Emergency contraception can be used after unprotected sex if you don’t want to get pregnant.
Key points about emergency contraception
- In New Zealand, there are 2 main types of emergency contraception: copper IUD and the emergency contraceptive pill (ECP).
- Emergency contraception doesn't protect you against sexually transmitted infections (STIs), so it is still important to use condoms during sexual intercourse.
- The most effective emergency contraceptive is the copper IUD, but the ECP can be effective and convenient in many situations.
- A copper IUD can be inserted up to 5 days after unprotected sex, or within 5 days of your earliest expected date of ovulation, whereas the ECP can be taken up to 72 hours (3 days) after unprotected sex.
- Talk to your healthcare provider to find out which type of emergency contraception is most suitable for you.
What is emergency contraception?
Emergency contraception can be used after unprotected sex if you don’t want to get pregnant. Unprotected sex means either:
- you haven't used protection, such as a condom or a regular contraceptive pill (‘the pill’)
- your normal contraception/ārai hapū fails, eg, a condom splits
- you have missed one or more of your regular contraceptive pills (the exact number of missed pills depends on which type of pill you are taking and whether you usually take them every day or have a break each month)
- you usually take regular contraceptive pills (‘the pill’) but have been vomiting or had diarrhoea
- you have missed your contraceptive injection
- you have been forced to have sex without contraception.
How do I choose the right emergency contraception for me?
There are 2 main types of emergency contraception:
- copper intra-uterine device (IUD) – a small object that is placed inside your uterus (womb)
- emergency contraceptive pill (ECP).
When you talk to a nurse, doctor or pharmacist about getting emergency contraception, they will ask you a few important questions. These may seem like personal questions, but they want to make sure you get the emergency contraception that works best for you. The most effective emergency contraceptive is the IUD, but the ECP can be effective and convenient in many situations.
|Factors to consider||How they may affect the choice of emergency contraception|
|How long ago you had unprotected sex||
|If you are taking other medicines||
|Where and how can I get the emergency contraception||
|Ongoing contraception protection||
An IUD is a small object that is placed inside your uterus (womb). A copper IUD can be inserted up to 5 days after unprotected sex, or within 5 days of your earliest expected date of ovulation. To work this out, the nurse or pharmacist might ask when your last period was and how long your cycles are.
The IUD works by preventing implantation in your uterus and can be removed when your next period occurs or it can be left in place for ongoing contraception.
The copper IUD is recommended as the most effective form of emergency contraception for women who weigh over 70 kg or have a BMI of more than 26. It is also preferred if the unprotected sex occurred more than 3 days ago. A healthcare professional needs to insert the IUD, which can be uncomfortable, but while it is in place, it can be used for ongoing contraception.
A copper IUD is highly effective and is more than 99% effective in preventing pregnancy. Its effectiveness is not affected by factors such as body weight, BMI or if you are taking any medicines.
Emergency contraceptive pill
The ECP is a high dose contraceptive pill with a hormone called progestogen. The ECP works mainly by delaying ovulation, but there is a risk of pregnancy if you have unprotected sex later in your cycle. It doesn’t work once the egg has been released and fertilised. It doesn’t harm you or a developing embryo.
The ECP can be taken up to 72 hours (3 days) after unprotected sex, but is most effective when taken in first 24 hours – it is less effective as time passes. The ECP has a success rate of 98% for those of average weight when taken within 72 hours after unprotected sex.
The ECP may not be as effective for women weighing over 70 kg. You should consider using the IUD or taking double the dose (take 2 ECPs together). This is an unapproved dose, and the effectiveness has not been fully studied.
Tell your doctor or pharmacist about any other medication you are taking. Some other medicines such as antiepileptics and antibiotics affect the way the ECP works, so you may need extra doses or a copper IUD. If you vomit within 3 hours of taking the ECP you’ll need to take another dose.
How do I take the ECP?
The ECP is a tablet. If you weigh less than 70 kg, take 1 tablet as soon as you can within 3 days (72 hours) of unprotected sex. Your healthcare provider will explain how to take the tablet. Follow their instructions carefully to ensure the ECP works properly. Do the following when taking the ECP:
- Take it as soon as possible.
- It helps to take it with food as some women feel sick after taking the ECP.
- If you vomit within 3 hours, go back to your healthcare provider as you may need to take it again.
- If you are already using regular contraception, such as the oral contraceptive pill ('the pill'), keep taking this at your regular time.
What happens next?
- Some women may notice bleeding or spotting after taking the ECP and some may have an early or later start to your next menstrual period.
- Even if you have a period, it's important to have a pregnancy test 3–4 weeks after taking the ECP to make sure you are not pregnant.
- There is no evidence that the ECP will affect the unborn baby if you do become pregnant.
The ECP does not give you any ongoing protection against pregnancy. It is important to use condoms or another form of contraception for ongoing protection against pregnancy. You can talk to your healthcare provider about this, as using ECP as a regular method of birth control is not recommended.
Where can I get the ECP?
The currently funded ECP is known as Postinor and this is available through:
- Your GP clinic (or find a GP)
- Accident and medical clinics
- Sexual health clinics
- Family Planning clinics
- Most community pharmacies.
- New Zealand Aotearoa’s guidance on contraception Ministry of Health, NZ, 2020
- Contraception: which option for which patient? BPAC, NZ, 2019
Angela is a pharmacist in the Quality Use of Medicines Team at Waitematā District Health Board. She has experience in hospital pharmacy in New Zealand and in the UK, and was previously a medical writer for Elsevier in The Netherlands. Angela is interested in promoting the safe use of medicines, particularly high-risk medicines.