Morning-after pill: how to take it and its effects

What is the morning-after pill?

there are dozens of contraceptive methods available on the market. However, for various reasons, every day, thousands of women have sex without the proper protection of a birth control method, and are at high risk of developing a pregnancy.

In these cases, fortunately, there is still an alternative: emergency contraception, better known as the morning-after pill (PDS).

Unlike what happens with classic contraceptive methods, such as hormonal contraceptives, diaphragms and condoms, which are usually used before or during sexual intercourse, emergency contraception is a form of contraception that can be used after the end of unprotected relationship. When all else fails, PDS is the solution.

Therefore, the morning-after pill is an emergency contraceptive method, in pill form, which can be used after intercourse, being able to inhibit a pregnancy when the woman imagines having had intercourse without the necessary precautions.

It is important to emphasize that emergency contraception, as the name implies, is a birth control method to be used only in emergency situations. Under no circumstances should the morning-after pill be used routinely, as a substitute for traditional birth control methods, as it is less effective and there are no studies on its safety in this form of use.

What are emergency contraceptive methods?

Emergency contraception, also called post-coital contraception, is a birth control measure that should be used by women who do not want to become pregnant, but, due to carelessness or fatality, had sex without proper protection.

There are two forms of emergency contraception:

  • Emergency contraceptive pills, better known as the morning-after pill (PDS).
  • Intrauterine devices, known as an IUD.

The IUD is effective even if implanted after intercourse has already taken place. In this article, we’re going to emphasize the morning-after pill.

Trade names and average price

Levonorgestrel 0.75 or 1.5 mg

  • Day D.
  • Dopo.
  • Time H.
  • Neodia.
  • Norlevo (marketed in Portugal).
  • Pilem.
  • Postinor
  • Pozate.
  • Providence.

Today, the morning-after pill is a cheap drug. Most brands can be found with prices between 3 and 10 reais a box with 2 pills. Search before you buy. There is no study proving greater effectiveness of one brand compared to others.

Ulipristal 30 mg

  • Ellaone (sold in Portugal) → average price: 26 euros – box with 1 pill of 30 mg.
  • Ulip → average price: 30 reais – box with 1 pill of 30 mg.

How to take

After unprotected sexual intercourse, the morning-after pill should be taken as soon as possible, as its effectiveness diminishes over time.

Despite the traditional recommendation of 72 hours (3 days), up to the limit of 120 hours (5 days), emergency contraception can still be effective. It is important to note, however, that with each passing day, the contraceptive effectiveness of the regimen is reduced, especially after the first 72 hours.

Recently arrived in Brazil, ulipristal acetate is a type of emergency contraceptive pill whose efficacy remains high (above 98%) for up to 120 hours (5 days). Therefore, if for some reason you are only able to take PDS late, ulipristal is the best choice (if it is available in pharmacies in your city).

Because the morning-after pill is most effective in the first few hours, all sexually active women who do not plan to have children in the short term are recommended to have at least one box of the drug on hand for quick use in an emergency.

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For women who already use contraceptives regularly but need the morning-after pill because they have forgotten to take it correctly, the conventional pill can be restarted on the same day. In this case, however, as it is a return to the pill, in the first 7 days, the woman will not be fully protected, and during this interval she must make additional use of some other type of contraception, such as a condom.

levonorgestrel

Levonorgestrel is usually sold in a box of 2 tablets of 0.75 mg, which can be taken together or 12 hours apart. There is already on the market a single dose version (box with 1 tablet of 1.5 mg), which facilitates the single taking of the drug.

If you took levonorgestrel as a morning-after pill and had unprotected sex again after 24 hours, it is possible to take a second dose.

Ulipristal

Ulipristal is sold in a box of 1 tablet of 30 mg, and should be taken as a single dose.

Unlike levonorgestrel, ulipristal cannot be used more than once per menstrual cycle. Therefore, if you have had unprotected sexual intercourse, repeating the medication is not indicated.

When to use emergency contraception

The emergency contraceptive pill is not a commonly used contraceptive method. Generally, we indicate its use in two situations:

1. If you had vaginal intercourse without the protection of any contraceptive method (condom, IUD, pill, implant, diaphragm, etc.).

2. If you had sex and used a contraceptive method incorrectly or if it failed. This includes the following situations:

  • A condom that broke, was used incorrectly, or came off the penis during sexual intercourse.
  • A woman who normally takes a contraceptive pill containing estrogen and progesterone and forgot to take it for two days in a row.
  • A woman who normally takes a contraceptive pill containing only progesterone (called a minipill ) and has delayed taking it by more than three hours.
  • A woman who normally uses medroxyprogesterone acetate (also called Depo-Provera®) injections and has delayed her injection for more than two weeks.
  • Woman who normally uses contraceptive patches and removed them before or after the scheduled time.
  • Diaphragm or female condom that has broken or dislodged.
  • IUD that came out accidentally.

How it works

In Brazil, the most used morning-after pill consists of 0.75 mg levonorgestrel (most common brands: Postinor-2, Pilem, Previdez 2, Pozato, Diad, Minipil2-Post and Poslov).

Levonorgestrel is a synthetic progesterone that acts as an emergency contraceptive method through two mechanisms:

  • Inhibition of ovulation.
  • Preventing the fertilization of the egg by the sperm.

Of the above two mechanisms, ovulation inhibition is the most important; hence the need to take the pill as soon as possible.

Basically, what the morning-after pill does is change the menstrual cycle . Most women end up menstruating within a week of their previous period. However, depending on which phase of the cycle the morning-after pill was taken, menstruation may come up to 1 week earlier than expected.

