Gynecology And Obstetrics-

Morning-after pill

Synonyms in a broader sense

pill
prevention
condom
Hormone bomb
post-coital contraception

Definition of the morning-after pill

What is special about the morning-after pill is that if you use a contraceptive inappropriately, e.g. birth control pills can be taken up to 48 hours after intercourse and prevent pregnancy. In addition to incorrect use of the contraceptive, other circumstances such as gastrointestinal flu can mean that the effect of the birth control pill, for example, is lost (see also: Contraceptive pill does not work).
The morning-after pill consists of tablets that contain high doses of gestagens or gestagens and oestrogens and prevent ovulation as well as implantation of the egg cell.

effectiveness

The Effectiveness of the morning-after pill depends on the time between ingestion and sexual intercourse. Within the first 24h lies the Pregnancy rate at 0.4%, but increases to 2.7% on the 3rd day. Thus, the reliability - depending on the time of use - is 70-90%.

Mechanism of action

There have recently been two differently effective hormonal substances in the morning-after pill. One is the chemically produced preparation levonorgestrel, which mimics an endogenous hormone, the progestin, and one is the preparation Ulipristal, which changes a hormone receptor.

The mode of action of levonorgestrel (trade name: Duofem or Levogynon) is not fully understood. However, the main effect is the inhibition of ovulation (Ovulation inhibition) specified. This is due to the inhibition of the body's own hormone LH (= luteinizing hormone) explainable, which in a part of the brain (Pituitary gland) and usually causes ovulation in the second half of the cycle through an increased release. From this, however, it can be deduced that if ovulation has already occurred, pregnancy cannot be prevented. The implantation inhibition (= Implantation inhibition) is caused by the hormonal premature transformation of the inner lining of the uterus (= Endometrium) explains, which then leads to a short withdrawal bleeding after discontinuation of the hormones and thus prevents the egg cell from implanting (morning-after pill).

Other approaches are that the increased progestin concentration leads to a thicker mucus in the cervix (similar to how the mini-pill works), which hinders sperm migration. In addition, the pH value of the secretion decreases, as a result of which the mobility of the sperm cells decreases. The mode of action of Ulipristal (trade name: ellaone) consists in the occupation of the body's own progesterone receptors. Progesterone (= luteal hormone) is a sex hormone which, among other things, is formed in the woman's ovaries. The inhibition of the progesterone effect also leads to the prevention of ovulation and to the prevention of a change in the uterine lining that is necessary for implantation (morning-after pill).

Read more on the topic: Effect of the morning-after pill.

Alternative to taking pills

A mechanical method of post-coital contraception is the insertion of a copper IUD (Intrauterine device). This can take up to 5 days after intercourse or during Contraindications to the morning-after pill can be used. The reliability is> 95%. As a foreign body in the uterus, the coil causes an inflammatory reaction in the mucous membrane, which prevents a fertilized egg cell from implanting. In addition, the released copper ions cause a decrease in sperm motility.

preparations

Levonorgestrel

The intake must be no later than 72 hours after intercourse be done (according to drug approval). The best effects are seen within the first 24 hours or between 24-48 hours afterwards. It can be at the Morning-after pill be a tablet with 1.5 g levonorgestrel, or 2 tablets with 0.75 g each, which are taken every 12 hours.

Ulipristal = the pill for even longer afterwards

Ulipristal (Trade name: ellaone) has only been on the market since mid-2009 and is approved for use up to 120 hours 5 days after intercourse. 30 mg Ulipristal are taken once. Studies show similar results as the conventional morning-after pill.

Lactation

During the Lactation is the ingestion of Levonorgestrel (Morning-after pill) possible, since the transfer into breast milk is very small. Nevertheless, it is recommended to take the tablet immediately after breastfeeding, so that the interval between breastfeeding is about 6 hours. For the compatibility of Ulipristal (Morning after pill) with breast milk is not yet known, so it is recommended to stop breastfeeding for 36 hours.

