Emergency Contraception

Emergency Contraception can prevent pregnancy after unprotected vaginal intercourse. It is also called post-coital or "morning-after" contraception. It is available from health care providers, Planned Parenthood? health centers, and other women's health and family planning centers. Emergency Contraception is provided in two ways

emergency contraception pills (ECPs)
insertion of an IUD

Emergency Contraception is used only if a woman is not already pregnant from a previous act of intercourse. ECPs prevent pregnancy by stopping ovulation or fertilization. IUDs prevent fertilization. Theoretically, EC could also prevent implantation, but that has not been proven scientifically. EC will not cause an abortion.

ECPs

Plan B? is a brand of ECPs designed and approved by the FDA specifically for emergency contraception. Certain birth control pills may also be prescribed for use as emergency contraception. Some ECPs are "combination pills" with estrogen and progestin ? synthetic hormones like the ones a woman's body makes. Others, such as Plan B, are progestin-only. Some clinicians review your medical history before they prescribe ECPs. Some may want you to give informed consent by signature or over the telephone.

How to Use ECPs

Plan B and other progestin-only ECPs can be taken in one dose or in two doses, 12 hours apart. Combined hormone ECPs must be taken in two doses, 12 hours apart. The number of pills in a dose varies with the brand of the pill. Use the same brand for both doses. ECPs can reduce the risk of pregnancy if started within 120 hours after unprotected vaginal intercourse. The sooner they are started, the better. ECPs reduce the risk of pregnancy by 75-89 percent when the first dose is taken within 72 hours. ECPs will not affect an existing pregnancy.

Pill Brand	Manufacturer	1st Dose	2nd Dose (12 hrs later)
Progestin-only Pills
Ovrette?	Wyeth-Ayerst	20 yellow pills	20 yellow pills
		or 40 yellow pills in one dose
Plan B?	Barr	1 white pill	1 white pill
		or 2 white pills in one dose
Combination Hormone Pills
Alesse?	Wyeth-Ayerst	5 pink pills	5 pink pills
Aviane?	Duramed	5 orange pills	5 orange pills
Cryselle?	Barr	4 white pills	4 white pills
Enpresse?	Barr	4 orange pills	4 orange pills
Lessina?	Barr	5 pink pills	5 pink pills
Levlen?	Berlex	4 light orange pills	4 light orange pills
Levlite?	Berlex	5 pink pills	5 pink pills
Levora?	Watson	4 white pills	4 white pills
Lo/Ovral?	Wyeth-Ayerst	4 white pills	4 white pills
LowOgestrel?	Watson	4 white pills	4 white pills
Lutera^TM	Watson	5 white pills	5 white pills
Nordette?	Wyeth-Ayerst	4 light orange pills	4 light orange pills
Ogestrel?	Watson	2 white pills	2 white pills
Ovral?	Wyeth-Ayerst	2 white pills	2 white pills
Portia?	Barr	4 pink pills	4 pink pills
Seasonale?	Barr	4 pink pills	4 pink pills
Tri-Levlen?	Berlex	4 yellow pills	4 yellow pills
Triphasil?	Wyeth-Ayerst	4 yellow pills	4 yellow pills
Trivora?	Watson	4 pink pills	4 pink pills

With a regular 28-pill birth control pack, use any of the first 21 pills for emergency contraception. Don't use the last seven pills in a 28-day pack. They are only reminder pills that contain no hormones. With Enpresse, use only the orange ones. With Triphasil or Tri-Levlen, use only the yellow ones. With Trivora, use only the pink ones.

Swallow the pills in the first dose as soon as possible, up to 120 hours ? five days ? after having unprotected sex. If you are using combined-hormone pills, you may want to take a medication to reduce nausea, such as Dramamine? or Bonine?.

If you are taking the pills in two doses, swallow the second dose 12 hours after taking the first dose. If you threw up after the first dose, be sure to use an anti-nausea medication one hour before taking the second dose. Or you may want to take the second dose as a vaginal suppository by inserting the pills with your fingers as high into the vagina as you can reach. (The medication will be absorbed through the vaginal tissue.)

If you vomit the second dose, do not take any extra pills. They probably won't reduce the risk of pregnancy any further.

After You Take the Pills

Your next period may be earlier or later than usual.
Your flow may be heavier, lighter, more spotty, or the same as usual.
If you see other health care providers before you get your period, remember to tell them that you have taken emergency contraception pills.
Schedule a follow-up visit with your clinician if you do not have your period in three weeks or if you have symptoms of pregnancy.
Be sure to use another method of contraception if you have vaginal intercourse any time before you get your period again.
Continue using the birth control method of your choice for as long as you want to avoid pregnancy.

Side Effects

Side effects associated with the use of ECPs usually taper off within a day or two.

