An emergency contraceptive pill (ECP) is an emergency contraceptive method taken within 72 hours or three days after having unprotected sex. It is also popularly known as the Morning-After Pill. These pills help to prevent an unintended pregnancy in case your primary birth control method has failed. The side effects of emergency contraceptive pills are not that serious or something to worry about.¹

The morning-after pill should be used as a backup method of birth control and not as the primary method. A pregnancy that has already begun cannot be stopped by ECP! So, as opposed to the ECP, if your pregnancy test is positive, your doctor might advise you to take an abortion pill. Do not confuse the morning-after pill with mifepristone (Mifeprex), also referred to as RU-486 or the abortion pill.

Levonorgestrel is an ‘over-the-counter’ pill which means that it is available without a prescription in India.² It helps prevent pregnancy by delaying or stopping ovulation. Further, it’s very important for everyone to know that the emergency contraceptive pill cannot stop a pregnancy that has already happened. 

How do emergency contraceptive pills affect your body?

The fact is that the dose of hormones in the ECP is significantly more than something intended for daily use, like the daily oral contraceptive pill (birth control pills). As a result, people who overuse ECPs may see their menstrual cycle getting affected - their periods may not resume normally. They may also observe weight gain and so on. ECPs are not recommended as long-term contraception options or as a replacement for standard birth control. It is never a good idea to rely on emergency contraceptive pills as a substitute for your regular contraceptive method - condoms, pills, intrauterine device (IUDs), and so on.³

When to take the emergency contraceptive pill?

Emergency contraceptive pills are not the same as regular birth control pills or other forms of routine birth control. You should take it only when all other forms of birth control have failed or were ineffective. Use of emergency contraceptive pills may be appropriate in the following circumstances:

• If you had sex without using any form of birth control.

• Failure of the birth control method (a broken condom, forgotten birth control pill or missed dose of birth control shot).

• If you have experienced non-consensual sex.⁴

Your cycle may be delayed by one week as a result of the emergency contraceptive pill. If your periods doesn't start three to four weeks after using the emergency contraceptive pill, get a pregnancy test. 

Do emergency contraceptive pills work during ovulation?

The emergency contraceptive pill is more effective only if taken before ovulation because it primarily functions by delaying ovulation. It can work even in the luteal phase, efficacy is lower. Ovulation is a natural aspect of the female reproductive cycle. The release of an egg from the ovaries during this stage allows sperm to fertilise it and start the process of embryonic development. If you do not ovulate, there will be no egg to be fertilised by the sperm. Hence, you will not get pregnant.⁵

What are the side effects of emergency contraceptive pills?

If you are going to take the morning-after pill, here's why you don't have to worry about the side effects. The common complications of emergency contraceptive pills are short-term and go away within a few days. The side effects of emergency contraceptive pills are similar to that of side effects of birth control pills. In case the persist for a longer time, contact your doctor.⁶

The following are common minor side effects of emergency contraceptive pills: 

• Nausea

• Vomiting

• Fatigue

• Dizziness

• Headache

• Lower abdominal pain or cramps

• Sore or tender breasts

• Heavy menstrual bleeding or bleeding between periods ⁷

Later, you may also have other symptoms like: 

• Spotting - You may have some spotting within the next week of taking the emergency contraceptive pill. Also, your next period can be lighter or heavier than usual. You need not be worried because that is common. Although if the bleeding seems very heavy and doesn’t stop, call your doctor.

• Irregular menstrual cycle - Due to the emergency contraceptive pill, your period may arrive a little early or late, which is normal. However, you should take a pregnancy test if you do not get your period within 3-4 weeks of taking the pill.⁸

How long do side effects of emergency contraceptive pills last?

Emergency contraceptive pills (ECP) are generally safe for almost every woman. Emergency contraceptive pills do not have any severe or long-term side effects. It may have some side effects that are usually temporary and nothing to stress about. All these possible side effects of ECPs will get resolved in a few days or weeks.

How effective is the emergency contraceptive pill?

If taken within 72 hours of having unprotected sex, emergency contraceptive pills can reduce the risk of pregnancy by up to 87% when taken as directed.⁹ When determining the effectiveness of the emergency contraceptive pill in preventing pregnancy, it is critical to consider time. The emergency contraceptive pills work for up to 72 hours or three days after having unprotected sex. But the sooner you take the emergency contraceptive pill, the more likely it is to prevent pregnancy. Despite the name "morning-after pill," you don't need to wait until the next day to take these pills.

Are emergency contraceptive pills harmful?

While the emergency contraceptive pill is a viable option for avoiding pregnancy during unprotected sex, it is not advised for regular use because it is not as effective as other forms of regular contraception. Also, the emergency contraceptive pill does not protect against sexually transmitted infections (STIs).

