tag:theconversation.com,2011:/id/topics/morning-after-pill-5019/articlesMorning after pill – The Conversation2023-08-31T13:41:56Ztag:theconversation.com,2011:article/2121402023-08-31T13:41:56Z2023-08-31T13:41:56ZEmergency contraception: here’s what you probably don’t know but should<figure><img src="https://images.theconversation.com/files/545250/original/file-20230829-21-sw8ysk.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5607%2C3741&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The 'morning after pill' can actually be taken up to five days after unprotected sex.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/morningafter-pill-174171692">Image Point Fr/ Shutterstock</a></span></figcaption></figure><p>Things don’t always go to plan when it comes to sex. Sometimes condoms break (or are even forgotten altogether) and daily contraceptive pills can be missed. Whatever the reason, if you need to prevent an unplanned pregnancy you might decide to use <a href="https://www.nhs.uk/conditions/contraception/emergency-contraception/">emergency contraception</a>.</p>
<p>There are three main options for emergency contraception: levonorgestrel tablets (known as Levonelle in the UK and <a href="https://www.plannedparenthood.org/learn/morning-after-pill-emergency-contraception/whats-plan-b-morning-after-pill">Plan B</a> in the US), ulipristal tablets (<a href="https://www.ellaone.co.uk/magazine/ask-ella/what-is-ulipristal-acetate/">EllaOne</a> in the UK and Ella in the US) and having a copper intra-uterine device (IUD – sometimes called the coil) fitted.</p>
<p>In the UK and US, you can get levonorgestrel and ulipristal from pharmacies. In UK pharmacies, there’s typically no charge if it’s offered as part of an NHS service. In other parts of the world, levonorgestrel is often <a href="https://en.wikipedia.org/wiki/Emergency_contraceptive_availability_by_country">easier to access</a> than ulipristal. For emergency IUD fittings, you need to go to a contraceptive and sexual health clinic, or your GP or gynaecologist.</p>
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<img alt="Quarter life, a series by The Conversation" src="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em><strong><a href="https://theconversation.com/uk/topics/quarter-life-117947?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">This article is part of Quarter Life</a></strong>, a series about issues affecting those of us in our twenties and thirties. From the challenges of beginning a career and taking care of our mental health, to the excitement of starting a family, adopting a pet or just making friends as an adult. The articles in this series explore the questions and bring answers as we navigate this turbulent period of life.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/period-delay-tablets-can-help-you-temporarily-skip-your-period-heres-how-they-work-184991?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Period delay tablets can help you temporarily skip your period – here’s how they work</a></em></p>
<p><em><a href="https://theconversation.com/stis-are-on-the-rise-heres-how-to-navigate-telling-a-partner-if-youve-got-one-208267?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">STIs are on the rise – here’s how to navigate telling a partner if you’ve got one</a></em></p>
<p><em><a href="https://theconversation.com/five-important-things-you-should-have-learned-in-sex-ed-but-probably-didnt-202177?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Five important things you should have learned in sex ed – but probably didn’t</a></em></p>
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<h2>How does it work?</h2>
<p>Although we often call emergency contraceptives “the morning-after pill”, the hormonal pill options can be taken up to five days after unprotected sex. The IUD can sometimes be used even later.</p>
<p>Levonorgestrel and ulipristal both work by delaying ovulation. This means that if there are sperm inside the fallopian tubes, there won’t be an egg for them to meet and fertilise. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/20116841/">Ulipristal is more effective</a> when ovulation is expected within a day, as it can still delay the release of an egg even after the ovulation process has started (when levels of a hormone called luteinising hormone start to rise). Levonorgestrel can’t delay ovulation once this starts.</p>
<p>In a typical menstrual cycle, you’re most at risk of pregnancy on <a href="https://doi.org/10.1136/bmj.321.7271.1259">days nine to 14</a>. But even if you’re more than halfway through your typical monthly cycle, these tablets can still work. This is because you can’t actually calculate when precisely <a href="https://www.bishuk.com/bodies/female-fertility-explained/">ovulation has occurred</a> until the next time your period arrives – so it’s better to get help than spend time stressing at home.</p>
<p><a href="https://www.brook.org.uk/your-life/emergency-contraception/">The IUD works</a> by making the environment within the uterus unfriendly to sperm, and so prevents the sperm fertilising an egg that may have been released. It can be inserted up to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3619968/#DES140C11">five days</a> after the earliest date you could have ovulated. For example, if you usually have 28 day cycles, you could use this up to day 19 (18 days after the day your last period started).</p>
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<img alt="A clinician wearing blue surgical gloves holds the copper IUD in their hands." src="https://images.theconversation.com/files/545251/original/file-20230829-23-gwd4hy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/545251/original/file-20230829-23-gwd4hy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/545251/original/file-20230829-23-gwd4hy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/545251/original/file-20230829-23-gwd4hy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/545251/original/file-20230829-23-gwd4hy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/545251/original/file-20230829-23-gwd4hy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/545251/original/file-20230829-23-gwd4hy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The copper IUD can be kept in and used as a regular form of contraception.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/doctor-holding-tshaped-intrauterine-birth-control-2075766613">New Africa/ Shutterstock</a></span>
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<p>It’s important to note that all of these methods are contraceptives, and don’t cause abortions. If you’re already pregnant, these won’t stop a pregnancy.</p>
<p>Emergency contraceptives also cannot protect against <a href="https://www.tht.org.uk/hiv-and-sexual-health/sexual-health/stis">sexually transmitted infections</a> (STIs) – so if you think you’ve been exposed to one, it’s important to visit a <a href="https://www.tht.org.uk/hiv-and-sexual-health/pep-post-exposure-prophylaxis-hiv">sexual health service</a> or your doctor.</p>
<h2>How effective is it?</h2>
<p>The <a href="https://www.nhs.uk/conditions/contraception/iud-coil/">IUD</a> is over 99% effective at preventing pregnancy, even when used as an emergency contraceptive. The coil can also be left in as a regular method of contraception afterwards.</p>
<p>While it’s the most effective form of emergency contraception, it can be uncomfortable or even painful to have an IUD fitted. It’s also somewhat less convenient than popping to a local pharmacy for a pill or using GP or online doctor services.</p>
<p>Ulipristal can be taken up to five days after unprotected sex. It’s at least <a href="https://www.sciencedirect.com/science/article/pii/S0140673610601018">95% effective</a> at stopping pregnancies when taken within this time frame. </p>
