*Population Reports*
Practical Guide to

Emergency Contraceptive Pills

Questions	and Answers

Providing ECPs: Suggested Steps for Health Care Providers Most important is to see that the woman gets the pills and knows how to take them. If possible, these steps are useful:
Q:	What are Emergency Contraceptive Pills (ECPs)?
A:	ECPs can be taken after unprotected sex to help prevent unintended pregnancy. They contain some of the same hormones as pills used for daily oral contraception. ECPs are sometimes packaged especially for emergency use (dedicated products), or they can be special doses taken out of a regular pill pack.
Q:	What are reasons to use emergency contraception?
A:	A woman has had unprotected sex, and she wants to prevent pregnancy. For example: She did not expect to have sex and was not using contraception. Sex was forced. A condom broke or slipped. She ran out of oral contraceptives, started a new packet of pills several days late, or missed three or more active pills in a row, and she did not use condoms or spermicide. She is late for a contraceptive injection—more than two weeks late for depo medroxyprogesterone acetate (Depo-Provera), more than one week late for norethindrone enanthate (Noristerat), or more than three days late for a monthly injection (such as Cyclofem or Mesigyna). In Short, any reason that a woman is concerned that she might become pregnant is an appropriate reason.
Q:	What pills can be used as ECPs?
A:	Four types of pills can be used. All four types contain the progestin levonorgestrel, or norgestrel. Progestin-only dedicated products, Progestin-only oral contraceptives, Combined oral contraceptives, Combined progestin-estrogen dedicated products (see table below). Progestin-only pills are more effective and cause much less nausea and vomiting than combined pills.
Q:	How effective are ECPs?
A:	Among 100 women, if each has sex once in the second or third week of her menstrual cycle without using contraception, 8 women are likely to become pregnant. If all 100 women use progestin-only ECPs, only one is likely to become pregnant. If all 100 women use combined OCs for emergency contraception, only two are likely to become pregnant. ECPs are appropriate in emergency situations, but they are not as effective as ongoing use of most modern contraceptives.
Q:	When should ECPs be taken?
A:	As soon as possible after unprotected intercourse. The first dose should be taken within 72 hours after intercourse.
Q:	Are there side effects?
A:	Yes. Some women have nausea, vomiting, dizziness, headache, breast tenderness, abdominal pain, or a heavier or lighter menstrual period. Nausea and vomiting are most common. With combined pills about 20% of women vomit. With progestin-only pills about 6% vomit. Antinausea medications can help (see What Women Should Know below).
Q:	Do ECPs cause abortion?
A:	No. ECPs will not disrupt an established pregnancy. They are not effective once the process of implantation has begun.
Q:	Do any medical conditions rule out use of ECPs?
A:	No medical conditions rule out ECPs. Medical conditions that rule out continuing use of oral contraceptives do not apply to ECPs. Furthermore, there is no suggestion that ECPs increase the risk of complications—such as certain circulatory system diseases—associated with ongoing OC use.
Q:	After using ECPs, when can a woman start an ongoing method of contraception?
A:	ECPs do not provide continuing protection from pregnancy. Therefore it is important to start an ongoing method of contraception after ECP use. Most methods can be started at once. For example: Condoms and spermicides can be started at once. A woman who wants to start another method later needs to use these methods if she has sex before then. If a woman chooses to use oral contraceptives regularly, she should take the first pill on the next day after she finishes the ECPs. She should also use condoms for the next seven days. A woman who wants an IUD for ongoing contraception can have it inserted within five days of unprotected intercourse in place of taking ECPs. Injectables and implants can be started within seven days after the beginning of the next menstrual cycle. The woman should use condoms until then. Couples who want to use a fertility awareness-based method such as periodic abstinence may need to abstain or use condoms at first and wait one or two cycles until the woman’s menstrual cycle becomes regular. All guidelines also apply to switching to another method after regular use of oral contraceptives.
Q:	Where should ECPs be offered?
A:	Anywhere that women can get ECPs easily, including chemists’ shops and convenience stores, as well as at clinics, emergency rooms, shelters, and private health care providers’ offices.
Q:	Where should women find out how to use ECPs?
A:	Information can come from a pharmacist, a community-based provider, a doctor, a nurse, or from radio, television, newspapers, magazines, package inserts, fliers, telephone recordings, or the Internet.
1	Help the client feel at ease. Let her know that you understand her needs, you will not judge her behavior, and you will keep her visit confidential.
2	Ask when unprotected sex took place. ECPs should be started as soon as possible within 72 hours after unprotected intercourse.
3	Give the woman the pills. Explain how to take them (see How to Use ECPs below), and point to the pills as you explain. She can take the first dose at once.
4	Tell her that, if she vomits within two hours of taking the pills, she may take another dose either by mouth or vaginally.
5	Explain and discuss important points about ECPs (see What Women Should Know below).
6	Discuss the woman’s need for ongoing contraception. If she expects to have sex and wants to avoid pregnancy, it is best if she can choose an ongoing method. In some circumstances— for example, if her partner prevents it—she may not be able to use an ongoing method. In any case, consider offering an extra supply of ECPs for future use. Even if she does not expect to have sex, offer her condoms or spermicide just in case. You also can offer her oral contraceptives, with instructions on when to start them, in case she changes her mind.
7	When there is a chance that she might have acquired a sexually transmitted infection (STI), she should be treated for the most common STIs.

