may safely use these methods again. If menstruation does not begin within three weeks, or any other signs of pregnancy appear, the woman should immediately contact her obstetrician-gynecologist (ObGyn).

In cases where pregnancy occurs despite use of the morning after pill, recent research suggests that there are no adverse consequences for the mother or her developing fetus.

For women who wait longer than 72 hours, there is another form of emergency contraception available. A “T” shaped device known as a copper-bearing intrauterine device (IUD) can be inserted into the uterus by a health care professional up to seven days after an act of unprotected sex. Once inserted, the device prevents a fertilized egg from implanting itself in the wall of the uterus. The device can be removed by the physician after the woman’s next menstrual period, or it can be left in place for up to 10 years as a regular method of contraception. This type of emergency contraception is a good alternative for women who cannot safely take the hormones contained in emergency contraceptive pills.

The IUD is also more effective in preventing pregnancy. According to the NWHIC, the copper-bearing IUD is 99.9 percent effective in preventing pregnancy. The effectiveness of these methods, however, is greatly affected by timing. The earlier a woman receives emergency contraception after unprotected intercourse, the greater the chance for success.

The Food and Drug Administration approved the sale of the emergency contraceptive drug levonorgestrel (Plan B) without prescription for women aged 18 and older in August 2006. The pills will only be sold behind the counter at pharmacies and women will be required to show photo identification for proof of age to obtain them. It is important to note, however, that a woman should not take high doses of her own birth control pills to prevent a pregnancy. Although birth control pills can be used as emergency contraception, proper use requires instruction from a physician or healthcare professional.