Emergency contraceptive pill is a pill used by women after having an unprotected intercourse (sex), to prevent her from getting pregnant. It is also known as morning after pill or postcoital pill. However, morning after pill is a misleading term, because it can be used immediately after having sex or within 72 hours of having sex. With constant research this method has been developed which is very effective in preventing unwanted pregnancy with very less side effects and is very easy to use also. 

Miss.xyz, 22yrs came with severe pain in the abdomen for over 2 hours. On a regular enquiry into her history, she menstruated 10 days back which was less in amount as compared to her previous cycles. In closer enquiry, she confirmed that she had taken an emergency contraception after an episode of unprotected sex. I investigated further and diagnosed her to have ruptured right sided tubal pregnancy. As a result she was advised and had to undergo laparoscopic surgery to control the bleeding and was discharged after one day of her stay at the hospital.  

My discussion in this article is about whether this drug should be made as an over the counter medicine i.e. it can be available without any prescription. There have been lots of discussion about this and there are groups of people both in favor and against.

The argument in favor of it is that many couples would hesitate to take any help from the physician and also have inhibition to take it. Unmarried couple would generally avoid having any discussion about it and therefore avoid going to the physician. With increasing awareness about this method of contraception among the people, if it is not made available without prescription, it would not serve the purpose of being an effective emergency contraception.

Argument against the use making it OTC drug is that it would increase the rate of sexual activity amongst the teenage population. It would also increase the incidence of unprotected intercourse increasing the incidence of sexually transmitted diseases. It would also make the use of regular contraception which provides a better protection less favored.

The new emergency contraceptive pill containing levonrogesterol (1.5 gms), is very effective in preventing intrauterine gestation if taken within 72 hours. The main side effect of it is that it causes nausea, vomiting, giddiness and in few women it can also cause some amount of bleeding after 2-3 days. It is advised not to take it multiple times in the same cycle as it increases the chances of failure. The inadvertent use of over the counter way of use of such pills has made this as one of the new cause of ectopic pregnancy. Ectopic pregnancy is when the pregnancy is located outside the normal uterine cavity. It is a life threatening condition and also a cause of maternal mortality.

The exact causes of increased ectopic pregnancy in using this contraception are not known. Probably due to
–   The inherent mechanism of action by which it acts in preventing pregnancy. By reducing the chances of the pregnancy the over all rate of ectopic pregnancy and intrauterine pregnancy is low, but when pregnancy occurs it being ectopic becomes more common.
–   Levonrogesterol acts on the fallopian tube and decreases the motility of the tubes. As it does not prevent ovulation, any fertilized egg has a tendency of getting implanted in the tube.
–   This method of contraception does not prevent pelvic infection. Recurrent pelvic infection is the known cause for increased rate of ectopic pregnancy.
–   Multiple use of emergency contraception in the same cycle decreases the effectiveness of the method and predisposes to increased chances of ectopic pregnancy.

WHO studies have shown that it does not increase the overall rate of ectopic pregnancy. It means that by reducing the chances of pregnancy, it reduces the overall rate of ectopic pregnancy. Yet if pregnancy happens, it is more likely to be ectopic pregnancy than a natural conception.

Emergency contraceptive pill is a novel method of emergency contraception but also a new cause of ectopic pregnancy. I do not support the concept of universal and easy availability of such emergency contraceptive pills until there is adequate sex education in the population. The other methods of contraception which have a higher efficacy and time tested should always be more propagated than this.

Barrier contraception which also provides protection against sexually transmitted diseases is the best choice. Proper use and availability should be more focused upon than using emergency contraceptive pill.

And If emergency contraceptive pill has to be used then it is beneficial to consult a physician at least once before or after the use. Couple needs to be educated upon certain dos and don’ts about the method.

Prevention is better than cure, always. Be safe be happy

Dr. Sunil Eshwar

Aikya is a speciality clinic dedicated to women and child health care, located on Kanakapura Main Road, Bangalore, India 560062