ECP- Emergency Contraceptive pills

(famous Trade Names- I-Pills, Plan-B etc)

Active Ingredient - Levonorgestrel

Definition:- Emergency (hormonal) Contraceptive Pills sometimes are referred to as “morning-after” or “post-coital” pills. The term “emergency contraceptive pills” is preferred because it conveys the important message that the treatment should not be used as an ongoing contraceptive method, and it avoids giving the mistaken impression that the pills must be taken in the morning.

When is Emergency Contraception Appropriate?

No contraceptive method is 100 percent effective, and few couples can use their method perfectly every time they have intercourse. Emergency contraception provides an important safety net when:

• A condom breaks


• No contraceptive is used.


• A woman misses 2 or more contraceptive pills in a row or starts a new pack 2 or more days late.


• A diaphragm or cervical cap slips out of place.


• A woman is more than 2 weeks late for a contraceptive injection.


• Intercourse occurs unexpectedly and without contraceptive protection.


• A woman is raped.

Emergency Contraception is not a substitute for regular contraceptive use. It is less effective than regular contraception (used correctly) and provides no protection from HIV or sexually transmitted infections (STI's). However, in emergency situations, it can play an important role as a back up for other methods. It is second-chance contraception.

What is my risk of pregnancy from unprotected intercourse?

The risk of pregnancy is virtually 0 during the first three days of the cycle (day 1 of the cycle is the first day of bleeding). The risk begins to rise steadily thereafter, reaching 9% on about day 13, begins to decline slowly thereafter to about 1% on day 25, and remains at about 1% as late as day 40 and beyond. (Average cycle length is 29 days, but it is normal to have cycles that last anywhere from 20 days or less to 40 days or more.) However, it is important to note that these figures are averages and that the risk for an individual woman may be higher or lower. The important point is that almost any act of unprotected intercourse entails some risk of pregnancy and that EC can reduce this risk substantially.

How long after unprotected sex can emergency contraceptive pills be taken?

The current treatment schedule is one dose within 72 hours after unprotected intercourse, and a second dose 12 hours after the first dose. ECP should be taken as soon after unprotected intercourse as is practical.

As of October 15, 2003, the Maryland State Family Planning Clinical Guidelines have broadened their recommendations. "Published studies have demonstrated: (1) That the 72-hour limit for giving emergency contraception is too restrictive and that any of the accepted dosages of emergency contraception are effective up to 120 hours (5 days) after unprotected sexual intercourse and (2) that a single 1.5 mg dose of levonorgestrel is equally as effective as two 0.75 mg doses of levonorgestrel taken 12 hours apart."

How effective is emergency contraception?

On average, if 100 women have unprotected intercourse once during the second or third week of their cycle, 8 will become pregnant. Following treatment with combined ECP, 2 will become pregnant (a 75% reduction in the risk of pregnancy) Following treatment with progestin-only ECP, 1 will become pregnant (a 85% reduction in the risk of pregnancy Even when used perfectly, ECP is not as effective as other methods of ongoing contraception when it is used correctly.

What are the side effects of ECP?

Almost all women can safely use ECP. The only absolute contraindication to use of ECP is confirmed pregnancy, simply because ECP will not work if a woman is pregnant. There are no long term or serious side effects from using ECP. About 50% of women who take combined ECP experience nausea and 20% vomit. If vomiting occurs within 1 hour after taking a dose, some clinicians recommend repeating that dose. The non-prescription anti-nausea medicine meclizine, reduces the risk of nausea by 27% and vomiting by 64% when two 25 mg tablets are taken 1 hour before combined ECP, but the risk of drowsiness is doubled (to about 30%). The risk of nausea and vomiting with progestin-only (no estrogen) PLAN B ECP is far lower than the risk with combined ECP. Other side effects of ECP include fatigue, headache, dizziness, and breast tenderness.

How do I take Emergency Contraception?

Swallow the first dose as soon as possible. ECP is more effective the sooner after unprotected sex they are started.

Take the second dose 12 hours later. It is not even known what is the optimal timing between doses, much less whether the second dose is even necessary.

As noted above, recent published guidelines indicate that the two doses of levonorgestrel (0.75mg)can be taken at the same time.

Do not swallow any extra ECP. More pills will probably not decrease the risk of pregnancy any further. More pills will increase the risk of nausea and vomiting.

If you have nausea, it is usually mild and should stop in a day or so. If you vomit within one hour after taking a dose, call your clinician. You may need to repeat a dose. You may need some anti-nausea medicine.

What is  Plan B®/I-Pill ®?

Plan B®/I-Pill ® is the first progestin-only emergency contraceptive to be approved by the United States Food and Drug Administration (FDA). Although oral contraceptive pills containing progestin have been in use for routine contraception for many years, Plan B®/I-Pill ® contains the first progestin-only tablet specifically developed for post coital contraception. Plan B®/I-Pill ® is safe for most women and is highly effective. Each Plan B®/I-Pill ® packet includes a single course of treatment and consists of two tablets, each containing 0.75 mg levonorgestrel, a totally synthetic progestogen. Inactive ingredients include colloidal silicon dioxide, potato starch, gelatin, magnesium stearate, talc, cornstarch, and lactose monohydrate. The first tablet should be taken as soon as possible within 72 hours (3 days) of unprotected intercourse. The second tablet is taken 12 hours later. As noted above recent published studies indicate that the two doses can be taken at the same time and that it can be taken up to 5 days post event.

How is Plan B®/I-Pill ® Different from Other Emergency Contraception Regimens?

Most significantly, the new levonorgestrel-only regimen is better tolerated. After a single act of unprotected intercourse, correct use of Plan B®/I-Pill ®  reduces the risk of pregnancy by 89 percent. Plan B®/I-Pill ® demonstrated a superior safety profile with respect to nausea and vomiting. The incidence of nausea in women taking Plan B®/I-Pill ® was reduced from 50.5 percent with ECP's containing estrogen to 23.1 percent with the Plan B, and the incidence of vomiting was reduced from 18.8 percent to 5.6 percent.

How does Plan B®/I-Pill ® Work?

Mechanism of Action The exact mechanism of action of Plan B®/I-Pill ® is unknown. Levonorgestrel is believed to act as an emergency contraceptive principally by preventing ovulation or interfering with fertilization (by altering the tubal transport of sperm and/or ova). In addition, it may inhibit implantation by altering the endometrium. Plan B®/I-Pill ® is not effective once implantation has begun. Once pregnancy is established, Plan B®/I-Pill ® cannot interrupt the pregnancy or cause an abortion.

How safe is Plan B®/I-Pill ®?

No serious complications have been associated with Plan B®/I-Pill ® treatment. Used as directed, Plan B®/I-Pill ® is safe for most women. A physical examination is not required prior to prescribing Plan B®/I-Pill ®

What happens if they fail?

If Emergency Contraceptive Pills fail, you may have counseling, education and referral options, just as would any other woman diagnosed with an unintended pregnancy. There is no evidence that Emergency Contraceptive Pills pose danger to a woman's fetus