Last partial update: July 2016 - Please read disclaimer before proceeding
Emergency contraception – Reassurance if you are uncertain.
Usually a woman is aware that she is not covered regarding contraception when she has had sexual intercourse. This opportunity to prevent unplanned pregnancy should not be ignored with the hope that all will be well. Emergency contraception is freely available in Australia from pharmacies and a doctors prescription is not needed. It works for up to five days following the unprotected sexual intercourse and has almost no side effects. (It is NOT just a morning after pill.)
What is emergency contraception?
Emergency contraception is basically a special dose of the hormone progesteron that a woman can take to reduce the chance of becoming pregnant following unprotected sexual intercourse. This includes rupture of condoms or taking the pill incorrectly as well as having intercourse without any contraception. It is important to realise that, while pregnancy is more likely when sex occurs at certain times during the menstrual cycle, a woman can become pregnant at almost any time, even when sex occurs during menstruation. Thus, emergency contraception needs to be considered any time unprotected intercourse occurs.
Emergency contraception comes pre-packaged and consists of two pills containing a large dose of a progestin hormone. There are two brands, Postinor-2 or Levonelle-2, and both are available over-the-counter from any pharmacy. It does not require a doctor’s prescription.
The two pills are usually taken by 12 hours apart, with the first one being taken as soon as possible after the unprotected sexual intercourse occurred. (Recent evidence has shown that taking both together is equally effective.) The closer emergency contraception is started to the episode of unprotected sexual intercourse the more effective it is. However it will work up until about 5 days after. Thus, the term ‘morning after pill’ that is commonly used to describe emergency contraception is quite misleading.
Emergency contraception works in two ways.
- In women who have not yet released an egg (ovulated) during the cycle, it acts to delay ovulation until after the sperm from the sexual contact has gone, thus preventing egg fertilisation.
- Where ovulation has already occurred, it is thought to act by prevent preventing the fertilised egg from implanting in the uterus.
Overall, it prevents about 87% of pregnancies; although if it is taken within 24 hours of intercourse, the success rate is around 99%. It causes few side effects, although irregular bleeding (often as spotting) can occur and about 2% of women will get some nausea. The menstrual period following taking emergency contraception should occur at the expected time and if it doesn’t or is delayed, a pregnancy test should be done. The woman should continue her usual form of contraception, including the COCP (the pill), during the cycle that the emergency contraception is taken in.
Most women can take emergency contraception safely, although prior medical advice should be sought if the woman has had a hormone-dependent cancer and it should not be taken when a woman is already pregnant. A very small amount of the medication (about 0.1%) will enter breast milk in lactating women. Some medications will also reduce its effectiveness. (Talk with your doctor.)
The cost is in the region of $20 to $30.
Medical practitioners can provide this form of medication from samples they have of the mini-pill, but the progesterone dose in the mini-pill is quite small and two doses of 25 tablets are required to replicate the dosage provided in the commercially available emergency contraception preparations.
Avoiding unplanned pregnancy
Unplanned pregnancy is common in women in general but especially in young women. It almost always is presents a very difficult problem for the woman concerned, who is confronted with, either terminating the pregnancy and suffering the associated the psychological trauma, which can go on for many years after the actual termination, or overcoming the difficulties of giving birth to and bringing up an unplanned child. (This is especially a problem for teenage pregnancies where 60 per cent of women who choose to become mothers have no male partner.)
While no exact figures exist, it is estimated that about 85,000 abortions occur in Australia each year (about one in five of all pregnancies).The majority occur in young women, with about 17 per cent in teenagers and 47 per cent in women in their twenties.
About 20 per cent of Australian women will become pregnant in their teenage years, with the rate being about 44 per 1000 female teenagers per year. While some of these are planned and wanted, about 53 per cent (or 23 per 1000) end in termination.
This teenage termination rate is the sixth highest amongst OECD countries and does not compare favourably with many other developed countries. For example, the rates for German (5.3 per 1000 per year) and Dutch (3.9 per 1000 per year) teenagers are less than a quarter of those for Australian teenagers. (1996 figures)
This is perhaps not overly surprising when you consider that about 50 per cent of first time sexual intercourse in Australia occurs without any contraception being used.