<p>Levonorgestrel is <a href="https://www.tht.org.uk/hiv-and-sexual-health/sexual-health/improving-your-sexual-health/contraception/emergency">95% effective</a> at preventing pregnancy if taken within 24 hours of unprotected sex. But this drops to 58% effectiveness if taken between two and three days after unprotected sex.</p>
<p>Depending on the point in your cycle when you had unprotected sex, ulipristal is often a better option. But both tablets are up to 95% effective at stopping pregnancies when taken soon after unprotected sex.</p>
<p>Levonorgestrel and ulipristal are preferably only taken once in each monthly cycle, as they are possibly less effective if used <a href="https://www.brook.org.uk/your-life/morning-after-pill/">more than once</a>. It’s also important to continue with other forms of contraception, such as condoms or the contraceptive pill, until your next period arrives – ulipristal can reduce the effectiveness of some contraceptive pills, so speak to your healthcare provider about taking it.</p>
<p>In my practice as a community pharmacist, I always prefer to recommend ulipristal because of its longer period of effectiveness. It is more expensive though, and so sometimes it isn’t always available as part of a free service. Both levonorgestrel and ulipristal are available without prescription in the UK.</p>
<p>Certain medical conditions (especially those affecting your gastrointestinal system, <a href="https://www.nhs.uk/conditions/crohns-disease/">such as Crohn’s</a>) and medications (such as antiepileptic drugs) can affect how well the pills work. In this circumstance, it’s worth speaking with a doctor about your options as an IUD may work better for you. </p>
<h2>What should you expect?</h2>
<p>Nausea and vomiting are the most common side effects from taking the morning-after pill. It may also cause your next period to begin earlier or later than normal. Some people have also reported headaches or dizziness.</p>
<p>The IUD can make periods heavier or more painful. This often subsides after three to six months if you have chosen to keep it in.</p>
<p><a href="https://www.nhs.uk/conditions/ectopic-pregnancy/">Ectopic pregnancy</a> (when a fertilised egg implants in a fallopian tube) may be possible if emergency contraception fails. If you have lower stomach pain (even if your period arrives), it’s important to seek immediate help as this can be very serious.</p>
<p>If your period is more than seven days late or is shorter or lighter than normal, you should take a pregnancy test to check the emergency contraception has worked.</p>
<p>There’s zero shame in using an emergency contraceptive if you need it. Just remember it’s less effective than regular forms of contraceptives, so only use it as a backup plan. It’s also worth noting that emergency contraceptives have no effect on long-term fertility and can be used even if you plan to have children later on.</p><img src="https://counter.theconversation.com/content/212140/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cathryn Brown does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Whatever your reason for using it, emergency contraceptives can help prevent unplanned pregnancies.Cathryn Brown, Lecturer in Pharmacy Practice, University of Central LancashireLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1913102023-04-19T12:44:30Z2023-04-19T12:44:30ZEmergency contraception is often confused with abortion pills – here’s how Plan B and other generic versions work to prevent pregnancy<figure><img src="https://images.theconversation.com/files/520092/original/file-20230410-26-r8dpzm.jpg?ixlib=rb-1.1.0&rect=46%2C0%2C5200%2C3440&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Morning-after pills are most effective when taken within three days after sex.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-taking-contraceptive-pill-royalty-free-image/91558808?phrase=Morning%20after%20pill&adppopup=true">Ian Hooton/Science Photo Library via Getty Images</a></span></figcaption></figure><p>Since the overturning of Roe v. Wade in June 2022 and the <a href="https://theconversation.com/supreme-court-overturns-roe-upends-50-years-of-abortion-rights-5-essential-reads-on-what-happens-next-184697">end of constitutional protection for abortion</a>, emergency contraception has become more difficult to obtain and – more than ever – shrouded in misinformation. </p>
<p>Attempting to control inventory, Amazon, Rite Aid and Walmart have <a href="https://www.theguardian.com/society/2022/jun/28/emergency-contraception-pills-pharmacies">imposed purchase limits on the emergency contraception known as Plan B</a> since the Supreme Court’s ruling. Panicked buyers have been trying to stock up on the drug in case it becomes unavailable. </p>
<p>Several legislators and proposed bills have <a href="https://nwlc.org/resource/dont-be-fooled-birth-control-is-already-at-risk/">conflated emergency contraception with abortion</a> and are trying to limit access to it. The <a href="https://theconversation.com/anti-mifepristone-court-decisions-rely-on-medical-misinformation-about-abortion-and-questionable-legal-reasoning-203742">recent court ruling</a> <a href="https://www.washingtonpost.com/politics/2023/04/07/texas-abortion-pill-ruling-mifepristone/">blocking access to mifepristone</a> – which has been approved by the FDA since 2000 – is an ominous sign to many that emergency contraception could be the next target. </p>
<p>Regardless of one’s stance on abortion, it is important to understand why emergency contraception should be a basic component of women’s reproductive health care and family planning services. As a researcher of <a href="https://www.researchgate.net/profile/Amie-Ashcraft">women’s sexual and reproductive health and decision-making</a>, I have extensively researched access to emergency contraception.</p>
<h2>What is emergency contraception?</h2>
<p>Emergency contraception is the only way to prevent pregnancy after sex has already occurred. It can be used when no contraception was used or it was used incorrectly, such as with missed birth control pills or broken condoms. Emergency contraception is also used to prevent pregnancy after sexual assault or rape. </p>
<p>Emergency contraception can take the form of pills – sometimes called the morning-after pill – or <a href="https://www.acog.org/womens-health/faqs/long-acting-reversible-contraception-iud-and-implant">an intrauterine device, or IUD</a> that delays ovulation. </p>
<p>There are two types of emergency contraception pills. The most widely known is <a href="https://medlineplus.gov/druginfo/meds/a610021.html">levonorgestrel</a>, which is sold in the U.S. under the brand name <a href="https://www.planbonestep.com/">Plan B</a>, along with numerous generic versions. </p>
<p>Levonorgestrel was <a href="https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/plan-b-one-step-15-mg-levonorgestrel-information#:%7E">first approved for over-the-counter sale</a> to women 18 and older in 2006, and in 2013 age restrictions were removed. </p>
<p>The second type of emergency contraception pill is ulipristal acetate, which is sold under the brand name ella. Both Plan B and ella work by delaying ovulation. In addition, ella <a href="https://doi.org/10.3109/09513590.2014.950648">also thins the uterus lining</a> so that even if an egg were fertilized, it is harder for it to implant in the uterus to start a pregnancy. </p>
<p>Both types of pills are effective at preventing pregnancy. Plan B is most effective if taken within three days of sex, with some declining effectiveness on days four and five. Ella is effective if taken within five days of sex and, unlike Plan B, is equally effective all five days.</p>
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<figcaption><span class="caption">Studies show emergency contraception prevents pregnancy only before the egg is fertilized, not after.</span></figcaption>
