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Navigating the Fertile Window: Emergency Contraception

EMERGENCY CONTRACEPTION: KNOW YOUR OPTIONS

By now, you know that no contraceptive method is 100% effective. Armed with this knowledge, it’s important that both you and your partner have discussed what you will do if your barrier method fails or if you make a mistake (incorrect observations / misunderstanding of the rules / “heat of the moment” slip-up).

Are you and your partner both comfortable with seeking and using an emergency contraceptive (EC) in this event? Emergency contraceptives are unique in that they can be used after sex to prevent a pregnancy.

 

We have three available EC options:

  • Levonorgestrel-containing pill (brand names include: Postinor-1, Postinor-2, Postrelle -1, Postella-1, NorLevo, NorLevo-1, Levonelle-1 and Levonelle-2)
  • Ulipristal Acetate pill (brand name: EllaOne, Ella)
  • Copper IUD

 

Deciding which type of emergency contraception to use may depend on:

  • When you believe life begins (and your beliefs on abortion)
  • How important effectiveness is to you
  • How comfortable you are with taking synthetic hormones
  • How comfortable you are with having an IUD insertion
  • Whether you are classed as clinically obese

 

WHEN DOES LIFE BEGIN?

The official medical definition of the beginning of a new life is when an embryo implants into the uterine wall.

However, some people believe for religious or personal reasons that new life begins as soon as an egg is fertilised by a sperm (before it implants into the uterine wall).

For people who hold this view, any type of contraceptive that causes the uterine lining to be inhospitable to the implantation of a fertilised egg may be considered an abortifacient. If you hold these beliefs and do not agree with abortion, you may wish to avoid using all types of emergency contraception.

The main way that the copper IUD works is by immobilising sperm. This stops sperm from being able to reach the egg to fertilise it. It’s unlikely that sperm can survive exposure to the copper; however, if they do manage to fertilise an egg, the fertilised egg will struggle to implant into the endometrium. This is because copper causes the endometrium to become inhospitable to implantation.

Currently, there is still debate among the scientific community as to whether emergency contraceptive pills act to make the endometrium inhospitable to implantation. The main way that EC pills work is by preventing or delaying ovulation. The best available evidence suggests that EC pills have no effect on implantation; however, due to ethical and scientific constraints, it is not possible to definitively rule out that they might have some effect.

If you believe life starts at fertilisation and you are not comfortable with this level of uncertainty about whether EC pills interfere with the process of implantation, you may wish to avoid them altogether.

 

WHICH METHOD OF EC SHOULD I TAKE?

The copper IUD is the most effective form of emergency contraception. If you’re not comfortable with the IUD insertion process, then Ella/EllaOne is the next most effective form of contraception. Levonorgestrel-containing pills (often known as Plan B), are the least effective; however, they will still prevent the majority of unplanned pregnancies at around 97.8% effectiveness.

Generally, Ella/EllaOne is more effective and has a wider window of action than Levonorgestrel (LNG)-containing pills. Ella/EllaOne can be taken up to 5 days after unprotected sex, whereas LNG-containing pills can only be taken up to 3 days after unprotected sex. Ella/EllaOne can be effective when it is taken during the surge of luteinising hormone (LH) that triggers ovulation; however LNG-containing pills are not effective once the LH surge begins. LNG-containing pills are less effective for those who are classed as clinically obese (a BMI of over 30kg/m2). Ella/EllaOne is also less effective for obese people, but to a lesser extent than LNG-containing pills.

If unprotected sex occurs very early in your fertile window, LNG-containing pills are an acceptable option. If unprotected sex occurs later during your fertile window while you are experiencing peak-type cervical mucus I recommend using Ella/EllaOne instead as there is a higher chance it will prevent pregnancy.

The table below shows the pros and cons of the three different types of emergency contraception. Make sure that you and your partner have taken a look and are comfortable and educated with this information in advance of needing to use it.

 

WHEN AM I SAFE FOR UNPROTECTED SEX AFTER TAKING HORMONAL EMERGENCY CONTRACEPTION?

If you’ve taken PlanB or EllaOne (or a variation of either of these), you may notice that your temperatures rise. This does not necessarily mean that you have ovulated – these medications often cause an artificially raised temperature.

Because of this, it is very important that you wait until you have successfully confirmed your next ovulation before having unprotected sex again.

If you are unsure, please contact your instructor for guidance.