MORNING AFTER PILL AND EMERGENCY CONTRACEPTION METHODS Emergency contraception in oral form, is colloquially referred to as the ‘morning-after’ pill. This type of contraception occurs following intercourse and is a method in order to prevent pregnancy following unprotected sex, or if failure of birth control methods occurs. Emergency contraception may refer to two main methods, a hormonal contraception method as well as an intrauterine method of contraception. Contraception which is classified as hormonal refers to an oral drug which contains the hormones, oestrogen and progesterone. Two popular ‘morning after pills’ are Levonelle and ellaOne. The term ‘Morning-after pill’ may be misleading, since ellaOne may be taken in a time frame of up to 120 hours, while Levonelle may be taken up to 72 hours following unprotected intercourse. Levonelle contains levonorgestrel as an active ingredient and is a synthetic hormone which mimics the natural hormone, progesterone. On the other hand, in ellaOne, ulipristal acetate is the main active ingredient, hence enabling the pills to present different methods of contraception. Progesterone plays a major role in the process of ovulation and is also responsible for the thickening of the endometrium (uterine lining) in preparation for the implantation of a fertilized egg. Although studies do not confirm the direct methods by which Levonelle works, it is thought to work via delaying or preventing ovulation from occurring, hence the mature ova is not liberated and its travel down the fallopian tubes into the uterus is inhibited, thus elimination of the possibility of a sperm cell fertilizing the egg results. On the other hand, ellaOne containing ulipristal acetate prevents the hormone progesterone from performing its normal action of ovulation and the build up of the endometrium. Moreover, it thus prevents pregnancy mainly by preventing or delaying ovulation. The action of these pills is not yet fully comprehended, due to the nature of the methods of contraception by which the pills act. Both drugs, Levonelle and ellaOne respectively may affect the sperm and the ova in multiple ways and may also target the uterus. Sperm mobility, change in cervical mucus, as well as alterations in the endometrium may also occur.
IUD’s (intrauterine methods of contraception) refer to contraceptive devices, usually Tshaped and small in size which are made from copper and plastic. Once inserted in the uterus by a paramedic, it acts in a similar way to the pills preventing the egg from being fertilized, or on the other hand, preventing the fertilized egg from successful implantation in the uterine lining. It may be also introduced in the uterus up to five days following unprotected intercourse. The IUD may also be introduced as an ongoing method of contraception. Research does not eliminate the possibility that the IUD and morning-after pill may effect the implantation of a fertilized egg. Presently emergency contraception drugs are not licensed in Malta, hence are not available from pharmacies in Malta. However, active ingredients present in Levonelle and ellaOne, levonorgestrel and ulipristal acetate respectively are found in Malta as the main active ingredients present in other available drugs, such as Microgynon 30 which is a contraceptive pill distributed in pharmacies around Malta, as well as Esmya (ulipristal acetate 5mg) which is used to treat fibroids (non-cancerous growths) which occur in the uterus, following or during childbearing years. Sources • • • • • •
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