Interestingly, the situation does not improve greatly as women get older. The overall termination rate in Australian women aged 15 to 44 years is similar at about 20 per 1000 women per year. Overall, almost 20 per cent of Australian women will have an abortion at some stage in their lives.
From the above it is obvious that contraception use in Australia needs to improve.
Contraception is still mostly left up to women
Contraception in Australia is still mainly left up to the female. This is very understandable as it is primarily women who face the consequences. In order to avoid becoming pregnant, a woman must;
a. choose a reliable form of contraception that suits her
b. use it properly all the time.
(Contraception also often needs to help prevent sexually transmitted diseases.)
a. Choose a reliable form of contraception that suits her.
There are many different forms of contraception available. Most are very good at preventing pregnancies but none are perfect. For example, the oral contraceptive pill has, overall, about a 96% success rate. This means that if 100 women used the pill as a contraceptive for a year, about four would become pregnant.
All forms of contraception have side effects and problems related to their use and these will play an important part in the decision about which to choose. These will be discussed when each form of contraception is examined. (Also see the summary table below.)
b. Use it properly all the time
Failure of contraception is a big problem. In a recent study of Australian women seeking an abortion, about 14 per cent stated they were using the pill at the time. Most forms of contraception work well when used properly all the time. However, it is the nature of much sexual intercourse to be unplanned and at times even opportunistic, often depending on the mood of the participants. While, for some, this is part of what makes it exciting, it does not help with planning successful contraception. The main reasons that contraception fails is that it is not used properly. Studies have shown that about 50 to 75 per cent of women taking the pill miss at least one tablet per cycle and about 20 per cent miss two or more pills per cycle.
Compliance with taking the pill: Studies have shown that about 50 to 75 per cent of women taking the pill miss at least one tablet per cycle and about 20 per cent miss two or more pills per cycle. If you take the pill do not underestimate the difficulty in taking it properly. To help with this, two alternative methods of taking the pill have been developed; vaginal ring and patches applied to the skin, both of which are used weekly rather than daily. (See later for detailed information re these choices.)
Alcohol is the biggest risk factor for contraception failure. When you add alcohol (and sometimes other illicit drugs) into the ‘sex equation’, you are liable to get even more spontaneous and unplanned sexual activity happening; which in some people is the reason for its consumption.
Contraception that relies on taking the contraceptive measure at the time, such as the appropriate use of condoms, is much more difficult to put into practice when alcohol and other drugs use is involved. Barrier methods are essential for protection against sexually transmitted disease and should be used all the time by couples who are not in a long term relationship. However, alone, they are generally considered as being not reliable enough as a means of contraception for anyone having sex more than very occasionally and this is especially the case when the couple consumes alcohol before sexual activity; and in Australia that is most couples. Some other more effective form of contraception that is not administered at the time of sexual intercourse needs to be used also.
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Other sexual health information for parents and adolescents on this web site
Contraception for adolescents and teenagers There is a separate section in the web site devoted to preventing teenage pregnancy.
See section 'preventing teenage pregnancy'
Unplanned pregnancy - What are the options?
See section 'Unplanned pregnancy options'
Sexually transmitted diseases and their prevention
This focuses on Chlamydia and Genital Hepres, the two most common sexually transmitted diseases in young people. Other diseases such as HIV/AIDS are also covered.
See section 'Sexually Transmitted Diseases and their prevention'Preventing teenage pregnancy
See section 'preventing teenage pregnancy'
Further information
Further reading regarding teenager sexual health
Sexwise by Dr Janet Hall. Published by Random House Australia. (What every young person and parent should know about sex. Dr Hall empowers her readers by telling them the facts - and giving it to them straight.)
Unzipped by Bronwyn Donaghy. Published by Harper Collins (A book that deals frankly and sympathetically with the crucial role that love and emotions play in every aspect of adolescent sexuality.)Further titles regarding puberty and adolescent sexuality are available on the Children’s Hospital at Westmead web site. www.chw.edu.au/parents/books. (Both the above books are mentioned on this web site and are recommended by staff at this hospital.)
Further information on sexual health
Sexual health information
www.shinesa.org.auFamily Planning NSW
https://www.fpnsw.org.auThe Resource Center for Adolescent Pregnancy Prevention web site
(A good USA site that provides information and skills for both adolescents and for educators about preventing unwanted teenage pregnancies.)
www.etr.org/recapp