Oral Contraceptive Pills - Part 1

How much do you know about the "Morning after Pill"?

Contraception refers to the methods that are used to prevent pregnancy. Some methods of contraception, such as using condoms, can also be used to prevent some sexually transmitted diseases (STDs). Besides using physical barrier (eg. using condom), using oral contraceptive pill (OCP) is definitely another effective way to achieve successful contraception but OCPs are definitely useless in preventing STDs.

In simple words, oral contraceptive pills are classified into emergency contraceptive pills and also daily contraceptive pills.

Emergency contraceptive pills, also known as "morning after pill", is an oral medication that is taken after sexual activity to prevent pregnancy. To make it easy, the "morning after pill" works by preventing the sperm from meeting the eggs (ova). Hence, ''morning after pill'' is not an abortion pill and it will not end an existing pregnancy.

You can go for emergency contraceptive pills in the following situations, for example:

(a) Had unprotected sex

(b) Missed dose(s) for daily routine contraceptive pills or patches

(c) Condom broke or slipped off after ejaculation

(d) Rape cases

There are basically two different types of emergency contraceptive pills, namely levonorgestrel and ulipristal acetate.

1. Levonorgestrel

Levonorgestrel, which is an example of a progesterone (female hormone), is often used together with oestrogen (another female hormone) as oral contraceptive pills. When levonorgestrel is used alone as "morning after pills'', its concentration used will be higher than the daily oral contraceptives because high concentration of levonorgestrel is needed to prevent fertilization by inhibiting ovulation and thickening the cervical mucus to trap the sperms.

Levonorgestrel-containing products should be taken as soon as possible (preferably within THREE days after unprotected sex) in order to have better effects in preventing pregnancy. The chance of preventing pregnancy ranges from 75% to 85%, depending on how soon the person takes the levonorgestrel-containing products after the unprotected sex. The levonorgestrel-containing "morning after pills" do not require prescription in Malaysia.

Postinor2® contains two immediate-release 0.75mg levonorgestrel tablets. After the first pill is taken, the second tablet should be taken 12 hours later. Surprisingly, some researches actually showed that there is no difference in the effects if two pills are taken together, take two pills 12 hours apart as recommended or wait, as long as, 24 hours to take the second dose. However, in Malaysia setting, one pill followed 12 hours later by another pill is still highly recommended. 

Escapelle® contains one sustained-release 1.5mg levonorgestrel tablet. It does not require a second dose and hence it is more preferred than Postinor2® but its cost will be higher than Postinor2®. In terms of preventing pregnancy after unprotected sex, there is no significant difference between Escapelle® and Postinor2®.

Bear in mind that, 2 courses of Postinor2® or Escapelle® should not be exceeded in a month. Exceeding 2 courses in a month might lead to irregular menstruation (including delayed or early) or spotting issue.

2. Ulipristal acetate

Ulipristal acetate prevents fertilization by inhibiting ovulation (release of egg from ovaries) and changing the womb conditions to affect the implantation of fertilized egg.

Ulipristal acetate-containing products can be taken within FIVE days after unprotected sex. Interestingly, it works in the fifth day just as good as the first day after unprotected sex. It works differently compared to levonorgestrel-containing 'morning after pill' and is shown to be more effective than levonorgestrel-containing products. However, it is recommended not to have more than 1 course of ulipristal acetate-containing product in a month.  Exceeding 1 course in a month might lead to irregular menstruation (including delayed or early) or spotting issue.

The ulipristal acetate-containing "morning after pill" also does not require prescription in Malaysia but it might require prescriptions from the physicians in other countries, such as New Zealand and Australia. However, it is more costly compared to levonorgestrel-containing product.

Frequently asked questions about "Morning after Pills"

1. Is emergency contraception right for me?

2. Can I use both levonorgestrel-containing product and ulipristal acetate-containing product together for better pregnancy prevention?

It is recommended  not to use two different kinds of morning-after pills (like Postinor2 and ella) at the same time, because they may counteract each other and not work at all. And do not take more than one dose of either type of morning-after pill at the same time because it will not give you extra protection from pregnancy, but it can make you feel sick.

3. Is the Morning-After Pill Safe?

Emergency contraception is safe - millions of people have used different kinds of emergency contraception for more than 30 years. So far no serious complications had been reported. 

Taking the morning-after pill more than once won't hurt you. But it is definitely not a good idea to use the morning-after pill as your regular, go-to method of birth control. That's because:

• The morning-after pill doesn't prevent pregnancy as well as other forms of birth control like the IUD, patch, ring and daily contraceptive pills.
• Taking the morning-after pill over and over again is more expensive than being on a regular method of birth control.
• The morning-after pill can cause temporary side effects that are harmless but annoying (like bleeding between periods or nausea).

Although it is totally safe to take the morning-after pill as recommended -- it is just not the best way to prevent unintended pregnancies in long-term.

4. How effective are those "morning after pills"? 

Levonogestrel pills, including the brands Postinor2 and Escapelle, are up to 89% effective when taken within the first 24 hours after unprotected sex. However, they are less effective as time passes, for example, it will only be 75% effective when it is taken on the third day after unprotected sex.

ella is 85% effective if taken within 120 hours (five days) after unprotected sex. It stays just as effective as time passes after sex.

The morning-after pill will not prevent pregnant for any unprotected sex you may have after taking the pills.

5. Does My Weight Affect Which Kind of Emergency Contraception I Can Use?

Yes, it does.

If you'd rather take a pill, ella is the brand of emergency contraceptive that works best -- no matter what you weight. But If you have a body mass index (BMI) that's higher than 35, it will be less effective.

If the IUD or ella are not the options for you, it is perfectly safe to take Postinor2 or Escapelle . But if you have a body mass index (BMI) that is higher than 25, it is less effective. If you have a body mass index (BMI) that is higher than 30, it may not work at all.

6. Am I still at risk of pregnancy if I have sex after taking emergency contraceptive pills?

Yes. Emergency contraceptive pills only protect against pregnancy when you take them after sexual activity. That means you can still get pregnant if you take emergency contraception and then have sex again without using another kind of contraception or your birth control fails. If you still don't want to get pregnant, you will need to take emergency contraceptive pills again.

Although emergency contraceptive pills would probably still protect you if you had sex immediately after taking them, there is no research to show how long they would work.




Thank you so much for reading and I will be continuing the oral contraceptive pills (OCP) with part 2 focusing on daily contraceptive pills!

Are you excited for the next post? It will be related to cough medications! Do you know that one of blood pressure medications is able to induce dry cough? If you would like to know more about it, then just stay tune for next Sunday! :)

Have a pleasant day!

Author:

Jordy Wong Der Yuan

BPharm (Hons) (IMU)

Editors:

Chang Jen Nee

BPharm (Hons) (IMU)

Lok Ker Yee

BPharm (Hons) (IMU)