Other Emergency Contraceptives available aside Plan B

Do you want to explore other alternatives for emergencies if Plan B is not suitable for you when needed? Take a read through other options available to make a choice.

Method 1:

Use of copper-bearing intrauterine device (Cu-IUD) which can be inserted within 5 days of unprotected sexual intercourse (1). This is suitable especially when a woman would prefer to start the use of a long-acting, reversible contraceptive method that is very effective.

How does Cu-IUD work?

Before the union of the sperm and egg, a Cu-IUD when inserted will cause a chemical change in the sperm and egg thereby interrupting fertilization.

How effective is the Cu-IUD?

These IUDs are effective from day one through day 5. Within 120 hours (5 days) of unprotected sexual intercourse, use of Cu-IUD, according to the WHO has a higher rate (more than 99%) of preventing pregnancy. IUDs do not matter how much you weigh, it works effectively for all eligible individuals.

Is the Cu-IUD safe for emergency contraception?

Cu-IUD is safe for your use as an emergency contraceptive, with an estimated low case of pelvic inflammatory disease (2). It is also less likely for the Cu-IUD to be ejected after insertion or puncture your womb when inserted.

Who should not use Cu-IUD?

1. Women with conditions such as listed below should not use Cu-IUD for emergency contraception. You should consult your doctor if you have any of these conditions but require emergency contraception.
   • Pelvic inflammatory disease (PID)
   • Infection occurring after birth (puerperal sepsis)
   • Cancer of the cervix
   • Unexplained bleeding from the vagina
   • Severe cases of a low blood platelet count (thrombocytopenia)
2. If a woman has a case of rape or sexual assault, Cu-IUD should not be used for emergency contraception because the woman may have a high risk of contracting sexually transmitted infection (STI) like gonorrhea or chlamydia. For such women, insertion of an IUD may pose them at high risk of PID due to the increased risk of STIs (2)

Method 2

Use of emergency contraceptive pills (ECPs) or the morning-after pill

These medications prevent or delay ovulation thereby preventing pregnancy

1. A single dose of ulipristal acetate (UPA) 30 mg (available brand Ella)
2. A single dose ECPs containing levonorgestrel (e.g., Plan B One Step, Postinor 2) 1.5 mg, or can be taken in 2 doses (0.75 mg each at 12 hours interval)
3. Combined oral contraceptives, COCs (estrogen and progestin in 2 doses). For example, the Yuzpe method or regimen, with one dose of 100 µg of ethinyl estradiol plus 0.50 mg of levonorgestrel followed by a second dose of 100 µg ethinyl estradiol plus 0.50 mg of levonorgestrel taken 12 hours apart.

How effective is UPA compared with levonorgestrel containing ECPs and COCs

UPA is the most effective of the ECPs.  Women who use UPA had a pregnancy rate of 1.2% while those who used levonorgestrel had a pregnancy rate of 1.2% to 2.1%, according to a meta-analysis of two studies (3).

UPA and morning-after pills containing levonorgestrel have similar effect when taken within 72 hours of unprotected sexual intercourse; however, studies have shown UPA to be more effective than levonorgestrel ECPs 3 to 5 days after unprotected sexual intercourse (4).

If you weigh 195 pounds or more (greater than 88 kg), UPA may be less effective (5).

The use of combined oral contraceptive as emergency pill may be less effective than UPA or levonorgestrel (6)

Are UPAs and COCs safe for use?

 Just like the levonorgestrel containing pills (Plan B), side effects of UPAs and COCs are similar, like nausea and vomiting, fatigue and minor bleeding between periods. COCs however, can cause more frequent occurrence of side effects (6).

These ECPs do not cause any side effects in the long-term nor have there been reports of serious complications, and will not affect your pregnancy in future.

Be mindful not to use two different kinds of ECPs like that of the UPAs and the levonorgestrel at the same time or within the five days you intend to use morning-after pills. They may oppose and mitigate the effect of each other, which may result in contraceptive failure.

Which type of the ECPs can I access easily?

A prescription is not needed to access levonorgestrel morning-after pills. It can be purchased in most pharmacies, irrespective of your age. Any woman in her reproductive years may require a morning-after pill to avoid unintended pregnancies. 

UPAs and Cu-IUDs may be difficult to get because a prescription from a qualified prescriber will be needed. IUDs may be harder still, because a medical practitioner will be required to insert it into your womb

Can breastfeeding mothers use ECPs?