Half of the women who take the combined pills feel sick to their stomachs, but only for about 24 hours.
Less than one out of five women throw up with combined pills.
The risk of nausea and vomiting is lower with progestin-only ECPs.
Breast tenderness, irregular bleeding, dizziness, and headaches may also occur.

There have been no reports of serious complications among the millions of women who have used ECPs. Frequent use of ECPs may cause periods to become irregular and unpredictable. The side effects of anti-nausea medication may include drowsiness. Please follow the precautions on the package insert.

Emergency contraception may not prevent ectopic pregnancy. An ectopic pregnancy is one that develops outside the uterus. It must be treated to prevent complications that may be fatal.

If you think you may have an ectopic pregnancy, get medical attention immediately. Signs of ectopic pregnancy include

severe pain on one or both sides of the lower abdomen
abdominal pain and spotting, especially after a very light or missed menstrual period
feeling faint or dizzy

ECPs will not harm a fetus. Still, you should not use emergency contraception if you are pregnant.

Emergency IUD Insertion

A clinician can insert an IUD for emergency contraception within five days of unprotected intercourse. The Copper T 380A IUD (ParaGard?) is used for emergency contraception. It can be left in place for up to 12 years for very effective contraception. Or the IUD can be removed after your next menstrual period, when it is certain that you are not pregnant.

IUD insertion for emergency contraception is not recommended for women at risk for sexually transmitted infection at the time of insertion, including women who have been raped.

If you have an IUD inserted, you may want to have someone with you to escort or drive you home. You may need to rest afterwards.

The side effects, advantages, and disadvantages of using IUDs for emergency contraception are the same as those associated with using IUDs for ongoing contraception.

How Well Emergency Contraception Works

Combined ECPs reduce the risk of pregnancy by 75 percent if started within 72 hours of unprotected intercourse. For example, eight out of 100 women will become pregnant after having unprotected sex once during the second or third week of their cycles. But only two out of 100 will become pregnant after taking ECPs.
Progestin-only ECPs reduce the risk of pregnancy by 89 percent if started within 72 hours of unprotected intercourse. Only one woman out of 100 will become pregnant after taking progestin-only ECPs.
Emergency IUD insertion reduces the risk of pregnancy by 99.9 percent. Only one out of 1,000 women will become pregnant after emergency IUD insertion.

Emergency contraception is meant for emergencies only. ECPs are not as effective as the correct and consistent use of reversible contraception ? the IUD, the shot, the pill, the patch, or the ring.

ECPs do not continue to prevent pregnancy during the rest of the cycle. Other methods of birth control must be used.

Emergency contraception offers no protection against sexually transmitted infections. You may want to consider testing for sexually transmitted infections if there is a possibility that unprotected sex put you at risk.

Where to Get Emergency Contraception

Emergency contraception is available from

Planned Parenthood health centers
college, public, and women's health centers
private doctors
hospital emergency rooms ? unless they are affiliated with religions that oppose the use of birth control

ECPs are available directly from some pharmacists in a small but increasing number of states.

Some clinics and clinicians will prescribe ECPs over the phone and call the prescription in to a pharmacy. In some states, women can get a prescription online. Some clinicians routinely prescribe ECPs before they are needed. This allows women to use ECPs in emergency situations without having to wait to get an appointment.

You can get the names and phone numbers of five emergency contraception providers nearest you by calling, toll-free, the emergency contraception hotline ? 1-888-NOT-2-LATE. Or contact the nearest Planned Parenthood health center at 1-800-230-PLAN.

Costs Vary Widely

Fees may be less at family planning clinics and health centers. Some use a sliding scale based on income. Costs vary from community to community, based on regional and local expenses. Contact your nearest Planned Parenthood health center at 1-800-230-PLAN for information about costs in your area. Costs also depend on which of the following services are needed. Here are some estimates:

ECP	Range of Costs
Plan B	$8 - $35
one pack of combination pills	$20 - $50
two packs of progestin-only pills	$50 - $70
visit with health care provider	$35 - $150
pregnancy test	$10 - $20
Total Cost	$8 - $240

IUD ? The ParaGard IUD costs about $400 for exam, IUD, and insertion. It lasts for 12 years, which amounts to less than $35 a year if left in place. Costs vary from community to community, based on regional and local expenses. Contact your nearest Planned Parenthood health center by calling, toll free, 1-800-230-PLAN for information about costs in your area.

You May Want Emergency Contraception If

His condom broke or slipped off, and he ejaculated inside your vagina.
You forgot to take your birth control pills.
Your diaphragm, cap, or shield slipped out of place, and he ejaculated inside your vagina.
You miscalculated your "safe" days.
He didn't pull out in time.
You weren't using any birth control.
He forced you to have unprotected vaginal sex.

Contact your health care provider immediately if you have had unprotected intercourse and you think you might become pregnant.

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