WOMEN’S BODIES: EMERGENCY ‘MORNING-AFTER’ CONTRACEPTION
Have you ever realized (too late!) that you forgot to put in your diaphragm, or that the condom has torn, or that you’ve made a mistake about your ‘safe’ period? These accidents can happen, so all women should know about ‘morning-after’ contraception (which is called ‘post-coital contraception’ in the textbooks and needs a new name, as it can be used up to 72 hours, perhaps longer, after intercourse).
There are two ‘morning-after’ methods of preventing pregnancy:
• the morning-after pill
• IUD insertion.
The morning-after pill
If you can get to your doctor within three days, a short course of hormones (either oestrogen or oestrogen plus progestogen) may be prescribed. Studies have shown that less than five in a hundred women will conceive if this treatment is properly used.
How does the morning-after pill work?
The hormones work in either of two ways:
• by delaying ovulation until after all the sperm inside you have died
The hormones must be started within 72 -hours of the first unprotected intercourse. If started later, they may not work. The most common treatment is two doses of a particular type of contraceptive pill taken exactly 12 hours apart (so take the first dose at a time that won’t mean that you have to wake up in the middle of the night for the second dose). Sometimes high doses of oestrogen are used.
The only common side-effect (occurring in about 50 per cent of users) is nausea that occasionally leads to vomiting. Anti-nausea tablets may be prescribed at the same time (you shouldn’t drive for 12 hours after taking these). A few women develop sore breasts and mild headache, which subside within two days of finishing treatment. Some will have light bleeding from the vagina a few days after finishing the hormones. This isn’t a normal period.
Your next period may be early, on time or late. It occurs usually within four weeks, depending on the stage your menstrual cycle had reached when you started treatment.
If you are already pregnant from the previous cycle or from earlier in your present cycle, the morning-after pill won’t stop that pregnancy from continuing, but the hormones won’t harm the foetus. There is no evidence of increased risk of ectopic pregnancy when the combined contraceptive pill is used for post-coital contraception.
Women often ask why the morning-after pill couldn’t be used with every cycle. The answer is that it can only be relied on for sexual intercourse within the 72 hours before treatment. This means that frequency of sex would be very limited, or that you would have to take the hormones every few days. You would be taking higher doses of hormones than if you were on the Pill, and would probably have very irregular periods.
The antiprogestogen RU486, so far used only as an abortifacient, is at present being studied for its safety and effectiveness as morning-after pill. Researchers predict that this may be its most useful application.
Copper IUD insertion
If done within five days of a single act of unprotected sex, this will prevent pregnancy in the cycle of insertion and provide on-going contraception. This method of post-coital contraception is not often suggested, but it may be appropriate if woman is suitable for an IUD and wants to use one. The IUD method can only be
used when there is no possibility of pregnancy from intercourse earlier in the cycle Post-coital contraception has been around since the 1960s, but it’s never had wide publicity. I wonder if this is because those in the know feared that if the word got around, women might be more likely to be careless about regular contraception. I more people knew about it, there would be fewer requests for abortion. And it’s infinitely more effective than the old folk methods of jumping up and down after sex or keeping your fingers crossed until your next period arrives!
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