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‘The morning after pill’: four common myths debunked

Sigrid Firth Contraception

A number of misconceptions surround the topic of emergency contraception or ‘the morning after pill’, which not only leads to confusion but could result in an unplanned pregnancy. Here we debunk four of the common myths about emergency contraception and provide you with information about accessing the method that is right for you, when you need it.

Myth 1: There is only one form of emergency contraception
There are THREE forms of emergency contraception. These are as follows:

1. A 1.5mg single dose emergency contraceptive pill (ECP) that can be used up to 72 hours (three days) after unprotected sex and is available from pharmacies as an over the counter medication (i.e. no prescription is required). This should be taken as soon as possible after unprotected sex or contraceptive failure.

2. A 30mg single dose ECP that can be used up to 120 hours (five days) after unprotected sex and is available from pharmacies as an over the counter medication (i.e. no prescription is required). This should be taken as soon as possible after unprotected sex or contraceptive failure.

3. Insertion of a copper intrauterine device (IUD) by a doctor within five days of unprotected sex is a highly effective method of emergency contraception.[1] The IUD is also an immediate form of long-term contraception.

While emergency contraception is commonly known as the ‘morning after pill’ it is important to remember that you should take it as soon as possible following unprotected sexual intercourse. The sooner you take it, the more effective it will be.

Myth 2: Pharmacists simply choose not to sell ECPs to people other than the woman taking the medication (a partner or family member, for example).
Pharmacists need to determine there is a therapeutic need for the medicine and this often requires speaking directly to the woman who wants an ECP.

For this reason, the pharmacist will ask you a series of questions to ensure you are eligible for an ECP, such as:

• what is your usual method of contraception?
• why do you need emergency contraception?
• how much time has passed since you had unprotected sex?
• are you taking any other medications?

Once the pharmacist has determined you can safely take an ECP, they will provide you with the medication, explain how to take it and discuss the potential side effects.

Myth 3: Taking an ECP induces an abortion and affects future fertility.
ECPs actually work by preventing or delaying ovulation (the release of the egg from the ovaries)[2], thus preventing pregnancy in most cases if taken within the specified time period. They do not cause an abortion and there is no evidence that ECPs harm a developing foetus if you are already pregnant at the time of taking the medication.[3][4] And ECPs have absolutely no impact on your future fertility.

Myth 4: Ovulation is predictable and contraception is unnecessary if you know your menstrual cycle.
The menstrual cycle has four phases: menstruation, the follicular phase, ovulation and the luteal phase. Every woman’s menstrual cycle is slightly different and each cycle can vary from month to month. While the average cycle is 28 days, it is not unusual for women to experience cycles of between 20 to 40 days.

Ovulation — the phase when the mature egg is released from the ovary —is highly unpredictable. Studies have shown that less than half of women ovulate between days 12 and 16,[5] and that ovulation can occur on most days of the cycle. While an egg can survive up to 24 hours following ovulation, the usual lifespan is between six and 12 hours. Sperm, on the other hand, can live up to five days inside the female reproductive tract, which means a woman can potentially get pregnant from having sexual intercourse five days before ovulation to 24 hours after ovulation.

When you add in variations in your menstrual cycle, it is clear that knowledge of your menstrual cycle is not adequate protection against an unplanned pregnancy. This is why it is important that you use contraception at all times during your cycle or, if you do have unprotected sex or contraceptive failure (such as a burst condom) you access emergency contraception as soon as possible after the event.

If you need emergency contraception, both emergency contraceptive pills are available from your local pharmacist without a prescription, or you can ask for an advance supply at your appointment at one of our clinics.

You might like to consider using a copper IUD, which is the most effective form of emergency contraception if inserted within five days of unprotected sex, subsequently providing a safe form of long-acting reversible contraception (LARC). For more information about IUDs or to make an appointment to talk to a doctor call Marie Stopes Australia on 1300 003 707.

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. Human Reproduction. 2012;27(7):1994-2000
2. Gemzell-Danielsson et al. ‘Mechanism of action of oral emergency contraception’, Gynecological Endocrinology. 2014.
3. Levy et al 2014, ‘Ulipristal acetate for emergency contraception: postmarketing experience after use by more than 1 million women’, Contraception, vol.89, pp. 431-433
4. Gemzell-Danielsson et al. ‘Mechanism of action of oral emergency contraception’, Gynecological Endocrinology. 2014.
5. Baird et al. ‘Application of a Method for Estimating Day of Ovulation Using Urinary Estrogen and Progesterone Metabolites’ Epidemiology, 1995