“Morning-after pills or pills” have become a relatively common method of birth control, compared to previous decades.
This is because they have shown positive effects in preventing pregnancy and a very small number of adverse effects. However, there are considerations that must be taken into account when taking the pill.
It’s also important to learn when to really use them, and when it’s okay to start regular methods of birth control, such as injections, the intrauterine device, oral contraceptives, and much more.
Next, we will give you a summary of what you should know and take into account before using it.
What is the morning after pill?
The morning after pill is part of the so-called emergency contraceptive methods. These are contraceptive measures that can be used immediately after intercourse to prevent pregnancy.
The main mechanism of the emergency contraceptive pill (ECP) is to stop the ovulation or fertilization process, both essential processes for the pregnancy to take place.
Thanks to advances in the area of pharmacology, adverse effects are more and more infrequent and show high efficacy in preventing fertilization of the egg, without significantly modifying the woman’s quality of life.
Composition and presentations of the morning after pill
ECPs, in general lines, are categorized into: those that contain estrogen and progestin, those that contain only progestin, and those that contain antiprogestin.
Among the most used pills in countries like the US, Canada, Australia, Denmark, Sweden and many more are those that only contain progestin, which is levonorgestrel.
The latter comes in two presentations: a blister containing a single 1.5mg Levonorgestrel tablet or a blister containing two 0.75mg tablets.
Others, such as ulipristal acetate (marketed under the name EllaOne), is a blister pack containing a single 30mg tablet.
When to use the morning after pill?
ECPs are used in a number of situations preceded by sexual intercourse. Next, we will name some of these situations.
By having unprotected intercourse
The main use of this pill is to avoid the risk of an unwanted pregnancy after having sexual intercourse without using some kind of protection (condoms, oral contraceptives or other methods).
Its use, especially in developed countries like the US, is quite common. In this country alone, in the period 2006-2010, one in nine women between the ages of 15 and 44 claimed to have used morning-after pills at least once or twice.
Of these, one in two women claims to have taken the pill for fear that their contraceptive method would not work properly or because they had unprotected sex.
The use of ECPs is not limited to consensual sexual intercourse. In the US, during the 1960s, Diethylstilbestrol was offered to women who had been victims of sexual abuse.
Eventually, the FDA discontinued its use as a postcoital contraceptive due to the various adverse effects it presented (infertility, ectopic pregnancies, preeclampsia, preterm births, and much more).
When the condom breaks
The incorrect use of the condom or its breakage during the sexual act represents another very common reason why women take ECP. Condom breaks are situations that, although not frequent, can occur .
The percentage of broken condoms varies from study to study, but even up to 29% of men who use condoms say they have experienced a condom break in the three months prior to the survey.
Among the reasons why it can occur: using expired condoms, inserting it incorrectly, “turning it over” and reusing it, condoms exposed to humid environments, drastic changes in temperature or direct exposure to sunlight.
When generating displacement of the diaphragm
The contraceptive diaphragm is a circular dome, made of a thin, soft silicone-based material, that is inserted into the vagina before intercourse. Its purpose is to obstruct the passage of sperm to the uterus, preventing pregnancy.
The effectiveness of the diaphragm as a contraceptive method, when used in conjunction with spermicides, is 92-96%. This means that out of 100 women, only 4 or 8 can become pregnant.
That means there are certain risks, such as displacement of the diaphragm during intercourse, which could result in sperm entering the uterus and possible fertilization of the egg.
When the IUD is expelled
The expulsion of the intrauterine device (IUD) is a possibility that every woman
decide to use this contraceptive method, you should know. It is defined as the inability of the device to anchor itself to the endometrium of the uterus.
Certain factors influence the possibility of expulsion, such as: the professional’s ability to insert the device, the age and pregnancy of the woman, the time interval since its placement, and when it was placed.
The risk of expulsion is higher in young women who have not had children, especially during the first few months, as the body has not yet adjusted to the device.
By incorrectly taking oral contraceptives
The nature of oral contraceptives requires that they be taken at precise times, otherwise their effectiveness may be reduced.
