Many have been cautioned against using emergency contraceptive pills (ECPs) more than twice in a lifetime due to their danger and side effects. This article seeks to dispel this myth and provide accurate advice on the safe use of contraceptive methods like contraceptive pills.
Get to know contraceptive pills
A contraceptive pill is a contraception with hormones to prevent the fertilization between an egg and sperm. The pills may contain one hormone (progestin-only) or two hormones (combination, containing estrogen and progestogen). Hormonal contraceptives come in many forms, such as oral contraceptive pills, contraceptive patches, vaginal rings, hormonal intrauterine devices (IUD), contraceptive injectables, and contraceptive implants.
Mechanism of action of contraceptive methods are as follows:
- Inhibition of ovulation to prevent fertilization
- Local effects: Certain contraceptives can thicken the cervical mucus, making it challenging for sperm to penetrate or thinning the endometrium, making it unreceptive to implantation.
Emergency contraception is available in progestin-only, and combination hormonal contraceptives, or anti-progestogens. IUDs can also serve as emergency contraception. Emergency contraception pills contain high hormone doses and should be used solely for this purpose, like post-non-consensual intercourse, missed contraceptive pills, condom mishaps, or sexual assaults.
Type of contraceptive pills
Types of birth control are classifiable into two major types as follows:
- Single hormone contraceptives containing progesterone only
- Combination hormonal contraceptives containing progesterone and estrogen.
Both contraceptives work by inhibiting ovulation and thickening the cervical mucus, preventing sperm from entering the uterus and fertilizing an egg in a fallopian tube. They also thin the endometrium, preventing a fertilized egg from implanting in the uterus.
Moreover, both progestin-only and combination contraceptives are available in several forms as follows:
Combination contraceptives
- Oral contraceptive pills: Take one pill once daily. Each pack contains 21 active and seven dummy pills. Some brands may have 24 active and four dummy pills.
- Contraceptive patch: Apply a patch once a week for three consecutive weeks with a week break.
- Vaginal ring: Use a ring for three weeks, with a one-week break.
Single hormone contraceptives
- Oral contraceptive pills: Take one pill a day. Each pack contains 28 pills. Take the pills consecutively without a break. Missing a pill may lead to less efficacy and increased side effects.
- Contraceptive injectables: Repeat the injection every three months
- Contraceptive implant: Typically inserted beneath the skin of the upper arm. A single-rod implant provides effective contraception for three years, while a two-rod implant offers five years of efficacy.
- IUD: Fitted inside the uterus, providing five years of efficacy.
Nowadays, contraceptives are utilized not just for birth control but also for easing the symptoms of gynecological diseases, which is an indirect benefit of the hormones.
Contraceptives inhibit ovulation and reduce the synthesis of prostaglandin, a chemical that causes menstrual cramps. Extended use of contraceptives can lead to amenorrhea and thinning of endometrium, alleviating the symptoms of certain diseases like endometriosis. The primary purpose of contraceptives, aside from birth control, is to offer symptomatic relief and slow down disease progression in mild cases not requiring surgery rather than curing the diseases. Indications differ from individual to individual.
Is it true that one should not take emergency contraceptive pills more than twice in a lifetime?
Emergency contraceptive pills (ECPs), including both progestin-only and combination hormone pills, contain higher doses of hormones. The mechanism of action of ECPs is not well understood. They are less effective than regular contraceptive pills and have limitations. ECPs should be taken within five days after intercourse, as effectiveness decreases afterward.
To answer the question above, the hormonal effects of ECPs are not harmful. However, emergency contraceptive pills (ECPs) should only be used when necessary due to their lower efficacy rate of 95%, while regular contraceptive pills have a higher efficacy rate of 99%. It is, therefore, not recommended to rely on ECPs as a primary form of contraception, particularly for sexually active individuals, as there are more effective contraceptive options available.
What are the side effects of contraceptives?
For progesterone-only contraceptives, side effects may include breakthrough bleeding. Conversely, combination contraceptives containing estrogen result in fewer breakthrough bleedings but more nausea and vomiting.
Birth control advice from an OB-GYN doctor
Most current contraceptive methods are safe and effective, indicating that no method is notably superior to others. Personal preferences can influence the choice of contraceptive methods. A doctor will suggest an appropriate contraceptive method after gathering relevant information. Factors that a doctor may consider include:
- How long should the contraception last: 1-2 years for short-term and three or more years for long-term contraception.
- Conscientiousness in taking medication: how strictly one takes contraceptive pills. Contraceptive pills may not be suitable for those who are forgetful about taking medications.
- Drug cost
- Side effects of contraceptive methods.
Birth control pills are ideal for individuals who are disciplined in their medication routine since they must be taken daily without fail. If you forget to take 1-2 pills, you should consume all the missed pills as soon as you remember. If you miss three pills, dispose of the pack, and wait for your next period to start before beginning a new pack. These contraceptives are effective for short-term birth control spanning 1-2 years; pregnancy is possible shortly after discontinuing the pills.
Contraceptive injections are progestin-only injectable contraceptives, with effects lasting three months or 12 weeks, requiring a new injection every three months. They work by inhibiting ovulation. It may take up to six months after stopping the injections before you can become pregnant. One advantage of this method is its affordable price.
An intrauterine device (IUD) is a contraceptive device inserted into the uterine cavity. There are two types of IUDs available. The first is a hormonal IUD, which acts locally. This type of IUD thickens cervical mucus, thins the endometrium, and may weakly suppress ovulation. A hormonal IUD lasts for five years and can be costly. The other type is a copper IUD. A copper IUD induces a non-infectious inflammatory reaction, creating an environment in the uterus that is not conducive to implantation. Since a copper IUD does not prevent ovulation, it does not affect menstrual cycles. Its contraceptive effect lasts between 8 and 10 years, and its main advantage is its affordable price.
Contraceptive patch and vaginal ring are combination contraceptives. The patch is applied to the skin, releasing hormones into the body, while the ring releases hormones absorbed through the endometrium. Their effect lasts for three weeks. After this period, remove the ring and wait one week for withdrawal bleeding. The main advantage of these methods is convenience, making them ideal for individuals who struggle to remember to take daily medication and desire short-term contraception.
A contraceptive implant is a type of progestin-only birth control. It is typically inserted under the skin of the upper arm and remains effective for 3-5 years, varying by the specific implant used. This method is ideal for individuals seeking extended contraception.
In conclusion, it is inadvisable to rely on emergency contraception often because emergency contraception has lower effectiveness compared to other forms of contraception, not because it is harmful to the body. Medical professionals advise against unnecessary use or substitution of regular contraception with emergency contraception. It should only be resorted to in true emergencies.
