Morning-after pills: Are they a safer family planning option?

For most women and girls realizing that they are at risk of getting an unwanted pregnancy is a very scary experience. For some, that unwanted pregnancy is regarded as a stumbling block to their future wellbeing. This can push them to think of a variety of options to get rid of or prevent it in time. Thankfully, the morning-after pill or emergency contraception can dramatically reduce the likelihood of an unwanted pregnancy, especially if taken shortly after unprotected sexual intercourse, according to medics. The morning after pill can only work if fertilisation has not taken place. / Net photo. Reproductive health experts argue that any woman or girl is eligible to use emergency contraception anytime they fear possible pregnancy risks. There are no absolute medical restrictions or age limits to the use of emergency contraception. According to the World Health Organisation (WHO), emergency contraception refers to methods of contraception that can be used to prevent pregnancy after sexual intercourse. The morning-after pill can be used in a number of situations following unprotected sexual intercourse. These may include concerns about possible contraceptive failure, incorrect use of contraceptives and sexual assault, among others. Though, it is not known to which extent they are used locally, some women say when they have unprotected sex, the morning-after pill is the best option. And the fact that the emergency contraception can be bought over the counter in any pharmacy without a need for medical prescription makes it more accessible for those in need. “Even though the prices are slightly high, the morning-after pills are among the most sought after products by young women. Some seek for it regularly implying that it is their best option of preventing unwanted pregnancies,” says Grace Akimana, a pharmacist. The emergency contraceptive pill regimens recommended by WHO are ulipristal acetate, levonorgestrel, or combined oral contraceptives (COCs) consisting of thinyl estradiol plus levonorgestrel. How does emergency contraception work? Dr Iba Mayele, a gynecologist and obstetrician at Galicien Clinic in Kigali, says the fact that pregnancy doesn’t happen immediately after you have had sex makes it posible to prevent pregnancy after a woman has had unprotected sexual intercourse. “It’s all about timing. Sperms can live inside a woman’s body for up to six days after sex waiting for an egg to show up. If one ovulates during that time, the sperm can meet with the egg and cause pregnancy. “Morning-after pills work by temporarily stopping the ovary from releasing an egg. It’s kind of like pulling the emergency brake on ovulation. Where a woman is in her menstrual cycle and how soon she takes morning-after pills can affect how well they prevent pregnancy,” he explains. Mayele notes that morning-after pills won’t work if the body has already started ovulating. This is why timing is so important, especially if a woman /girl is using Plan B and other levonorgestrel morning-after pills. “Most people don’t know exactly when they ovulate, so it’s best to use emergency contraception as soon as possible, no matter where they are in their menstrual cycle or whether or not they think they are about to ovulate,” he says. Effectiveness According to WHO, emergency contraception can prevent up to over 95 per cent of pregnancies when taken within five days after sexual intercourse. “If a woman uses it correctly after having unprotected sex, it makes it much less likely to get a pregnancy. But they don’t have to use it regularly as their only protection from pregnancy, because it’s not as effective as regular, non-emergency birth control methods like the IUD, pill or condoms,” says Dr John Muganda, an obstetrician and gynecologist. Possible side effects According to reproductive health experts, the most common side effects of morning-after pills include gastrointestinal nausea and vomiting, spotting and hormonal imbalance that may results in irregular menstruation. “If vomiting occurs within 1 hour of taking the emergency contraceptive, it is generally recommended that an anti-nausea medication be given and the emergency contraceptive be given again. Thankfully, the nausea tends not to last very long either and most women feel better by the next day,” says Antoine Kayitare, a nurse at Polyclinic la Medicale in Kigali. Muganda adds that since the morning-after pill disrupts the normal hormonal signaling that regulates the menstrual cycle, it is not surprising that bleeding irregularities are common. “This can result in spotting, having a period that comes up to a week earlier or even late. It can also result in a period that is lighter or heavier than normal,” he says. Experts say in most cases, the first menstrual period after taking emergency contraception will occur within one week of the usual timing. “In cases where the period is delayed, this can obviously be of great concern for women fearing pregnancy. The morning after pill will not interfere with pregnancy tests, and a urinary pregnancy test can be used for reassurance after a missed period,” says Kayitare. Is there any long-term effect to one’s reproduction? According to reproductive health experts there are no major long-term side effects associated with the use of emergency contraceptives no matter how often one may use them. “After one takes an emergency contraception pill, their next period may come sooner or later than normal. Most women will get their period within a week of the expected date. Their period also may be heavier, lighter, spotty, and more or less painful than is normal for them. But there is nothing to fear at all because this doesn’t harm their reproductive system and they can get pregnant anytime they want it in the future,” explains Muganda. Despite the fact that emergency contraceptives can be effective in preventing unwanted pregnancies, experts advise not to rely on them all the time because they cannot protect you from sexually transmitted infections whenever one has unprotected sex. They emphasise that the best option is to use condoms, which give double protection from pregnancy and STIs.