There exists a huge disparity between knowledge and use of contraceptives. While many will acknowledge the existence of contraceptives and admit to using them, few have accurate information concerning them. Hearsay forms a huge chunk of what most know about the topic, some too promising while others just plain wrong. Contraceptives play a major role in preventing maternal morbidity and mortality and their correct use is key. As custodians of the drugstores, it is our role and duty to provide the public with accurate information on matters medicine. In light of that, let’s talk emergency contraception.

What is the Emergency Contraceptive Pill?

The E-pill or the ‘morning after’ pill, as many call it, is a form of emergency contraception (EC) which aims to prevent pregnancy following unprotected sex. The pill acts as a safety net giving one a second chance at preventing conception if taken within 120hrs since intercourse.

There are a number of brands of dedicated emergency contraceptive pills – Postinor 2 or P2 for short, Pregnon, Smart lady, ECee2, Levo-72, Emcon etc. These are available in government health facilities or over the counter in pharmacies.

The active ingredient in these pills is levonorgestrel. This progestin is similar to hormones produced by the female body making these pills safe to use.

When should one use the E-Pill?

E-pill is taken after having unprotected sex or in the following scenarios;

• If no method of family planning is used
• If a FP method fails e.g. the condom breaks, the IUD slips out etc.
• If the woman forgets to take her daily oral contraceptive pills or is late for her injectable by 2 weeks
• In cases of rape

Contrary to what the name implies, the morning after pill should be taken as soon as possible, preferably within 24hrs and not necessarily in the morning. Within 24hrs, chances of preventing pregnancy are as high as 95%. These chances reduce by the hour and as you approach the 72^nd hour, they stand at around 58%. Most are said to be effective up to 5 days but, if you decide to wait that long you would be toying with fate and you might just join the I-took-the-pill-but-it-failed club. Do not be a statistic if you can avoid it.

It is worth stating that E-pill will not work if conception has already occurred as it is NOT an abortion pill and it cannot harm a growing fetus.

E-pill DOES NOT protect one against sexually transmitted diseases such as HIV/AIDS, syphilis, gonorrhea etc. only a barrier method (e.g. condoms) can

How should one take E-pill?

The pack usually contains 2 pills; take one pill as soon as possible and the other 12 hours later OR take both pills at once. The latter option is easy to comply with and works just as well. Ideally, you should only use E-pills once in your cycle lest your hormones go over the roof resulting in undesired side effects and irregular menses. Use barrier methods (condoms, diaphragm, spermicide) or alternative birth control methods for the rest of your cycle.

How does the E-pill prevent pregnancy?

To ensure survival of the species, the human body is programmed to achieve conception. Emergency contraceptive pills prevent this by;

• Thickening the cervical mucus making it impenetrable to sperms
• Thinning the uterine wall preventing implantation
• Inhibiting or delaying ovulation
• Reducing ovum/sperm motility in the fallopian tube preventing fertilization

Common side effects

Due to the high concentration of hormones in E-pills, different women will react differently to them and some short-term side effects are expected. These side effects are manageable and usually resolve in 24hrs.They include;

• Nausea and vomiting – to manage this, the pills can be taken with food. A medic can also prescribe an antiemetic drug to be taken before the pills.

If one vomits in less than 2 hrs. after taking the e-pill, not a substantial amount of the drug has been absorbed into the system and a repeat of the dose is required

If the vomiting occurs more than 2hrs, she need not repeat the dose

Other common side effects include;

• Fatigue
• Dizziness
• Breast tenderness
• Headache
• Cramps
• Light vaginal bleeding or spotting

How will one know that the E-pill worked?

You can only know the pill worked if you receive your period. You might want to see your doctor if;

• Your period is more than 5 days late
• Your period is unusually heavy or light
• If you suspect you are pregnant – if pregnancy occurs, the possibility of an ectopic pregnancy should be explored

Can E-pills fail to work?

Yes. Emergency contraceptive pills are not failproof. Besides the amount of time that has elapsed before taking the pills, other factors can affect the workings the pills. These include;

• Weight – high weight and BMI is associated with lowered effectiveness of E-pills containing levonorgestrel
• Some antibiotics e.g. rifampicin, griseofulvin, these enzyme inducing antibiotics speed up livers ability to break down contraceptives lowering their plasma levels and effectiveness
• Anticonvulsants e.g. carbamazepine
• Expired pills- make sure to check the expiry date of all your drugs before taking them
• Counterfeit pills – Buyer beware! While experts spend hours in the lab to improve reproductive health status quo, fraudsters are out selling counterfeits. Get your E-pills from a licensed pharmacy and keep your fingers crossed.

For Postinor 2, scratch the white box at the back with a metallic coin, a fake will reveal nothing, a genuine one will say original

For ways to spot counterfeits, click here

People with history of migraines, deep vein thrombosis or allergy to levonorgestrel are advised against using E-pills.

How often can one take E-pills?

Emergency contraceptive pills should be used for just that – emergencies. E-pills should not be used more than once in one menstrual cycle. If you find yourself using them twice or more in a month, it high time you rethought your FP methods. E-pills are not as effective as regular methods of contraception and should not be used as such. The more times you take E-pills, the more likely you are to stumble on the one time they fail to work. There are several more effective family planning methods to choose from. To take a quizlet and find you a method that works for you click here.

Are there alternative to emergency contraceptive pills?

Yes. Emergency intrauterine device (IUD) is the most effective method of EC. This T shaped copper and plastic device is inserted into the uterus by a doctor up to 5 days after unprotected sex. This method is not affected by weight and if one so wishes, they can decide to keep the IUD in the uterus as an ongoing family planning method.

Certain birth control pills in increased doses can serve as emergency contraception. Example; 2 doses (each 20 tablets) of Microlut, 2 doses (each 4 tablets) of Microgynon and Chaguo Langu

NB: This article is for informational and educational purposes only and it is not intended to be a substitute for professional medical advice.

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