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<p>The most effective types of emergency contraception are IUDs that are inserted by a health care provider. Copper IUDs – also referred to as nonhormonal IUDs – are sold under the brand name Paragard. They release into the uterus copper ions that are <a href="https://www.mayoclinic.org/tests-procedures/paragard/about/pac-20391270">toxic to both eggs and sperm</a>. This allows them to be used as emergency contraception if inserted within five days after sex, and as ongoing contraception for up to 10 years. </p>
<p>Levonorgestrel IUDs – referred to as hormonal IUDs – are sold under the brand names Mirena, Liletta, Kyleena and Skyla. The levonorgestrel released into the uterus makes the mucus around the cervix thicker so that a sperm cannot penetrate to fertilize the egg, and it is as effective as the copper IUD when inserted as emergency contraception <a href="https://doi.org/10.1056/NEJMoa2022141">for up to five days after sex</a>. Both Paragard and Mirena IUDs have been approved by the FDA for use as contraception, but they are <a href="https://www.contemporaryobgyn.net/view/updates-on-emergency-contraception">not yet approved specifically for use as emergency contraception</a>.</p>
<h2>How is emergency contraception different from the abortion pill?</h2>
<p>For many years, the way that emergency contraception works has been misunderstood. There has been confusion about whether emergency contraception is an abortifacient – that is, a medication that triggers an abortion. The key difference is that the abortion pill works only when a woman is pregnant, and emergency contraception works only when she is not.</p>
<p>The so-called abortion pill is used for a medication abortion and actually consists of <a href="https://www.bedsider.org/abortion/abortion-pill">two separate pills that do different things</a>. </p>
<p>The <a href="https://theconversation.com/what-the-fdas-rule-changes-allowing-the-abortion-pill-mifepristone-to-be-dispensed-by-pharmacies-mean-in-practice-5-questions-answered-197339">first of these pills is mifepristone</a>, which functions to block production of the pregnancy hormone progesterone so that the uterus lining thins and the embryo detaches from it. This is the pill that is receiving national attention because of clashing court rulings over access, a battle that is headed to <a href="https://www.statnews.com/2023/04/13/abortion-mifepristone-texas-appeals-court-restores-access-access/">the Supreme Court</a>.</p>
<p>The second pill, misoprostol, stimulates contractions in the uterus to eject the embryo and gestational sac. Emergency contraception prevents a pregnancy before it occurs, whereas the abortion pill ends a pregnancy once it’s begun.</p>
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<figcaption><span class="caption">Some observers say there’s a possibility of an eventual ban on Plan B and other contraceptives.</span></figcaption>
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<h2>How do abortion restrictions jeopardize emergency contraception?</h2>
<p>With the increase in abortion restrictions, access to a full range of contraceptive options – including emergency contraception – is more critical than ever. </p>
<p>There are already numerous barriers to obtaining emergency contraception in a timely manner. The most effective types of emergency contraception, ulipristal acetate and both hormonal and nonhormonal IUDs, must be obtained from a health care provider. This means a woman needs an appointment – usually available only on a weekday during business hours – as well as transportation and the means to pay for the appointment, either through health insurance or self-pay. She may need to take time off of work to attend the appointment, or she may need to obtain child care.</p>
<p>For many women in poor, rural or geographically isolated neighborhoods, these barriers are difficult to surmount. This is particularly true given the short window of time in which emergency contraception is effective.</p>
<p>Levonorgestrel emergency contraception pills are available over the counter and should be easily accessible, but individuals trying to purchase them run into numerous obstacles. These include <a href="https://doi.org/10.1016/j.japh.2020.07.027">low stocks in pharmacies</a> – especially independent pharmacies – and <a href="https://doi.org/10.1016/j.srhc.2022.100765">point-of-sale restrictions</a>, such as requirements that purchasers be a certain age, show identification or have parental consent. People also encounter high rates of misinformation about when to take levonorgestrel for maximum effectiveness and about sales restrictions. Finally, they encounter pharmacy staff who object to selling it because they <a href="https://doi.org/10.1177/0969733020918926">misunderstand how it works</a>.</p>
<p>The surge in demand for emergency contraception since the reversal of Roe v. Wade and the <a href="https://www.theguardian.com/society/2022/jun/28/emergency-contraception-pills-pharmacies">purchase limits put on it by retailers</a> have exacerbated these access challenges. </p>
<h2>What are the benefits of emergency contraception?</h2>
<p>Access to emergency contraception promotes women’s health in several ways. <a href="https://www.cdc.gov/reproductivehealth/contraception/unintendedpregnancy/index.htm">Nearly half of pregnancies in the U.S. are unintended</a>, and emergency contraception can prevent about <a href="https://www.who.int/news-room/fact-sheets/detail/emergency-contraception">95% of unwanted or mistimed pregnancies</a> when used within five days of sex. It can also be used as a backup option when another form of contraception fails. And it can be given to survivors of sexual assault. Emergency contraception also <a href="https://www.guttmacher.org/news-release/2005/emergency-contraception-ec-played-key-role-abortion-rate-declines">reduces the need for abortions</a>.</p>
<p>Overall, access to a full range of contraceptive options – including emergency contraception – gives women greater control over their reproductive choices. The ability to control the number and spacing of their pregnancies improves the health, social and <a href="https://iwpr.org/iwpr-issues/reproductive-health/the-economic-effects-of-contraceptive-access-a-review-of-the-evidence/">economic outcomes</a> of both women and their families.</p><img src="https://counter.theconversation.com/content/191310/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amie Ashcraft does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The increase in abortion restrictions may also lead to a decline in access to emergency contraceptives.Amie Ashcraft, Service Assistant Professor in Family Medicine, West Virginia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2031312023-04-10T20:00:33Z2023-04-10T20:00:33ZBritish Columbia’s coverage of contraceptives should inspire the rest of North America<figure><img src="https://images.theconversation.com/files/520087/original/file-20230410-7003-jfzc31.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6000%2C3655&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">British Columbia's move to provide free contraception is an act of defending and upholding reproductive rights and freedoms.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p><a href="https://bc.ctvnews.ca/access-to-free-birth-control-begins-in-british-columbia-1.6339248">As of April 1, 2023 all residents of British Columbia gained access to free prescription contraception</a>. This includes the birth control pill, injections and implants, IUDs and emergency contraception known as Plan B or the “morning after” pill.</p>
<p>The bold move makes good on a campaign promise of the NDP government. </p>
