Morning-after pill: everything you need to know

In Italy there are two pharmacological methods of emergency contraception that can reduce the risk of an unwanted pregnancy.

Morning after pill, five-day after contraception, morning-after spiral: many different terms to indicate what should be more simply and correctly called “emergency contraception”, precisely because the time factor is fundamental when you want to reduce the risk of unwanted pregnancy after unprotected intercourse or following the failure or misuse of a contraceptive method.

The term “emergency” also stresses that this form of contraception must be an occasional measure and not replace a regular contraceptive method.

The reality of the facts, however, reveals an increase in its use, especially among twenty-year-olds. In 2016, pharmacy sales reached 487,000, an increase of 25 percent compared to the previous year, when 390,000 pills were sold.

According to the Ministry of Health, the boom in sales indicates, however, that in our country there is still a lack of a culture of prevention, especially among the youngest, and that there is therefore ample room for improvement in the planning policies of sexual and reproductive health of the couple. In fact, sexuality, contraception, health and well-being should be talked about more, with educational campaigns, but also at school and in the family.

Methods for emergency contraception

It is estimated that in the Western world about 50 percent of pregnancies begin with an “accidental” conception, due to the lack of contraception or the failure of the method used.

Most of these pregnancies end in voluntary termination, but this could be avoided by emergency contraception. This can be implemented in Italy using three possible methods:

– the “morning after pill” based on oral progestogen preparations containing levonorgestrel

– the “five-day after pill” based on ulipristyl acetate

– the copper spiral (IUD, Intra uterine device), which must be inserted into the uterus by the gynecologist.

In the case of levonorgestrel, one 1.5 mg tablet should be taken in a single administration within 72 hours of the offending relationship, bearing in mind, however, that the effectiveness is maximum if the pill is taken within 12 hours of intercourse and decreases as time passes.

The same applies to ulipristil acetate (one 30 mg tablet in a single administration), which however has a longer window of efficacy, equal to 120 hours from intercourse.

Both of these hormonal methods have the objective of preventing fertilization, interfering with ovulation. They do not cause an abortion and are not effective when taken by a woman who has already ovulated or is already pregnant. Once the embryo implantation begins, the emergency contraceptive no longer has any effect.

Copper IUD acts differently, reducing sperm count and motility. Not only that, it is able to modify the inner lining of the uterus (endometrium), making it unsuitable for pregnancies. It can be used for up to five days after risky sexual behavior and then it can be left in the uterus for up to 10 years to be used as a contraceptive method.

In Italy it is off-label: it can be used, but at personal responsibility, especially of the gynecologist who must place it. Before inserting it, the doctor must be reasonably certain that there is not already a pregnancy implanted in the uterus.

The importance of timing

A woman can only get pregnant for about a week in each month. The highest risk is on and during the day before ovulation. Since oral methods of emergency contraception only work if ovulation has not yet occurred, the sooner the treatment is given, the more likely it is to be used when it still works.Timeliness is therefore very important and is one of the reasons why experts in the world of gynecology invite you to no longer use the concepts of morning-after pill, morning-after contraception, five-day after pill and so on. On the one hand they are conceptually wrong, on the other hand they can induce women not to use emergency contraception when more than a day has passed, or to use it only after the “five days”, reducing the chances of success.

When to use the morning-after pill

Emergency contraception is indicated when you do not want to become pregnant, but you think that your contraceptive method has not worked properly or in the case of unprotected sex.

In particular, the main circumstances that lead the woman to resort to it are:

– the breakage of the condom or its leakage during intercourse

– failure to take one or more doses of the contraceptive pill

– the recent or ongoing use of drugs that could promote malformations of the fetus (teratogens) in case of pregnancy

– after a sexual assault.

One of the myths, which sometimes constitutes an obstacle to the use of this secondary prevention system of unwanted pregnancies, is the belief that it can only be used once in a lifetime, once a year or only once during the menstrual cycle. In fact, the World Health Organization states that there are no restrictions on repeated use, but be careful to use the same method in case it is necessary to resort to emergency contraception again within five days of first intake.

Emergency contraception should not be repeated more than once in 24 hours, even if more unprotected sexual acts have occurred during this time.

Contraindications

Pharmacological methods of emergency contraception are completely useless and ineffective if pregnancy is already underway. However, even when taken at any stage of pregnancy, there is no evidence of possible teratogenic effects.

The morning-after pill has no particular contraindications, but is not recommended in case of:

– genital bleeding whose cause is unknown

– gynecological tumors

– known allergy to the drug.

It can be taken without problems by women suffering from migraines, by smokers over 35 years of age or with other contraindications to the use of oral contraceptives containing estroprogestin.

The 5-day after pill should not be taken by people with galactose intolerance (galactosemia), with diseases involving reduced liver function or allergies to the active substance ulipristal acetate and all other components of the drug. It is also contraindicated in women with severe asthma not well controlled by oral glucocorticoids and women suffering from severe lactose intolerance. When taken by women who are breastfeeding, breastfeeding should be stopped for seven days.

Possible side effects

Levonorgestrel is typically a drug with a good safety profile and well tolerated. The most common disorder is nausea. Other possible side effects include abdominal pain, fatigue, dizziness and vomiting.

Most women will have their next period within about a week of the expected date. If this does not happen three weeks after taking it, it is advisable to contact your doctor and/or take a pregnancy test.

The most common side effects of the 5 Day After pill (ulipristal acetate) are similar and include nausea, headache, dizziness, abdominal pain, vomiting, muscle pain, breast tenderness, mood disorders and fatigue. Usually all these effects tend to disappear within a couple of days, but in case they persist for longer, it is advisable to consult a doctor for advice and indications.

There are also side effects that occur more frequently, and others that appear more rarely. Let’s see what they are.

How to have the “morning-after pill” and the five-day after pill

Both ulipristal acetate and levonorgestrel can be purchased in pharmacies without a prescription, but only by adults. This means that once you turn 18 you can request them directly from the pharmacist without going to a doctor.

It is a pity, however, that, as revealed by a recent survey, as many as 42 percent of women are not aware of it and consider it necessary to present a prescription and that more than 50 percent of pharmacists consider the morning-after pill a “dangerous” product, thus hindering its sale.

For minors, however, the obligation of a medical prescription remains, which can be requested from any doctor, not necessarily the gynecologist. To get the medical prescription, girls can, for example, go to the emergency room, to a public clinic, to their family doctor and, on holidays and pre-holidays, to the medical guard. Conscientious objection is allowed, but the medical objector is still obliged to provide all the information so that the young woman can receive the prescription and the drug in good time.