So that 3 or more combined oral contraceptive pills, which are not taken on time, constitute a risk of pregnancy. For progestogen pills, taking them more than 3 hours late represents a risk.
Another example is Desogestrel pills, which are taken 12 hours later than they should (ie 36 hours after the last pill taken).
These irregularities when consuming birth control pills decrease their effectiveness and make the woman need ECP.
How does the morning after pill work?
The main mechanism of operation of ECPs is to prevent fertilization by inhibiting the ovulation process in women. Next, we will detail, by part, its mechanisms of action.
Prevents the egg from leaving the ovary
Pregnancy after intercourse occurs only if it occurs during ovulation or the five days that precede it, it is the so-called fertile period or window of the menstrual cycle.
The spermatozoa, housed in the uterine crypts, can remain there for up to five days and fertilize the egg if the right conditions are met. The mechanism of contraceptives such as Levonorgestrel, is to prevent fertilization in the first place.
Luteinizing hormone is a hormone secreted during the menstrual cycle, which reaches a peak on the days close to ovulation. It is responsible for the release of the egg from the ovary.
The administration of contraceptives during the day of maximum secretion, inhibits or delays ovulation, although this effect depends, to a large extent, on the phase of the cycle at the time of taking the pill. Its greatest effect seems to be during the follicular phase.
Alters cervical mucus
On the surface of the cervical endometrium lies a layer of mucus that allows sperm to penetrate and adhere once they have entered the uterus. Contraceptives seem to modify the physicochemical properties of this.
The sperm residing in the crypts of the cervix retain their viability and are capable of fertilizing the ovum for up to five days later.
The reason is unknown, but contraceptives are capable of modifying this and reducing sperm survival, that is, altering the ability of sperm migration.
Prevents embryo implantation
The hypothesis that ECPs cause morphological and microscopic changes in the endometrium and, by extension, in the implantation capacity of the blastocyst, is a controversial idea.
Recent reviews seem to indicate that it has little or no effect. Therefore, the hypothesis that the contraceptive effects occur during the luteal phase gains more weight than the idea that these have an anti-implantation effect.
Considerations about the morning after pill
Despite their benefits as contraceptives, ECPs are not a magical and completely foolproof solution. Their effectiveness, like oral contraceptives, largely depends on the circumstances in which they were taken.
Next, we will explain some of these.
Its action is effective the first 24 hours
The maximum peak of effectiveness for certain ECPs occurs during the first 24 hours after intercourse. Levonorgestrel, for example, begins to modify sperm survival in the uterine cavity 3-10 hours after intercourse.
After 5 hours, Levonorgestrel modifies the pH of the endometrial mucus, which immobilizes the spermatozoa and prevents their migration to the ovum. At 9 hours, they induce a greater production of mucus to make it impossible for sperm to pass through.
Can be used up to 5 days after
Despite their high efficacy during the first 24 hours after intercourse, they are still effective even after 70-120 hours.
The efficacy interval varies according to the drug: Levonelle should be taken during the first 3 days, while EllaOne can be taken up to 5 days afterwards.
It should not be used twice in the same menstrual cycle.
There is not a large body of information or evidence demonstrating the long-term effects that repeated and prolonged use of these contraceptives may have on women.
However, the use of these pills as the only method is absolutely not recommended, since prolonged exposure to high doses of these hormones increases the risk of developing menstrual cycle irregularities and other adverse effects.
Avoid its use in case of hepatic insufficiency
Liver failure (or any disease, acute or chronic, of the liver) represents a challenge for doctors when administering medications, as this interferes with the drug elimination process.
If these are not eliminated, they accumulate in the body, which could lead to toxic effects. Estrogen-containing contraceptives are associated with cholelithiasis and hepatic adenoma in patients with liver disease.
On the other hand, those that contain progestin (for example, Levonorgestrel, trade name Plan B), have not been shown to cause hepatotoxicity or exacerbate symptoms of liver failure.
However, officially, the administration of pills such as Levonorgestrel and EllaOne is not recommended in patients with severe liver failure.
Avoid use in case of severe asthma
Women who suffer from asthma and are being treated with oral glucocorticoids are not recommended to take certain hormonal contraceptives, since they contain estrogen.