<p>It’s the focus of sustained activism of groups like <a href="https://www.accessbc.org/">AccessBC</a> and Action Canada for Sexual Health and Rights, and was ignited by the ongoing abortion politics south of the border, where a judge in Texas just <a href="https://www.nytimes.com/2023/04/07/health/abortion-pills-ruling-texas.html">issued a preliminary ruling invalidating the Food and Drug Administration’s 23-year-old approval of the abortion pill mifepristone</a>. That ruling was almost immediately followed <a href="https://apnews.com/article/washington-abortion-pills-lawsuit-fda-1857d1a4fd356c61ad76e00621e93b44">by a contradictory decision</a> by a judge in Washington state.</p>
<p>The <a href="https://www2.gov.bc.ca/gov/content/health/health-drug-coverage/pharmacare-for-bc-residents/what-we-cover/prescription-contraceptives">B.C. policy</a> could serve as a model for other provinces — Ontario’s Progressive Conservative government, for example, has already said it’s “<a href="https://www.thestar.com/politics/provincial/2023/03/08/ontario-looking-closely-at-bc-plan-to-offer-free-contraception-health-minister-says.html">looking closely at what British Columbia has proposed</a>.” </p>
<p>Nonetheless, universal coverage of contraception beyond British Columbia is unlikely at the moment. It does not seem to be a serious proposal of any current provincial government. </p>
<p>While some provincial opposition parties have promised universal contraception, policy progress depends on whether they actually get elected. It will also depend on a number of factors that will shape their political agenda once in office.</p>
<h2>List not fully complete</h2>
<p>The new coverage in B.C. is extended to anyone with a provincial health card and requires a physician’s prescription until later this spring, when <a href="https://www2.gov.bc.ca/gov/content/health/accessing-health-care/pharmacy-services">pharmacists will be able to prescribe contraceptives</a>. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/519991/original/file-20230409-6385-i30zeg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A package of birth control pills." src="https://images.theconversation.com/files/519991/original/file-20230409-6385-i30zeg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/519991/original/file-20230409-6385-i30zeg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=458&fit=crop&dpr=1 600w, https://images.theconversation.com/files/519991/original/file-20230409-6385-i30zeg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=458&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/519991/original/file-20230409-6385-i30zeg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=458&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/519991/original/file-20230409-6385-i30zeg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=576&fit=crop&dpr=1 754w, https://images.theconversation.com/files/519991/original/file-20230409-6385-i30zeg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=576&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/519991/original/file-20230409-6385-i30zeg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=576&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A one-month dosage of hormonal birth control pills.</span>
<span class="attribution"><span class="source">(AP Photo/Rich Pedroncelli, File)</span></span>
</figcaption>
</figure>
<p>The list of contraceptives included in this plan <a href="https://www.timescolonist.com/local-news/bc-provides-list-of-birth-control-methods-to-be-covered-6668608">is comprehensive but not exhaustive</a>. Other forms of birth control and menstrual regulation, according to the B.C. government, might be considered in the future. </p>
<p>There seems to be no significant discussion of extending the coverage to B.C. residents who don’t have a provincial health card, such as undocumented residents and migrant workers for whom <a href="https://www.alternateroutes.ca/index.php/ar/article/view/22448">reproductive rights</a> are already sometimes inaccessible. </p>
<p>And accessibility will be dependent upon pharmacists’ willingness to dispense medication, something that might be particularly contentious, not to mention time-sensitive with emergency contraception. </p>
<p>Pharmacists are allowed to refuse to stock or dispense medication as a matter of conscience, something that has been a <a href="https://doi.org/10.1370/afm.2562">barrier for medication abortion access</a> in Canada, especially in rural areas. Yet despite these criticisms, the B.C. plan serves as an example of equitable primary sexual and reproductive health care delivered at the provincial level.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/roe-v-wade-canada-can-respond-to-u-s-bans-by-improving-access-to-abortion-care-here-185827">Roe v. Wade: Canada can respond to U.S. bans by improving access to abortion care here</a>
</strong>
</em>
</p>
<hr>
<h2>Opposition promises in other provinces</h2>
<p>Opposition parties in Alberta, Manitoba and Saskatchewan have all promised to implement the <a href="https://bc.ctvnews.ca/access-to-free-birth-control-begins-in-british-columbia-1.6339248">same policy</a> if elected. But at this point, such a commitment really just amounts to a progressive idea in the context of conservative provincial politics, with <a href="https://thecanadaguide.com/data/provincial-premiers/">centre-right parties in power in eight of 10 provinces. </a></p>
<figure class="align-left ">
<img alt="A man is seen in profile under a large golden ceiling light." src="https://images.theconversation.com/files/519993/original/file-20230409-24-z3gijl.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/519993/original/file-20230409-24-z3gijl.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=406&fit=crop&dpr=1 600w, https://images.theconversation.com/files/519993/original/file-20230409-24-z3gijl.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=406&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/519993/original/file-20230409-24-z3gijl.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=406&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/519993/original/file-20230409-24-z3gijl.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=511&fit=crop&dpr=1 754w, https://images.theconversation.com/files/519993/original/file-20230409-24-z3gijl.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=511&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/519993/original/file-20230409-24-z3gijl.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=511&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">B.C. Health Minister Adrian Dix is seen during a news conference with his provincial counterparts in Vancouver in November 2022.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Darryl Dyck</span></span>
</figcaption>
</figure>
<p>This means that the B.C. policy might reflect the uniqueness of the province’s political dynamics and also demonstrates what is possible, given the right political conditions, in the realm of <a href="https://doi.org/10.1086/722896">reproductive rights</a>. </p>
<p>It’s also reflective of the broader North American <a href="https://doi.org/10.1177/14647001221114611">politics of abortion</a>, as the timing of the policy — a campaign promise of the NDP government, elected in 2020 — seems to respond to the reversal of reproductive rights in the United States with the <a href="https://www.nytimes.com/2022/06/24/us/roe-wade-overturned-supreme-court.html">overturn of <em>Roe v. Wade</em> </a> in June 2022.</p>
<p>The end of constitutional protection of the right to abortion in the U.S. created momentum for strengthening abortion policy and reproductive rights in Canada. </p>