How to Use ECPs
To use progestin-only pills for emergency contraception, a woman must take:

A total of 0.75 mg of levonorgestrel within 72 hours after intercourse, and then a second dose of 0.75 mg 12 hours later. (see table below for numbers of pills to take.)

To use combined OCs for emergency contraception, a woman should take pills totaling 0.5 mg levonorgestrel (or 1.0 mg norgestrel) and 100 µg ethinyl estradiol within 72 hours after intercourse, and the same dose 12 hours later. For example:

Two pills containing 50 µg ethinyl estradiol and 0.25 mg levonorgestrel (or 0.50 mg norgestrel), and then two more of these same pills 12 hours later, OR
Usually four “low-dose” combined pills, each containing less than 50 µg of ethinyl estradiol and 0.15 mg levonorgestrel (or 0.30 mg norgestrel), and then four more of these same pills 12 hours later. (A few brands differ; see table below.)

If you are taking...	Number of pills to swallow as soon as possible (within 72 hours)	Number of pills to swallow 12 hours later
Dosages for Emergency Contraceptive Pills			Brochures in many languages, available from PATH
Dedicated Progestin– Only ECPs Plan B Postinor-2 NorLevo	1 pill 1 pill 1 pill	1 pill 1 pill 1 pill
Dedicated Combined ECPs Preven E-Gen-C Schering-PC-4 NeoPrimovlar Tetragynon Imediat	2 pills 2 pills 2 pills 2 pills 2 pills 2 pills	2 pills 2 pills 2 pills 2 pills 2 pills 2 pills
Progestin-Only OCs Microval Ovrette	25 pills 20 pills	25 pills 20 pills
Combined OCs Alesse Eugynon Levlen Levlite Levora Lo-Femenal Microgynon Lo-Ovral Nordette Ovidon Ovral Rigevidon Tri-Levlen Triphasil Trivora	5 pink pills 2 white pills 4 light-orange pills 5 pink pills 4 white pills 4 white pills 4 yellow pills 4 white pills 4 light-orange pills 2 pills 2 white pills 4 pills 4 yellow pills 4 yellow pills 4 pink pills	5 pink pills 2 white pills 4 light-orange pills 5 pink pills 4 white pills 4 white pills 4 yellow pills 4 white pills 4 light-orange pills 2 pills 2 white pills 4 pills 4 yellow pills 4 yellow pills 4 pink pills
Remember that in 28-day pill packs the last 7 pills are not “active” pills and therefore cannot be used for ECP.

The sooner ECPs are started, the more effective they will be.	What Women Should Know About ECPs
The first dose of ECPs should be taken as soon as possible within 72 hours after unprotected intercourse. The second dose should be taken 12 hours later. The sooner ECPs are started, the more effective they will be. ECPs will not protect against other acts of unprotected intercourse later in the menstrual cycle. In fact, ECPs can delay ovulation, so a woman might still get pregnant later in the same cycle. To keep avoiding pregnancy, a sexually active woman should start an ongoing method of contraception as soon as possible. ECPs are not as effective as consistent, correct, and ongoing use of OCs or many other modern family planning methods. ECPs do not protect against sexually transmitted infections, including HIV, which causes AIDS. Especially with combined pills, many women have nausea (upset stomach), and some women vomit after taking ECPs. Taking an antinausea medication containing meclizine hydrochloride can help. Antinausea medication should be taken 30 minutes to one hour before the first dose of ECPs and repeated as directed on the package. Taking more than the recommended dosage of ECPs will NOT make ECPs more effective. The extra pills will only cause more nausea. The pills will not make menstruation start immediately. A woman’s next period may come a few days earlier or later than expected. This is not harmful and not a reason to worry. She should suspect pregnancy, however, if: Her period is more than one week later than expected, or She has not menstruated within three weeks after treatment, or Her period is unusually light. ECPs are not 100% effective. If they fail, however, the available research suggests that ECPs will not harm the fetus or the course of pregnancy.

The sooner ECPs
are started,
the more effective
they will be.

What Women Should Know About ECPs

The first dose of ECPs should be taken as soon as possible within 72 hours after unprotected intercourse. The second dose should be taken 12 hours later. The sooner ECPs are started, the more effective they will be.
ECPs will not protect against other acts of unprotected intercourse later in the menstrual cycle. In fact, ECPs can delay ovulation, so a woman might still get pregnant later in the same cycle. To keep avoiding pregnancy, a sexually active woman should start an ongoing method of contraception as soon as possible.
ECPs are not as effective as consistent, correct, and ongoing use of OCs or many other modern family planning methods.
ECPs do not protect against sexually transmitted infections, including HIV, which causes AIDS.
Especially with combined pills, many women have nausea (upset stomach), and some women vomit after taking ECPs. Taking an antinausea medication containing meclizine hydrochloride can help. Antinausea medication should be taken 30 minutes to one hour before the first dose of ECPs and repeated as directed on the package.
Taking more than the recommended dosage of ECPs will NOT make ECPs more effective. The extra pills will only cause more nausea.
The pills will not make menstruation start immediately. A woman’s next period may come a few days earlier or later than expected. This is not harmful and not a reason to worry. She should suspect pregnancy, however, if:
- Her period is more than one week later than expected, or
- She has not menstruated within three weeks after treatment, or
- Her period is unusually light.
ECPs are not 100% effective. If they fail, however, the available research suggests that ECPs will not harm the fetus or the course of pregnancy.

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