In general, the typical characteristics of menstruation – such as number of days, appearance and blood volume – remain unchanged. If you notice relevant differences, it could be a sign of pregnancy. It is recommended to take a test to confirm.

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Does the morning-after pill cause miscarriage?

No, the morning-after pill is not abortifacient! Abortion is prohibited by law in Brazil. If the emergency contraceptive pill were abortifacient, it would not be allowed to be marketed.

Technically, an abortive medication is one that works after the egg has been fertilized. Abortion is the loss of an embryo that was developing in a uterus. As explained, the action of levonorgestrel is prior to the implantation of the fertilized egg in the uterus, therefore, it is not an abortive drug.

If levonorgestrel is taken after the egg has already been implanted in the uterus, it will have no effect on the course of the pregnancy. In addition to not causing abortion, there are no studies that indicate the danger of fetal malformation, if the drug is accidentally used in women who are already pregnant.

Ulipristal, in turn, can have harmful effects on the fetus and should not be taken if the woman suspects that she is already pregnant.

Efficiency

If taken correctly and within 5 days, ulipristal is 98.5% effective.

Levonorgestrel, on the other hand, has the following success rates:

  • 95% when taken within the first 24 hours after intercourse.
  • 85% when taken between 24 and 48 hours after intercourse.
  • 58% when taken between 49 and 72 hours after intercourse.
  • 15 to 20% when taken between 73 and 120 hours after intercourse.
  • Close to 0% when taken after 120 hours.

Some studies have shown a reduction in the effectiveness of the levonorgestrel pill in women weighing more than 75-80 kg (or BMI greater than 30). Despite this, the European Medicines Agency and the FDA consider the information currently available to be insufficient to conclude that the effectiveness of emergency contraception decreases with increasing body weight.

It is important to point out that the effect of the pill is only guaranteed for that sexual intercourse that motivated its use. If a woman returns to unprotected intercourse after taking the pill, there is no way of guaranteeing its contraceptive effect.

Side effects

PDS is an extremely safe treatment if taken correctly. There are no reports of serious side effects. Most side effects are mild and transient.

Among the most common adverse effects of the morning-after pill, we can mention:

  • Nausea and vomiting (most common adverse effects).
  • Dysregulation of menstruation (common within the first month after treatment).
  • Minor vaginal bleeding outside the menstrual period (common within the first month after treatment).
  • Dizziness.
  • Fatigue.
  • Headache.
  • Breast tenderness.
  • Abdominal pain.

If there is vomiting within the first two hours after taking the pill, we suggest repeating the regimen.

Contraindications

There are no absolute contraindications. Even women who have contraindications to the daily contraceptive pill, such as those with cardiovascular disease, liver disease, migraine, or an increased risk of thrombosis, can use PDS.

Women who are breastfeeding can take the morning-after pill, but they should be aware of the risk that part of the hormones will pass to the baby. Its use, therefore, should be occasional.

If the mother chooses ulipristal, it should be taken immediately after breastfeeding, and breastfeeding should be stopped for 36 hours. In this interval, the mother must maintain the extraction of milk artificially to maintain the stimulation of milk production.

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common doubts

Does the morning-after pill work during the fertile period?

Yes, the purpose of PDS is to prevent women from getting pregnant. If PDS did not work exactly at the time a woman is at risk of becoming pregnant, it would be of no use.

Does morning-after pill delay menstruation?

Yes, there can be interference with the menstrual cycle, both for more and for less.

In general, lowering your period within a week confirms the effectiveness of the morning-after pill.

However, depending on when in the menstrual cycle the PDS has been taken, menstruation may even take a little longer to come down. A few days late should not be a cause for panic. 

If menstruation has not come 3 weeks after using the morning-after pill, the patient should take a pregnancy test, as in these cases the possibility of pill failure should be considered.

How many times can I take the morning-after pill?

There is no set limit. Although not recommended, PDS can be taken more than once a month. If you had unprotected sex, took PDS, and had sex again 3-5 days later, the morning-after pill can be taken again.

However, it is important to highlight that it is not recommended to use PDS as a usual form of contraception. Repeated use of hormonal emergency contraception as a primary contraceptive method has the following disadvantages:

Less effective.
More expensive.
Higher incidence of menstrual irregularities.
Increased risk of short- and long-term side effects due to increased hormone intake.

Is the morning-after pill bad?

No. But it needs to be taken correctly. If you look at PDS as a form of emergency contraception, that’s usually fine. However, as explained in the previous topic, if PDS is used repeatedly, replacing the regular contraceptive pill, relevant side effects may arise.

Can I take the morning-after pill if I already take the regular birth control pill?

Whoever takes the contraceptive pill correctly does not need to take the morning-after pill.
However, as already explained, if you forgot to take your pill for more than 2 days in a row and had unprotected sex, PDS is indicated.

Can I take PDS around my period?

Yes, if unprotected intercourse occurred around menstruation, the morning-after pill can be taken without a problem.

Can I take the two morning-after pills together?

No. You only need to choose one of the options. Taking more than one pill does not increase effectiveness, but it does increase the risk of side effects.

Can the morning-after pill fail?

Yes, no contraceptive method is foolproof. PDS has a low failure rate, but higher than birth control pills in general. The failure rate for a single unprotected intercourse in the menstrual cycle for ulipristal is 1.5 to 2% and that for levonorgestrel is 2.5 to 3%. These rates are higher if a woman needs to use PDS for several different cycles or has more than one relationship in the same cycle.


References

Morning-after pill: how to take it and its effects
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