<p>In response <a href="https://www.nytimes.com/interactive/2022/06/24/us/politics/supreme-court-dobbs-jackson-analysis-roe-wade.html">to the U.S. Supreme Court ruling</a>, the <a href="https://www.cbc.ca/news/politics/abortion-funding-expanded-roe-v-wade-1.6449487">federal Liberal government has increased and sustained commitments to ensuring access to abortion</a> and other areas of sexual and reproductive health and rights.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/mexicos-help-to-american-women-who-need-abortions-should-inspire-canada-202117">Mexico's help to American women who need abortions should inspire Canada</a>
</strong>
</em>
</p>
<hr>
<h2>Reproductive justice</h2>
<p>Much of this work is carried out by organizations like <a href="https://www.actioncanadashr.org/">Action Canada for Sexual Health and Rights</a> and the <a href="https://nafcanada.org/">National Abortion Federation Canada</a>, with advocacy and information campaigns by the <a href="https://www.arcc-cdac.ca/">Abortion Rights Coalition</a>. </p>
<p>All insist that contraception and abortion are both matters of individual autonomy and <a href="https://www.sistersong.net/reproductive-justice">reproductive justice</a>. At the provincial level, <a href="https://montreal.ctvnews.ca/mobile/quebec-college-of-physicians-announces-new-guidelines-to-make-access-to-abortion-medication-easier-1.5988310">Québec reduced restrictions</a> on the dispensing of mifegymiso, the drug used in medication abortion. Other provinces, including <a href="https://www.thecoast.ca/news-opinion/how-to-get-an-abortion-in-nova-scotia-28911462">Nova Scotia</a>, created abortion self-referral networks.</p>
<p>But the B.C. government’s universal contraception announcement is the most recent positive policy response to the reversal of reproductive rights in the U.S.</p>
<p>Of course not all of the impact of the <em>Dobbs</em> decision on Canada has been positive. In the immediate aftermath of the overturn of <em>Roe</em>, the Manitoba legislature <a href="https://winnipeg.ctvnews.ca/ndp-bill-for-abortion-clinic-buffer-zones-defeated-in-house-1.5623693">defeated a bill</a> that would have provided buffer zone protection for abortion clinics. </p>
<p>The same organizations that benefit from increased federal funding — and use it to support women and other pregnant people — indicate that Canadian women who used to travel to the U.S. for certain kinds of abortions are finding it more difficult to do so due to increased restrictions and bans on the American side of the border.</p>
<p>The recent <a href="https://www.washingtonpost.com/politics/2023/04/07/abortion-pill-ruling-texas-washington/">duelling U.S. court decisions</a> concerning restrictions on mifepristone will only increase this difficulty and limit reproductive rights. </p>
<p>Policies like B.C.’s universal coverage of contraception will help to expand reproductive rights. That’s why it’s such an important decision.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/519992/original/file-20230409-16-dgu48i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A sea of people carrying pro-choice signs." src="https://images.theconversation.com/files/519992/original/file-20230409-16-dgu48i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/519992/original/file-20230409-16-dgu48i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/519992/original/file-20230409-16-dgu48i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/519992/original/file-20230409-16-dgu48i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/519992/original/file-20230409-16-dgu48i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/519992/original/file-20230409-16-dgu48i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/519992/original/file-20230409-16-dgu48i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">People march through downtown Atlanta in June 2022 to protest the U.S. Supreme Court’s decision to overturn Roe v. Wade.</span>
<span class="attribution"><span class="source">(AP Photo/Ben Gray, File)</span></span>
</figcaption>
</figure>
<h2>Defending reproductive rights</h2>
<p>On a practical level, funding for contraception has the effect of making birth control available for everyone, with no privilege for those who have private insurance or can afford to pay and no disadvantage for those who have trouble affording it.</p>
<p>But beyond this, public support and payment for contraception serves to normalize birth control, Plan B and sexual health and reproductive rights as a public good and as a matter of public responsibility. </p>
<p>In an age of increased privatization in health care in general, and the increased stigmatization and criminalization surrounding abortion, the B.C. move is a positive step that fully embraces sexual and reproductive health and rights for everyone in post-<em>Roe</em> North America.</p><img src="https://counter.theconversation.com/content/203131/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Candace Johnson receives funding from The Social Sciences and Humanities Research Council of Canada (SSHRC).</span></em></p>British Columbia’s move to provide free contraceptives is a positive step that fully embraces sexual and reproductive health and rights for everyone in post-Roe North America.Candace Johnson, Professor of Political Science, University of GuelphLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/591522016-06-29T02:55:13Z2016-06-29T02:55:13ZWeekly Dose: new morning after pill makes it difficult to choose which to take<figure><img src="https://images.theconversation.com/files/125310/original/image-20160606-25992-1k3fk45.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Some data has found one pill is slightly more effective, but you need to visit your doctor to get it and it needs to be taken in a hurry.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/downloading_tips.mhtml?code=&id=232823290&size=huge&image_format=jpg&method=download&super_url=http%3A%2F%2Fdownload.shutterstock.com%2Fgatekeeper%2FW3siZSI6MTQ2NTIyMDYyNSwiYyI6Il9waG90b19zZXNzaW9uX2lkIiwiZGMiOiJpZGxfMjMyODIzMjkwIiwiayI6InBob3RvLzIzMjgyMzI5MC9odWdlLmpwZyIsIm0iOiIxIiwiZCI6InNodXR0ZXJzdG9jay1tZWRpYSJ9LCJTZlNCQkF0cmZRQTJXOGgrdWNLOUcxMjZEdWMiXQ%2Fshutterstock_232823290.jpg&racksite_id=ny&chosen_subscription=163&license=standard&src=2J0-P0cm7hNcpDDb77nkJA-1-8">from www.shutterstock.com.au</a></span></figcaption></figure><p>Almost 200,000 unplanned pregnancies occur in Australia each year, though not all go full term. Safe and effective emergency contraception is necessary to help prevent unintended pregnancies in people who do not wish to fall pregnant.</p>
<p>Until 2015, the levonorgestrel “morning after pill” (for example the common brand name Postinor®) was the only oral emergency contraception available in Australia. It comes as one 1.5mg tablet or two 0.75mg tablets and is available from a pharmacist without a prescription from A$14.99.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/128577/original/image-20160628-7836-zar7yp.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/128577/original/image-20160628-7836-zar7yp.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=700&fit=crop&dpr=1 600w, https://images.theconversation.com/files/128577/original/image-20160628-7836-zar7yp.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=700&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/128577/original/image-20160628-7836-zar7yp.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=700&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/128577/original/image-20160628-7836-zar7yp.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=880&fit=crop&dpr=1 754w, https://images.theconversation.com/files/128577/original/image-20160628-7836-zar7yp.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=880&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/128577/original/image-20160628-7836-zar7yp.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=880&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>Now a new option, EllaOne® (ulipristal), is available in Australia with a doctor’s prescription. But how are they different, and which one should you choose?</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/128579/original/image-20160628-7842-z95iz5.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/128579/original/image-20160628-7842-z95iz5.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=700&fit=crop&dpr=1 600w, https://images.theconversation.com/files/128579/original/image-20160628-7842-z95iz5.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=700&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/128579/original/image-20160628-7842-z95iz5.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=700&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/128579/original/image-20160628-7842-z95iz5.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=880&fit=crop&dpr=1 754w, https://images.theconversation.com/files/128579/original/image-20160628-7842-z95iz5.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=880&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/128579/original/image-20160628-7842-z95iz5.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=880&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>How does it work?</h2>
