Emergency Contraception Guide 2024: Morning After Pills, IUD

What is emergency contraception?

Emergency contraception (EC) refers to the methods of contraception that can be used to prevent pregnancy after unprotected sexual intercourse.

When should I take emergency contraception?

For optimal effectiveness, EC should be administered promptly after unprotected sexual intercourse, ideally within a 5-day window. It's important to note that EC is ineffective if pregnancy has already been established.

What are the types of emergency contraception available in the market?

There are two types of EC:

1. The copper intrauterine device (IUD) 

2. EC pills. There are three types of EC pills: 1) ulipristal, 2) Levonorgestrel pills (morning-after pill), and 3) combined EC pills. 

How can I get morning-after pills in Singapore?

In Singapore, "morning-after pill" is available only by prescription from a qualified doctor, including general practitioners. While most physicians can prescribe the pills, not all clinics stock them or have staff experienced in women's health issues. It's important to consult a doctor who can address your concerns without judgment.

Given the time-sensitive nature of morning-after pills—it's most effective when taken as soon as possible after unprotected intercourse—we recommend visiting a women's health clinic, such as Thomson Women's Clinic, which has 11 locations across Singapore.

Important: The woman requiring EC must consult the doctor herself; partners cannot obtain the prescription on her behalf.

How effective is emergency contraception?

• The effectiveness of ulipristal is more than 85% and it maintains a higher degree of effectiveness between 72 and 120 hours.³

• Levonorgestrel can be taken as a single dose of 1.5 mg or two 0.75-mg doses taken at the same time or 12 hours apart within 72 hours of unprotected intercourse.³ There is decreased effectiveness as time passes after unprotected intercourse. The effectiveness ranges from 58% to 79%.

• Combined EC pills are 56% to 86% effective, depending on the timeliness of use after unprotected intercourse; it is most effective when used within 72 hours, and is less effective when used 72 to 120 hours after unprotected intercourse.³

• A copper-bearing IUD is more than 99% effective in preventing pregnancy when inserted within 120 hours of unprotected intercourse, This is the most effective form of emergency contraception available.

Who needs emergency contraception?

EC is particularly relevant for:

• Those forgetting to take several birth control pills in a row

• Concerns about possible contraceptive failure 

• Those not using a birth control method during sexual intercourse and do not intend to get pregnant

• Women who have been sexually assaulted

How to take emergency contraception?

1. IUD: The copper IUD has to be inserted into the uterus by a certified and trained medical doctor (gynaecologist) and can be removed during or after the next period.

2. EC pills: Some can be bought over the counter without a prescription. Others require a prescription. For optimal effectiveness, it is recommended to take EC pills as soon as possible following unprotected sexual intercourse. Although they can be used up to 5 days after the event, their ability to prevent pregnancy decreases with time, making prompt use crucial.

What are the pros and cons of emergency contraception?

Pros

• The EC pill is easy to take, accessible to most individuals, and readily available. It can be prescribed by any healthcare provider, and certain varieties are obtainable over the counter at an economical price. 

• It is considered safe, with no long-term side effects reported. 

• There are no adverse effects on infants born after an unsuccessful use of emergency contraception.

• The Emergency IUD offers a durable option for contraception. Once inserted, it can serve as a long-term, reversible contraceptive method for up to 5 years, depending on the type of IUD selected. This flexibility makes the emergency IUD a practical choice for those seeking immediate emergency contraception with the option for extended protection.

Cons

• It’s not as effective as regular contraception. Taking it doesn’t guarantee that you won't get pregnant.

• It doesn’t provide any protection against sexually transmitted infections, including HIV.

• Taking the pill may cause some irregular bleeding or disrupt the periods, causing them to come earlier or later than expected. This is more likely to happen when it’s taken more than once.

• The IUD needs to be inserted by a specially trained doctor and so is not easily accessible. It can cause pain and discomfort during insertion and there’s a small chance of developing an infection.

Where to get emergency contraception?

Emergency contraception is available at government health clinics, some general practitioner clinics, some genitourinary medicine (GUM) clinics, or hospital emergency departments.

What are the side effects of emergency contraceptives?

EC pills have not been shown to cause any serious complications. Your next period may not occur at the expected time. Other short-term side effects of EC pills can include the following:

• Headache

• Nausea and vomiting (especially if you are taking combined EC pills)

• Breast tenderness

• Abdominal pain

• Dizziness

• Fatigue

• Irregular bleeding/spotting

With the copper IUD, menstrual pain and bleeding may increase in the first few months of use.

FAQ

Is there anything that decreases the effectiveness of emergency contraception pills?

Being overweight or obese may decrease the effectiveness of EC pills. If you are overweight or obese, you may want to consider having a copper IUD inserted.

When can you start taking emergency contraception after giving birth?

Emergency contraception is not meant for long-term contraception after giving birth. However, you can use emergency contraceptive pills if you have sex without using contraception, or if you think your contraception might have failed if it's been 21 days or more since the birth. 

For IUD, it can be inserted within 10 minutes of placental separation or 4-6 weeks after giving birth.

Will emergency contraception delay my period?

Emergency contraception can sometimes affect your menstrual cycle. It's not uncommon for emergency contraception to cause changes in the timing of your next period. Your period might come earlier or later than usual, and you might experience spotting or irregular bleeding. These changes are usually temporary and should be resolved within a month or two. If you're concerned about the timing of your period after taking emergency contraception, it's a good idea to consult with a healthcare provider for personalised advice and guidance.

Does emergency contraception work during ovulation?

Emergency contraception can still be effective if taken during ovulation, but its effectiveness decreases the closer it is taken to ovulation. Emergency contraception primarily works by preventing or delaying ovulation, which is the release of an egg from the ovary. If ovulation has already occurred, emergency contraception may be less effective, as it may not be able to prevent fertilisation or implantation of a fertilised egg. 

However, emergency contraception can also make the uterine environment less conducive to implantation, which could potentially reduce the chance of pregnancy even if ovulation has already occurred. It's important to remember that emergency contraception is not 100% effective and should not be relied upon as a regular form of birth control. 

References

1. American College of Obstetricians and Gynecologists 2021

2. World Health Organization 

3. MICHELE C. BOSWORTH, MD, PATTI L. OLUSOLA, MD, AND SARAH B. LOW, MD. Am Fam Physician. 2014;89(7):545-550