Types of emergency contraception

Current emergency contraception solutions are :

• Fitted, as an intrauterine device

• Oral, as a tablet

The IUD which is suitable for EC is a Copper-T IUD

IUDs are considered the most effective EC option1, but they may not be a practical option for many women. The advantage of an IUD is that it provides an ongoing contraceptive solution.1 But when speed is of the essence, women may not want to rush a decision to fit this long acting reversible contraceptive (LARC).

The Copper-T IUD can be fitted up to 120 hours (5 days) after unprotected sex.2 Its use is restricted by its availability and the need to be inserted by a skilled healthcare professional.

Women who may need a copper IUD for emergency contraception must be advised to contact a GP, a gynaecologist or family planning service as a matter of urgency.2 Pharmacists should direct women to a local service known to provide IUDs.2

Copper IUD is considered the most effective EC method1, but in a situation where you need to act very quickly, IUD fitting takes time and involves an invasive and uncomfortable procedure.3

 

There are two oral ECs available4

• One containing levonorgestrel which was first made available in 1999

• One containing ulipristal acetate (ellaOne®), which was launched in 2009. Unlike other ECs, it was specifically developed for EC

 

The mechanism of action of oral ECs is to inhibit or postpone ovulation, so that no ovum is released5,8. Oral ECs are also called ECPs (Emergency Contraceptive Pills).

Mechanism of action of oral EC

ECPs work by inhibiting or delaying ovulation (the release of an egg), so that fertilisation cannot take place.5,8

Emergency contraceptive pills will not prevent pregnancy in 100% of cases.5 This is because there is a chance that the woman has already just ovulated when she takes an emergency contraceptive pill.6 Taking emergency contraceptive pills as soon as possible after unprotected sex gives the best chance of success.7  

ECPs have no effect on fertilisation if ovulation has already happened. They do not interfere with an implanted egg (pregnancy),5,8 so they do not cause abortion. 5,6

ECPs are suitable for women of reproductive age and have a very good safety profile.5,9 ECPs do not protect from sexually transmitted infections (STIs).8

As ECPs work by preventing or delaying ovulation, they are not 100% effective. If ovulation has just occurred before unprotected intercourse, ECPs will not be effective. Therefore, ECPs are back-up contraception solutions, which do not replace a regular contraceptive method. 

References
1.Cheng L et al. Cochrane Database Syst Rev. 2012; 8: CD001324.
2.Royal Pharmaceutical Society of Great Britain. Practice guidance on the supply of emergency hormonal contraception 2004.
3.Glasier AF et al. The Lancet 2010; 375: 555-562.
4.HRA Pharma Data on file. Clinical overview.
5.ellaOne® European Summary of Product Characteristics.
6.Faculty of Sexual and Reproductive Healthcare. Guideline on Emergency contraception 2012. Available at http://www.fsrh.org/pdfs/CEUguidanceEmergencyContraception11.pdf. Accessed October 2013.
7.NHS choices – emergency contraception. Available at http://www.nhs.uk/Conditions/contraception-guide/Pages/emergency-contraception.aspx. Accessed October 2013.
8.World Health Organization. (In association with the International Consortium for Emergency Contraception, International Federation of Gynacology and Obstetrics, International Planned Parenthood Federation, Department of Reproductive Health and Research). Fact sheet on the safety of levonorgestrel-alone emergency contraceptive pills. Available at: http://whqlibdoc.who.int/hq/2010/WHO_RHR_HRP_10.06_eng.pdf AccessedOctober2013.