<p>Levonorgestrel is a synthetic progestogen, which is a drug used to mimic the effects of the body’s own hormone, progesterone (a sex hormone involved in the menstrual cycle and pregnancy). It is thought to work by inhibiting or delaying ovulation, and impeding transport of sperm and/or egg to prevent fertilisation. It <a href="https://amhonline.amh.net.au/auth">may also change</a> the <a href="http://www.ncbi.nlm.nih.gov/pubmed/25740886">uterus environment</a> to make it more difficult for a fertilised egg to attach to it.</p>
<p>Last year the Therapeutic Goods Administration approved ulipristal (EllaOne), which has been used as emergency contraception in the European Union (EU) since 2009. Ulipristal was approved to treat uterine fibroids (common benign growths) in Canada in 2013 and the EU in 2015. However this was a 5mg dose, much lower than the 30mg emergency contraception dose.</p>
<p>EllaOne is an oral tablet (30 mg) that is taken as a single dose and is currently only available on prescription in Australia. EllaOne does not yet have a recommended retail price (RRP) in Australia, however, its RRP in the United Kingdom is £34.95, or almost A$70. </p>
<p>Ulipristal was developed from a molecule similar to progesterone and binds more strongly and more specifically to the progesterone receptor compared to levonorgestrel. Ulipristal blocks the effect of the body’s progesterone, inhibiting or delaying ovulation. It may also make it more difficult for a fertilised egg to attach to the uterus.</p>
<p>For emergency contraception, both levonorgestrel and ulipristal should be taken as soon as possible. However, while levonorgestrel should be taken within 72 hours, ulipristal should be taken up to 120 hours (five days) after unprotected sex or contraceptive failure. Contraceptive failure can be missing a regular active contraceptive pill, or having used a broken condom.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/125313/original/image-20160606-25999-mhv97h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/125313/original/image-20160606-25999-mhv97h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/125313/original/image-20160606-25999-mhv97h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/125313/original/image-20160606-25999-mhv97h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/125313/original/image-20160606-25999-mhv97h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/125313/original/image-20160606-25999-mhv97h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/125313/original/image-20160606-25999-mhv97h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/125313/original/image-20160606-25999-mhv97h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Whichever you choose, both should be taken as soon as possible.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/downloading_tips.mhtml?code=&id=171524915&size=huge&image_format=jpg&method=download&super_url=http%3A%2F%2Fdownload.shutterstock.com%2Fgatekeeper%2FW3siZSI6MTQ2NTIyMTQyOCwiYyI6Il9waG90b19zZXNzaW9uX2lkIiwiZGMiOiJpZGxfMTcxNTI0OTE1IiwiayI6InBob3RvLzE3MTUyNDkxNS9odWdlLmpwZyIsIm0iOiIxIiwiZCI6InNodXR0ZXJzdG9jay1tZWRpYSJ9LCJCOUdSUXQvK1dRcWl0M2hhMnJpQk1tb3RES3ciXQ%2Fshutterstock_171524915.jpg&racksite_id=ny&chosen_subscription=163&license=standard&src=2J0-P0cm7hNcpDDb77nkJA-1-33">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<h2>Side effects</h2>
<p><a href="https://www.tga.gov.au/auspar/auspar-ulipristal-acetate">Clinical trials</a> found levonorgestrel and ulipristal had comparable side effects. These were mild to moderate in nature, short-lived and resolved on their own. The most common side effects reported were stomach aches, nausea, and headaches. </p>
<p>Both levonorgestrel and ulipristal are metabolised and broken down by a specific liver enzyme called cytochrome P450 3A4. The effectiveness of these medications may be reduced when taken with other medicines that increase the activity of this liver enzyme (such as St Johns Wort and some epilepsy medicines).</p>
<p>Women who require emergency contraception because they missed a regular active contraceptive pill should resume taking their normal pill within 12 hours after taking levonorgestrel. However, ulipristal may reduce the effect of any contraceptive pill that contains a progestogen (synthetic progesterone).</p>
<p>Consequently, EllaOne’s manufacturer recommends waiting at least five days before the regular contraceptive pill is restarted. During this time, barrier methods of contraception (such as condoms) are recommended until cover from the regular contraceptive pill is achieved, so this can be up to one week after recommencing, or almost two weeks after taking EllaOne.</p>
<h2>So which is more effective?</h2>
<p>Levonorgestrel is most effective when taken within 24 hours after unprotected sex as it prevents 95% of expected pregnancies. After 24-48 hours, the effectiveness decreases to 85%, then 58% after 48-72 hours. Ideally it is taken within three days as the benefits after 96-120 hours are uncertain. </p>
<p>When used within 72 hours, ulipristal is linked to lower pregnancy rates compared to levonorgestrel. This effect is maintained up to 120 hours after intercourse. However, <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4216625/">neither is effective</a> after ovulation*, which usually occurs in the middle of each menstrual cycle. </p>
<p>The <a href="https://www.tga.gov.au/auspar/auspar-ulipristal-acetate">data from clinical trials</a> shows that within 72 hours of unprotected sex, there is a slightly lower risk of becoming pregnant with ulipristal than levonorgestrel. Ulipristal has some evidence to support use up to 120 hours after unprotected sex. So it is <a href="http://www.ncbi.nlm.nih.gov/pubmed/25740886">slightly more effective</a> than levonorgestrel up to 72 hours; and can work up to 120 hours. It is important to remember – the longer you wait after unprotected sex, the less effective either option is. </p>
<p>Women need to weigh up all these factors to make a decision for their circumstances. These can include the slightly higher efficacy of ulipristal, accessibility (without prescription from a pharmacy or needing to see their GP), the time elapsed since unprotected sex and cost.</p>
<p>It is also worth remembering there is no easy test from the GP surgery or pharmacy to determine if ovulation has already occurred. This means the morning after pill may not be effective.</p>
<p>The decision is not easy to make and the available information does not provide a clear solution. Each woman will have multiple factors that provide a unique mix, so it is not possible to provide blanket advice on a preferred option. Women requiring emergency contraception should discuss the matter with their GP or pharmacist. </p>