Combination with the birth control pill

The effect of the birth control pills is through the Taking the morning-after pill canceled so that additional contraceptives such as Condoms are necessary. There are controversial views about the continued intake over the cycle. Some gynecologists advise to continue taking it Intermenstrual bleeding to prevent and not to disturb the cycle, others advise to pause the pill afterwards until the next one Menstrual period.

Further procedure after taking

To be sure whether it has worked, a pregnancy test should be done about four weeks after using the morning-after pill.
If vomiting or diarrhea occurs after using the morning-after pill, the gynecologist should definitely be consulted again, as it may be necessary to take the morning-after pill again.

Interactions

Antibiotics, Johannis herbs, Drugs that deny PH value of Stomach increase (= proton pump inhibitor), antispasmodic drugs, that HIV drug ritonavir (AIDS) and diseases of the intestine that make it difficult to absorb nutrients (=Malabsorption disordere.g. in Crohn's disease) reduce the effectiveness of the morning-after pill.

Prescription requirement

The morning-after pill requires a prescription in Germany and can be obtained from a gynecologist or at a hospital emergency room at the weekend.

Cost of the morning-after pill

Similar to hormonal Contraceptive methods (The pill, 3 monthly injection, etc.) the statutory health insurance companies only cover the costs up to the age of 20, i.e. exactly until the 21st birthday.
The necessary preliminary examinations, medical consultations and follow-up examinations that have to be carried out in the course of taking the morning-after pill are only covered by the health insurance companies until this point in time.

In addition, a prescription fee of 5 euros must be paid from the age of 18.
Private health insurances usually do not take the morning-after pill at all, privately insured women are therefore forced to pay the costs themselves.
Depending on the manufacturer, the morning-after pill costs between 16 and 35 euros.

possible side effects of the morning-after pill

By taking the "Morning-after pill " various side effects can occur.

These differ from woman to woman. Some women experience no side effects at all, while others struggle with nausea, vomiting, or diarrhea.
Itching can also be caused by the morning-after pill. However, this is a rather rare side effect that affects less than 1 in 1,000 women who have taken the morning-after pill. Affected women usually complain of itching in the genital area, occasionally the itching can also occur in other parts of the body. The itching usually disappears on its own after a short time. If it persists for more than a few days, a gynecologist should be consulted. It could also be another cause of the itching, for example a fungal infection, that is not directly related to the morning-after pill.

Long-term use

The Morning-after pill should not be used long-term for contraception as it contains a high dose of hormones that can disrupt the natural cycle. As a result, there are more frequent side effects of the morning-after pill, which stress the body. The safety of the morning-after pill as a long-term method of contraception is also outperformed by other contraceptives, such as regular pill intake. Accordingly, the morning-after pill should be viewed as an emergency contraceptive and only used as such.

There is little long-term data on the long-term side effects of the morning-after pill.However, according to the current state of science, taking the morning-after pill does not affect fertility. According to current knowledge, the unborn child will not be harmed if a pregnancy is still present.

Effect on the liver

The active substances in the morning-after pill are broken down by the liver.

Accordingly, the liver is stressed when taking the preparation. People who already suffer from liver damage or liver disease should inform their gynecologist before taking the morning-after pill.
These women may not be allowed to take the morning-after pill, as this could worsen the liver disease. In addition, the breakdown of the hormone preparation is slowed down in the case of liver disease. This means that the active level in the body remains for a longer time than usual. This significantly increases the likelihood of side effects.
In women with poor liver function, it may be possible to switch to another preparation for subsequent contraception, this should definitely be clarified with a gynecologist.

Duration of side effects

If side effects occur after taking the morning-after pill, they are usually short-lived.
The body breaks down the drug through the liver and excretes it. Until this process is completed, side effects can occur. If very severe and long-lasting symptoms occur after taking the morning-after pill, it is advisable to consult a doctor. Some women have problems with the morning-after pill for a long time because the hormonal cycle can be disrupted by the single dose of hormones. In such cases, it can take until the end of the current monthly cycle for the hormonal balance to level off again. However, this is rather the exception.

Usually side effects only exist for a few days.

Also read: Abdominal pain from pill.