Not everyone is advised to use emergency contraceptive pills. Avoid taking the emergency contraceptive pill if:

• You have an allergy to one or more ingredients of the emergency contraceptive pill.

• You're taking a medicine that can make the emergency contraceptive pill less effective.

There are some indications that the emergency contraceptive pill won't work as well to prevent pregnancy in obese or overweight people as it does for women who aren't obese.¹⁰

Is it possible to get pregnant after taking the morning-after pill?

Yes, it is possible to become pregnant after taking the morning-after pill. If you take the pill after having unprotected sex, it can help you avoid pregnancy. However, it won't stop you from getting pregnant if you have unprotected sex after taking it. Therefore, you will need to take the morning-after pill once again if you use it and subsequently engage in unprotected sex.¹¹

How to know if the morning-after pill has worked?

The only way to know if the morning-after pill has worked is when you get your next period when it is due or when you take a pregnancy test after you have missed your period. Taking a test right after taking the morning-after pill will be ineffective. This is because there will be insufficient human chorionic gonadotropin (hCG) in the body at this stage. The level of hCG in your body will rise during pregnancy until it reaches its peak. A pregnancy test measures this, and it must reach a specified amount to be positive. You can take a pregnancy test on the first day of your missed period, but if it comes out negative and your period hasn't arrived after a week, you should test again. This time opt for a more accurate test.¹²

What are the signs that the morning-after pill hasn't worked?

If you take the emergency contraceptive pill right after having unprotected sex, it can be very effective. The longer you wait to use the emergency contraceptive pill, the less effective it is. A missed period is one of the primary indicators that an emergency contraceptive pill hasn't worked. Take a pregnancy test if your period doesn't arrive three to four weeks after taking the emergency contraceptive pill. 

Can emergency contraceptive pills cause infertility?

No, using an emergency contraceptive pill (ECP) more than once will not interfere with your fertility or prevent you from getting pregnant in the future.

Women should not be afraid to utilise ECP when they believe it is necessary. Since ECP is less successful at preventing pregnancy than birth control methods like the IUD, patch, pill, ring, or shot, it is not advised as a long-term method of birth control. Additionally, regular ECP use may make periods unpredictable and irregular.¹³

How many times can I use emergency contraceptive pills?

There is no cap on how many times you can use the emergency contraceptive pill. There are no major long-term side effects to the pill. But doctors often recommend not using these pills as a regular form of birth control. This is generally because of the higher amount of hormones in emergency contraceptive pills.¹⁴

Consult a doctor:

In most cases, you don't need to contact your doctor after taking the emergency contraceptive pill. However, get in contact if you experience significant lower abdomen pain three to five weeks after using the emergency contraceptive pill, bleeding, or spotting that lasts longer than a week. These could signify a miscarriage or the fertilised egg implanting outside of the uterus, typically in a fallopian tube (ectopic pregnancy).

It's also crucial to keep in mind that taking the emergency contraceptive pill does not protect you from sexually transmitted infections (STIs). Contact a doctor on Pinky Promise if you have any doubts about the possibility of being exposed to an STI.¹⁵ 

References

1, 3, 6, 9 - Levonorgestrel Emergency Contraception; From Web MD (https://www.webmd.com/sex/birth-control/plan-b). Retrieved on 20.10.2022 

2, 5, 7, 10, 13 - The morning after pill; From Mayo Clinic (https://www.mayoclinic.org/tests-procedures/morning-after-pill/about/pac-20394730). Retrieved on 20.10.2022 

4, 15 - Morning-after pill; From Cleveland Clinic (https://my.clevelandclinic.org/health/treatments/23386-morning-after-pill). Retrieved on 20.10.2022 

8 - Emergency contraception: What to expect; From Web MD

(https://www.webmd.com/sex/birth-control/what-to-expect-emergency-contraception). Retrieved on 20.10.2022 

11 - Can you get pregnant if you have unprotected sex one day after taking the morning-after pill? ; From Planned Parenthood (https://www.plannedparenthood.org/learn/ask-experts/can-you-get-pregnant-if-you-have-unprotected-sex-one-day-after-taking-the-morning-after-pill). Retrieved on 20.10.2022 

12 - How Can I Tell if the Morning After Pill Worked? ; From Nurx (https://www.nurx.com/faq/how-can-i-tell-if-the-morning-after-pill-worked/). Retrieved on 25.10.2022 

14 - Is it bad to take the morning-after pill more than once? ; From Planned Parenthood (https://www.plannedparenthood.org/learn/ask-experts/is-it-bad-to-take-ec-more-than-once-is-there-a-long-term-effect-will-i-not-be-able-to-have-a-baby-later-if-i-keep-taking-ec-often). Retrieved on 20.10.2022