<hr>
<p><em>*Correction: originally this article stated only ulipristal is ineffective after ovulation. The article has been updated to more accurately reflect the available data.</em></p><img src="https://counter.theconversation.com/content/59152/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Esther Lau is affiliated with the Pharmaceutical Society of Australia.</span></em></p><p class="fine-print"><em><span>Lisa Nissen is affiliated with Pharmaceutical Society of Australia (QLD branch committee)
Member of the QUM advisory board for Abbvie - Hepatitis C </span></em></p><p class="fine-print"><em><span>Greg Kyle, Jose Manuel Serrano Santos, and Yasmin Antwertinger do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Until 2015 the “morning after pill” Postinor was the only oral emergency contraception available in Australia. A new option, EllaOne, is available. How are they different, and which should you choose?Esther Lau, Course coordinator and Lecturer - Pharmacy, Queensland University of TechnologyGreg Kyle, Professor of Pharmacy, Queensland University of TechnologyJose Manuel Serrano Santos, Pharmacy course Coordinator and Lecturer in Pharmacy Practice, Queensland University of TechnologyLisa Nissen, Professor; Head, School of Clinical Sciences, Queensland University of TechnologyYasmin Antwertinger, Associate Lecturer in Pharmaceutical Chemistry, Queensland University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/209962013-12-02T14:55:33Z2013-12-02T14:55:33ZOverweight women shouldn’t panic about contraception<figure><img src="https://images.theconversation.com/files/36678/original/tdcvqwpx-1385981917.jpg?ixlib=rb-1.1.0&rect=0%2C1%2C1024%2C682&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Weighing up the options.</span> <span class="attribution"><span class="source">Puuikibeach</span></span></figcaption></figure><p>The warning made by HRA Pharma, the French manufacturer behind Norvelo emergency contraceptive pills, that the product <a href="http://www.theguardian.com/society/2013/nov/26/morning-after-contraceptive-doesnt-work-overweight-women">is ineffective</a> in women who weigh more than 80kg (12st 7lb) and has reduced effectiveness in women over 75kg is a major one, especially given the relatively small amount of data on which it appears to be based.</p>
<p>The decision was based on <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60101-8/abstract">a 2011 meta-analysis</a> that combined data from two studies comparing levonorgestrel, the active ingredient in the Norvelo contraceptive, to another emergency contraceptive called ulipristal acetate (UPA). A total of 1731 women took levonorgestrel pills, 38 of whom became pregnant, while 1714 women took UPA, 22 of whom became pregnant. Obese women accounted for 13.6% of the total study population, and overweight women accounted for 21.6%. </p>
<p>The move has also raised alarm in the US over Plan B emergency pills, which have an identical formula to Norvelo. The FDA in the US said <a href="http://www.businessweek.com/articles/2013-11-27/plan-bs-problem-with-heavier-women-isnt-news-in-europe">it was reviewing</a> the research.</p>
<p>While the study that sparked these concerns raises important concerns about the efficacy of levonorgestrel emergency contraception in overweight and obese women, the relatively small number of these women in the study and low number of pregnancies means we should be cautious in applying the results too broadly. Two important questions remain to be answered: how might obesity affect levonorgestrel emergency contraception, and what are the risks of changing the labelling on these pills based on the current evidence?</p>
<p>You are generally considered to be overweight if you <a href="http://www.nhs.uk/Tools/Pages/Healthyweightcalculator.aspx?Tag=">have a BMI</a> (your weight in kilogrammes divided by your height in metres) of around 25 to 29 and obese between 30 to 40. It is estimated that around 15-20% of pregnant women in the UK are overweight or obese, rising to <a href="http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Obstetric_Practice/Obesity_in_Pregnancy#1">more than a half</a> in the US.</p>
<p>And there are numerous ways that obesity can affect how a drug interacts with the body. Obese individuals may absorb a drug faster through the gut, have a different metabolism and serum concentrations of a drug, and can eliminate a drug either faster or slower from the body. This all depends on the various characteristics of a drug. </p>
<p><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2736633/">One study</a> that investigated the pharmacokinetics of an oral contraceptive pill containing levonorgestrel found that the maximum serum concentration in the body and time taken to achieve it were not different in normal weight and obese women. It was noted that obese women had a larger area under the concentration-time curve and that levonorgestrel had a longer half-life – this means that it took a greater overall exposure and a longer time to reach a steady state of concentration. The findings were in women who had taken a daily pill for 21 days, and it is unclear how these findings relate to a one-time dose of levonorgestrel as in an emergency contraception pill. </p>
<p>Without a clearer understanding of the pharmacokinetics of levonorgestrel as an emergency contraception in normal weight and obese women, it remains difficult to interpret the available data. For instance, it is unclear whether giving a larger dose of levonorgestrel to obese women would counteract the apparent decreased efficacy of a current recommended dose.</p>
<p>Ultimately, the decision of whether to allow overweight and obese women to continue using levonorgestrel as an emergency contraception must balance benefit and risk. While the meta-analysis that underpinned the decision does indicate reduced efficacy in women with a BMI greater than 25 kg/m2, what are the risks to obese women taking this regimen? </p>
<p>There are no medical dangers associated with levonorgestrel as an emergency pill and the risks of obesity <a href="http://www.theguardian.com/lifeandstyle/2013/sep/18/weight-jeopardises-health-pregnant-women-babies">during pregnancy</a> are well known – these <a href="http://www.nhs.uk/conditions/pregnancy-and-baby/pages/overweight-pregnant.aspx#close">can include</a> developing gestational diabetes or more complications during childbirth. </p>
<p>Until there are additional data to support the conclusion that these pills are ineffective in overweight and obese women, it seems most prudent to encourage the use of more effective emergency contraceptives, such as the copper IUD or UPA, but this doesn’t mean taking away levonorgestrel as an option.</p><img src="https://counter.theconversation.com/content/20996/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jenny Robinson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The warning made by HRA Pharma, the French manufacturer behind Norvelo emergency contraceptive pills, that the product is ineffective in women who weigh more than 80kg (12st 7lb) and has reduced effectiveness…Jenny Robinson, Fellow in Clinical Pharmacology, Johns Hopkins UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/102502013-03-20T00:15:24Z2013-03-20T00:15:24ZNote to pharmacists on how not to sell the morning-after pill<figure><img src="https://images.theconversation.com/files/21390/original/npd7shyk-1363649535.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pharmacists could have an empathetic conversation with women rather than having them fill in an intrusive questionnaire.</span> <span class="attribution"><span class="source">Tim Parkinson</span></span></figcaption></figure><p>The emergency contraceptive pill (morning-after pill) contains a hormone called levonorgestrel and can be bought without a prescription. It’s used to prevent pregnancy after unprotected sex, but many women are uncomfortable with their interaction with pharmacists when buying this drug.</p>