Just like Plan B, Cu-IUDs will not affect lactation.

UPAs are present in milk and should be avoided for 1 week after administration (7).

How long would it take to get my period after using emergency contraception?

After taking ECPs or using Cu-IUDs, your first period may delay or may be earlier. However, if you don’t get your period within 3 weeks of using ECPs like UPAs or Plan B, you should take a pregnancy test. 

Your menstrual cycle may be restored in subsequent months if you are not pregnant. You should note that, use of emergency contraception can lead to irregular periods and unscheduled bleeding.

When should I resume taking regular contraception after ECPs, if I’m already on one?

For UPA, you should resume the use of the regular contraception immediately after 5 days of use of UPA. You should abstain from sexual intercourse or use condom for the next one week resuming the regular contraception or until your next menses, whichever takes precedence.

If a Cu-IUD is to be used as a long-term contraceptive, it can be started at the time of use of UPA; however, there is a risk of decreased effectiveness of UPA by the Cu-IUD (8)

For Levonorgestrel or COCs, regular contraception can be started immediately after the use of Levonorgestrel or COCs. You should abstain from sexual intercourse or use condom for the next one week. 

For both scenarios, you should have a pregnancy test within three weeks if there is no withdrawal bleed during this period (9).

For the IUD, it can remain in the womb after 5 days to give continued protection against pregnancy for up to 7 – 12 years depending on the type.

How do I manage or prevent nausea and vomiting associated with using ECPs?

Routine use of drugs that prevent or alleviate nausea and vomiting (antiemetic) is not recommended. Depending on the clinical judgment or availability, your doctor may consider using one of these drugs.

If the medication is vomited within 3 hours of taking your ECP, another dose of the drug should be taken immediately. Antiemetic may be considered in this case (10).

References

1. Cleland K, Zhu H, Goldstuck N, Cheng L, Trussell J. The efficacy of intrauterine devices for emergency contraception: a systematic review of 35 years of experience. Hum Reprod 2012;27:1994–2000. http://dx. doi. org/10. 1093/humrep/des140external icon PubMedexternal icon
2. Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs and World Health Organization. Family planning: a global handbook for providers 2011 Update

3. Glasier A, Cameron ST, Blithe D, Scherrer B, Mathe H, Levy D, et al. Contraception. 2011 Oct;84(4):363-7. doi: 10.1016/j.contraception.2011.02.009. Epub 2011 Apr 2. Can we identify women at risk of pregnancy despite using emergency contraception? Data from randomized trials of ulipristal acetate and levonorgestrel.

4. Glasier AF, Cameron ST, Fine PM, et al. Ulipristal acetate versus levonorgestrel for emergency contraception: a randomized non-inferiority trial and meta-analysis. Lancet 2010;375:555–62. http://dx. doi. org/10. 1016/S0140-6736(10)60101-8 PubMed n
5. Jatlaoui TC, Curtis KM. Safety and effectiveness data for emergency contraceptive pills among women with obesity: a systematic review. Contraception 2016. Epub May 24, 2016. http://dx.doi.org/10.1016/j.contraception.2016.05.002external icon
6. Raymond E, Taylor D, Trussell J, Steiner MJ. Minimum effectiveness of the levonorgestrel regimen of emergency contraception. Contraception 2004;69:79–81. http://dx. doi. org/10. 1016/j. contraception. 2003. 09. 013external icon PubMed
7. The British National Formulary (March -September, 2021). BMJ Group, Travistock Square, London, WC1H9JP,UK: pp 850 – 855
8. Brache V, Cochon L, Duijkers IJ, et al. A prospective, randomized, pharmacodynamic study of quick-starting a desogestrel progestin-only pill following ulipristal acetate for emergency contraception. Hum Reprod 2015;30:2785–93
9. Salcedo J, Rodriguez MI, Curtis KM, Kapp N. When can a woman resume or initiate contraception after taking emergency contraceptive pills? A systematic review. Contraception 2013;87:602–4. http://dx. doi. org/10. 1016/j. contraception. 2012. 08. 013 PubMed 
10. Rodriguez MI, Godfrey EM, Warden M, Curtis KM. Prevention and management of nausea and vomiting with emergency contraception: a systematic review. Contraception 2013;87:583-9. http://dx. doi. org/10. 1016/j. contraception. 2012. 09. 031