Rael * 23 year old final year university student walks into my clinic . She is anticipating her final exams and soon thereafter start plans for a wedding with her fiancé Daniel*. They have been very careful with their safe days and using protection but last evening , they had an unprotected moment and she is ovulating today. She comes in because she wants advice on the best emergency contraception that is very efficient and without complications. She is not ready for a baby now and would like to focus on finishing school , getting high grades , getting a job and starting the tedious dowry/wedding preparations with Daniel. Her cycle has been very regular to the dot and she is sure that she has a very big chance of conceiving from the previous night’s encounter .
I’m surprised that we have younger ladies who are very armed with information and I congratulate her for seeking care timely and wanting to take control of her life . She says that my blog ( whose link was shared to her by a classmate)on not fearing contraception before marriage opened her eyes.
Emergency contraception according to WHO refers to methods of contraception that can be used to prevent pregnancy after sexual intercourse. These are recommended for use within 5 days of intercourse but are more effective the sooner they are used after the act of intercourse.
Emergency contraceptive pills prevent pregnancy by preventing or delaying ovulation and they do not induce an abortion. In case ovulation has already occurred, methods like the copper-bearing IUD prevents fertilization by causing a chemical change in the uterus and fallopian tubes that is toxic to sperms before they can reach the egg for fertilization. The copper-bearing IUD therefore acts as a spermicide, killing or impairing sperm so they cannot reach the egg. Copper IUDs do not contain any hormones, but release copper ions, which are toxic to sperm. They also cause the uterus and fallopian tubes to produce a fluid that contains white blood cells, copper ions, enzymes, and prostaglandins which is also toxic to sperm.The very high effectiveness of copper-containing IUDs as emergency contraceptives implies they may also act by preventing implantation.
Emergency contraception cannot interrupt an established pregnancy or harm a developing embryo; therefore doesn’t induce abortion and so it’s legally allowed.
Emergency contraception can be used in a number of situations following sexual intercourse. These include:
- When no contraceptive has been used or was forgotten e.g in patients on the daily pill .
- Sexual assault when the woman is to be protected against conception
- When there is concern of possible contraceptive failure such as a condom burst or slippage
- Miscalculation of the safe window or when not sure how to calculate
- Patients with sudden expulsion of an intrauterine contraceptive device (IUD) during or immediately after intercourse
So back to Rael , we get talking and the two main methods available locally are discussed which are as follows
- The high dose progesterone pills (150mg of levonorgestrel) popularly known as the P2 which should be taken within 72 hours of sexual intercourse (these pills can also be taken in 2 doses of 75mg each, 12 hours apart). This should not be abused and it’s recommended to be used infrequently and mainly during the fertile window.
- The copper IUCD which should be inserted within 120 hours (5 days)of unprotected intercourse
The pill will have same side effects like the oral contraception pills and if vomiting occurs immediately on taking the pills then it should be repeated immediately. The P2 has a failure rate of around 2% and the resultant pregnancy might be an ectopic pregnancy but this is rare. The P2 pill is also associated with irregularities of subsequent menses .
The copper IUD (Copper-T) is 99.2% effective as an emergency contraception if put within 120 hours . The downside is that it has to be put by a professional and may be unreachable by most especially younger students who may shy away from fertility clinics . The less than 1% that conceive would also most likely have an ectopic pregnancy but this is very rare . The advantage is that the woman can keep it as a continued effective contraception method and can last for upto 10 years . Removal is easy in the clinic and can be done by any medical cadre as long as the strings are visible .
The IUCD is also non-hormonal so no hormonal side effects like weight changes , menstrual irregularities are encountered . The return to fertility on removal is instant.
Rael opted for the IUCD . Luckily I had a a sterile insertion set and piece ready in the office and I was able to insert it for her immediately after confirming that her pregnancy test was negative (we have been conned by patients before so we always want to confirm). She was glad that she took medical consultation and saw a professional . Her next menses came on time and she is busy preparing for her exams .
I hope this is well understood. Take charge of your life ; do not let an oops moment change the trajectory of your life .