<p>The morning-after pill is licensed by the <a href="http://www.tga.gov.au/">Therapeutic Goods Administration</a> (TGA) to be used within three days of unprotected sex, but there’s <a href="http://www.ncbi.nlm.nih.gov/pubmed/21664508">evidence</a> that it’s effective for up to four days. Still, the sooner it is taken, the more effective it is.</p>
<p>It’s available as a tablet and is classified as “Pharmacist Only” medicine. The law requires pharmacists to supply such medicines only for a therapeutic need, and to personally deliver or supervise their delivery, and personally give directions for their use. To establish a therapeutic need, a pharmacist must ask the customer questions about her medical problem, medical history and the medications she’s taking. </p>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/21237342">Our recent study</a> of emergency contraceptive pill recommendations by pharmacists across Australia found that most of them used the Pharmaceutical Society of Australia’s (<a href="http://www.psa.org.au/">PSA</a>) written protocol to guide their supply. Pharmacists tended to follow the protocol rigidly, rather than using their discretion. </p>
<p>As recommended, many provided information to women about the emergency contraception in a part of the pharmacy where confidentiality could be assured. But 62% of the women we spoke to expressed concern about the lack of privacy. What’s more, many women were confused about this type of pill – some thought it caused an abortion (32%) and others that it would cause defects if they were to fall pregnant later (61%).</p>
<p>Only 20% of pharmacists always informed women about how the emergency contraceptive pill worked, while the majority spoke about how long it would remain effective after unprotected sex. Many pharmacists agreed that the pill shouldn’t be supplied if unprotected sex had occurred longer than three days ago. </p>
<p>If a woman had unprotected sex outside of this timeframe, a pharmacist can still supply the emergency contraceptive pill. This supply is called “off label” as it is outside of the TGA-licensed use. In such cases, pharmacists should inform women about the effectiveness of this emergency contraception beyond three days and document that they supplied it. (Or they could recommend the woman have an intrauterine device (IUD) placed instead. This IUD is the most effective form of emergency contraception and can be inserted up to five days after unprotected sex.) </p>
<p>But in situations where the emergency contraceptive pill is supplied within licensed use, documentation is not mandatory. The PSA checklist that women may be asked to complete in the pharmacy when they request the emergency contraceptive pill is also not required. It contains some irrelevant and ambiguous questions. </p>
<p>Completed checklists were initiated to protect both parties in the event that the woman becomes pregnant. They include a statement for the woman to read and sign and are stored in the dispensary and, later, shredded. </p>
<p>The emergency contraception pill is <a href="http://www.who.int/mediacentre/factsheets/fs244/en/">not dangerous</a> under any known circumstances or in women with any particular conditions, so using checklists is an outdated practice. It would better if the pharmacist had an empathetic conversation with the woman about her situation, to minimise any shame or embarrassment she may be feeling.</p>
<p>Many pharmacists in our study thought that supplying the emergency contraceptive pill for future use (“advance supply”) was unacceptable. There’s no evidence that advance supply has a negative impact on sexual health; in fact, advance supply would be good practice. Women need to be able to access this pill as soon as possible after they having unprotected sex. </p>
<p>In 2000, the head of the <a href="http://www.acog.org/">American College of Obstetricians and Gynecologists</a> recommended that “every woman store [a packet of the ECP] in her medicine cabinet”. </p>
<p>We also found 22% of pharmacists felt it was reasonable for their religious faith to influence supply. Pharmacists can refuse supply on such grounds, but must refer the woman to another supplier. Pharmacists who decline supply on religious grounds do so in the belief this contraception is an abortion pill, but the latest <a href="http://www.cecinfo.org/custom-content/uploads/2012/12/ICEC_FIGO_MoA_Statement_March_2012.pdf">evidence</a> shows that this is untrue. </p>
<p>The emergency contraceptive pill doesn’t prevent implantation of a fertilised egg and, if taken after implantation, has no effect on an existing pregnancy. It’s not the same as a medicine called mifepristone or RU-486, which was recently approved for medical abortion in Australia.</p>
<p>Australian common law states that a person has to be 16 years or older to consent to medical treatment. The revised PSA protocol now includes provision for those under the age of 16 to be able to access the emergency contraceptive pill. The new guideline has been extensively revised to help pharmacists assure that the women they serve can access and use this pill effectively, safely and unobtrusively. </p>
<p>The emergency contraceptive pill is a medicine that all women should be aware of. It’s available from pharmacies and the sooner it’s taken, the more effective it is. Pharmacists should help women access this pill because it can prevent unwanted and ill-timed pregnancies. Such pregnancies may carry a high risk of death or unhealthy state of mind for the rest of a woman’s life, especially where safe abortion isn’t accessible. </p>
<p>This is the third article in our short series about pharmacies. Click on the link below to read the previous instalments:</p>
<p><strong>Part One:</strong> <a href="https://theconversation.com/pharmacy-gravy-train-drives-up-the-cost-of-prescription-drugs-10016">Pharmacy gravy train drives up the cost of prescription drugs</a></p>
<p><strong>Part Two:</strong> <a href="https://theconversation.com/online-pharmaceuticals-bricks-not-clicks-keep-us-safe-12654">Online pharmaceuticals: bricks, not clicks, keep us safe</a></p>
<p><strong>Part Four:</strong> <a href="https://theconversation.com/pharmacists-should-drop-products-that-arent-backed-by-evidence-12646">Pharmacists should drop products that aren’t backed by evidence</a></p>
<p><strong>Part Five:</strong> <a href="https://theconversation.com/why-you-have-to-show-id-to-buy-cold-and-flu-tablets-2173">Why you have to show ID to buy cold and flu tablets</a></p><img src="https://counter.theconversation.com/content/10250/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>We received funding to do our study with pharmacists and women from the Australian Research Council in partnership with Sexual Health and Family Planning Australia.</span></em></p><p class="fine-print"><em><span>Angela Taft has received funding from the ARC to conduct a study on emergency contraceptive pills and a small amount as part of an ARC Linkage grant for this study from Schering. She has for many years been the National Coordinator or Co-Coordinator of the Public Health Associations Women’s Health Special Interest Group, which lobbied for ECP to be made available over the counter in its efforts to reduce or prevent unwanted pregnancies and bring down abortion rate.</span></em></p>The emergency contraceptive pill (morning-after pill) contains a hormone called levonorgestrel and can be bought without a prescription. It’s used to prevent pregnancy after unprotected sex, but many women…Safeera Hussainy, Lecturer in Pharmacy Practice, Monash UniversityAngela Taft, Associate Professor in Public Health, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.