Emergency contraception: morning-after pill

In the case of unprotected sexual intercourse or contraceptive failure, means such as the morning-after pill or the morning-after coil can prevent an unwanted pregnancy

If a woman is afraid of being unintentionally pregnant, the gynecologist is the reliable contact

© Shotshop / Marcin Balcerzak

Forgot the pill more than once or for too long? Has the condom slipped? Or a gastrointestinal infection got in the way and you fear that the pill will no longer work as a result? Contraceptive failures and emergencies happen quickly. Two different methods offer a way out: morning-after pill, available (also) without a prescription in pharmacies, or morning-after coil.

Morning-after pill

There are two "morning after pills" in Germany. One contains a progestin (levonorgestrel, LNG) in a relatively high dose, the other the active ingredient ulipristal (ulipristalacetet, UPA). Incidentally, both preparations have nothing to do with the "abortion pill" (active ingredient: mifepristone (RU 486)). However, UPA is a further development of mifepristone.

This is how the morning-after pill works

A few days before ovulation and on the day of ovulation itself, the likelihood of pregnancy is highest. Sperm are generally capable of survival and fertilization for five to seven days. Both preparations inhibit or delay ovulation.

It follows from this: In the "gained" time, the sperm cells usually die on site and can then no longer fertilize the egg cell. After ovulation, i.e. if taken too late, the medication no longer works. Even an existing pregnancy is not affected by the morning-after pill.

facts and figures

On the morning-after pill, one to three in every hundred women per cycle will become pregnant. For comparison: Without emergency contraception, around eight out of a hundred women per cycle will become pregnant. Young girls and younger women have used emergency contraception significantly more often than older ones.

According to the German Society for Gynecological Endocrinology and the Professional Association of Gynecologists, Ulipristal is now the standard for the morning-after pill. Because the active ingredient can stop ovulation (ovulation) a little later than levonorgestrel.

This means: UPA can be used within five days (120 hours) of unprotected sexual intercourse or failure of contraception. With LNG it is only three days (72 hours), because it no longer works when certain control hormones rise to trigger ovulation.

Therefore, if possible, LNG should be taken within twelve hours and no later than three days after the (presumed) breakdown in contraception. UPA, on the other hand, is still effective in this phase. Emergency contraception is and will always be a race against time: the earlier the treatment, the more effective it is.

The morning-after pill is (also) available in pharmacies without a prescription

© istock / kadmy

Who can get the morning-after pill?

Pharmacies can sell the morning-after pill to women of childbearing age without a prescription. Girls under the age of 14 should provide a parental consent form. The drug should be given to the affected woman personally.

For women up to their 20th birthday, the statutory health insurance companies cover the cost of the morning-after pill if a doctor has issued a prescription. For women aged 18 and 19, there is generally a prescription fee at the pharmacy.

Contraindications, possible side effects, problems

It is as easy to use as it is: The morning-after pill is a drug that interferes with the hormonal system and other body processes. So side effects must always be expected. In short, these are primarily headaches, dizziness, nausea or nausea and vomiting, breast tenderness, menstrual pain and menstrual irregularities. Affected women report, for example, spotting, heavy or light bleeding until the next menstruation, which can also occur late. However, pregnancy can sometimes express itself with such symptoms (see below).

The morning-after pill is unsuitable for allergies to the substances it contains and for severe liver and kidney diseases. Alternatively, you can then use the spiral afterwards (more on this below). This may also apply to very overweight women, because if the body weight is significantly increased, the effect of both levonorgestrel (from about 70 kg body weight) and Ulipristal (from about 95 kg body weight) diminishes - possibly. The data situation here is not entirely clear, but according to the European Medicines Agency (EMA), it is not sufficient to restrict its use.

If a woman is breastfeeding, she must take a week-long break after using UPA, including expressing and disposing of the milk. After LNG, an interruption of eight hours is sufficient: take it immediately after breastfeeding, then take a break.

If you have unprotected sexual intercourse several times in a monthly cycle, the morning-after pill is no longer the right choice. With LNG, the hormone load would be too high and could lead to menstrual disorders, and the effect also decreases. Experience with UPA is still limited. Switching from one preparation to the other is also not recommended. The morning-after pill also does not protect against conception later in the cycle.

If vomiting occurs within three hours of ingestion, another tablet should be taken.

UPA should not be taken if an existing pregnancy is suspected. If a woman fears from the outset that things are going to be pregnant, also because the next menstrual period does not start within a week of the expected time, and breast tenderness and morning sickness may occur, then before taking the morning-after pill, especially UPA, a pregnancy test is appropriate.

This also applies if there is bleeding with abdominal pain. In any case (even after taking UPA) an examination by the gynecologist is necessary in order to rule out an ectopic pregnancy, for example.

If pregnancy is confirmed, there is no longer any indication for either emergency contraceptive pill. In addition, little is known about the teratogenic effects of the morning-after pill such as UPA. It cannot be ruled out, but it cannot be deduced from the few data so far. No embryotoxic effects have been described for the morning-after pill with LNG.

Some drugs can affect the way LNG and UPA work. Ask your pharmacy for more information.

Spiral afterwards

The coil afterwards very effectively prevents the implantation of a fertilized egg cell up to the fifth day after conception at the latest. The doctor places the IUD in the uterus. Various copper IUDs, also approved for emergency contraception, are suitable for this, including the copper chain (see article "Copper IUD"). The coil then also serves for further contraception.

Depending on the type and tolerance, it can remain (active) in the uterus for three to five years or longer. Since the cervix is ​​not slightly open as it is with menstruation, the usual time to insert an IUD, the procedure can be a little more painful than normal.

Contraindications to the IUD afterwards

The IUD is not suitable for an existing pregnancy, an abdominal inflammation, malformations of the uterus or if it is too small.

What is the best way for an affected woman to proceed?

The morning-after pill is reserved for exceptional cases. When dispensing the product, the pharmacy will provide information about all important aspects, but also refer to the gynecologist who will give further advice - he is and remains the contact person for all questions about contraception that remain open.

As the attending physician, he is best able to see whether a means of emergency contraception and which one is suitable for the woman individually. It is also up to the gynecologist to insert an IUD and perform the preliminary examination.

In order to avoid future risks, it is important that the person concerned familiarizes themselves with the possibilities of safe contraception. Here, too, the gynecologist is the right person to contact, because he generally also knows the health issues of women. In this way he can constructively inform you about other aspects of sexuality such as the prevention of infections, suitable methods for safe contraception and self-determined sexual behavior.

If the woman has been using contraception so far, he explains how best to proceed, for example by continuing to take the pills and / or with additional contraceptive protection (for example with a condom for men) until the end of the cycle. This is important because after the latest possible time of taking and emergency contraception, the usual contraceptive pill will no longer work until the next menstrual period.

In addition, you can get advice from one of the recognized advice centers for family, partnership and contraception that various providers and social services in Germany offer, in an emergency, for example, from the women's emergency number.

Swell:

https://www.frauenaerzte-im-netz.de/familienplanung-verhuetung/die-pille-danach-nofallverhuetung/ (accessed on February 13, 2019)

https://www.abda.de/newsroom/meldung/artikel/pille-danach/ (March 9, 2018, accessed on February 13, 2019)



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