A study published in the American Thoracic Society 2018 International Conference , observed that there is a significant association between the use of oral hormonal contraceptives and premenopausal women with chronic asthma.
If you are lactating, stop for 8 hours
The contents of the drugs can pass from the bloodstream into certain bodily secretions, such as breast milk during lactation. This means that the neonate or infant is exposed to these drugs.
Therefore, in the case of Levonorgestrel, it is recommended to stop breastfeeding for at least 8 hours after its administration. In the case of EllaOne, it is recommended to stop breastfeeding for one week.
Menstruation can be early or late
Among the possible adverse effects of DBS, there are temporary changes in the menstrual cycle. However, they are not common effects. A large number of women affirm that menstruation began on the expected date.
On the other hand, a smaller percentage of women affirmed that there was a delay of menstruation of up to almost or more than 7 days. In others, there was no delay, but the menstruation came days earlier than expected.
Avoid its use in case of allergy to the components
Drugs can come in different presentations and, depending on which one, they are accompanied by other inactive substances (excipients). Lactose monohydrate is an example of an excipient that accompanies certain birth control pills.
However, certain people may be allergic to the medication itself or to the substances that accompany it, such as lactose, for example.
If you are lactose intolerant or suffer from a galactose malabsorption disorder (due to lactase deficiency), you should avoid its use and consult for alternatives.
Make sure you are not pregnant
Emergency hormonal contraceptives should not be administered if your period is late, if you have symptoms of a possible pregnancy or if one is suspected.
Although there are no records indicating a possible teratogenic effect on the effect, there is also no information to support its safety on the fetus. Therefore, taking ECPs is not recommended at all if pregnancy is suspected.
it is not abortive
There is no evidence to indicate that the consumption of the pill produces teratogenic effects (that is, malformations of the fetus) or induces abortion.
In this sense, studies where high doses of emergency oral contraceptives have been administered did not result in any risk for the development of the embryo.
Does not produce infertility
ECPs do not appear to have any effect on fertility levels in women. Certain ECPs, such as Levonorgestrel, can alter a woman’s ovulation date, either earlier or later. However, this does not decrease a woman’s ability to become pregnant.
However, the woman is recommended to start traditional contraceptive treatments in order to minimize the risk of pregnancy, since emergency pills should not be used as the only contraceptive method.
Side effects of the morning after pill
Almost all medications can have side effects, and morning after pills are no exception. These side effects are generally short-lived, just a couple of days, and are usually not serious.
It is important to note that side effects may vary depending on the brand of pills, and on each woman. The following are the most common side effects of morning after pills.
Dizziness, nausea and vomiting
Among the most common symptoms are dizziness, nausea in about 50% and vomiting in 20% of women who took morning-after pills. If vomiting occurs and just two hours have passed after ingesting the pill, it is recommended to repeat the dose.
Abdominal pain and headache
Among the side effects is pain in the lower part of the stomach or belly that can be described as abdominal pain, accompanied or not by cramps in the area. If the pain persists for more than two days, it is recommended to see a doctor.
The pills of the day after, being hormonal contraceptive methods, it is common for them to produce headaches, this is due to the effects of estrogens against aldosterone.
Fatigue
Tiredness and fatigue are other side effects directly related to the hormones contained in this medicine. These feelings of heaviness disappear spontaneously after 24 or 48 hours.
Pain in the breasts
Breast pain and tenderness is a common side effect of many hormonal birth control pills, so it is, too, on morning-after pills, and it usually goes away within a couple of days. If the pain persists, it is recommended to see a doctor.
Heavy bleeding and between menstrual cycles
After taking the morning-after pill, bleeding may occur in some women, however, there are few alterations that occur in the menstrual cycle, and all these possible irregularities are tolerated by the woman.
It should be noted that 50% of women , after taking the morning-after pill, present their menstrual cycle normally and on the expected date. Some women may have their menstrual period early or late by a maximum of 5 days.
University Professional in the area of Human Resources, Postgraduate in Occupational Health and Hygiene of the Work Environment, 14 years of experience in the area of health. Interested in topics of Psychology, Occupational Health, and General Medicine.