Progestin-Only and Emergency Birth Control Pills
Progestin-Only and Emergency Birth Control Pills
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Written by: Lisa Cheng
Progestin-Only Birth Control Pills
Progestin-Only Birth Control Pills
Progestin-only pills only contain progestin at a lower dose than combination pills. Progestins primarily stop the egg’s release from the ovaries, similar to its action in combined oral contraceptives. These pills (often called minipills) are safe for breastfeeding women. In fact, breastfeeding women who use minipills are more effectively protected from unintended pregnancies than non-breastfeeding women. Estrogen has been found to adversely impact milk production in some women; as such, combined oral contraceptives are not typically prescribed if the mother is fully or nearly fully breastfeeding within six months of giving birth. (1) Moreover, there may be other health reasons why a woman cannot take estrogen and minipills are typically the alternative.
The minipill needs to be taken daily and at the same time to ensure its effectiveness. If their intake is delayed by more than 12 hours, another form of contraception must be used during intercourse until the regimen is corrected. (2) There are two 28-day courses that can be chosen for progestin-only pills: i) all pills contain progestin, with no non-hormonal pill; or ii) 24 hormonal pills and 4 non-hormonal pills.
There are some myths or misunderstandings about progestin-only contraceptives that need to be clarified.
· Breast milk is ‘dried-up’ postpartum if a woman is taking progestin-only pills. -- False.
This is incorrect. In fact, minipills do not have any impact on milk production, which is why they are safe prescription medications for breastfeeding mothers.
· Oral pills only days that intercourse occurs. -- False.
Oral pills need to be taken daily regardless of whether intercourse is expected to happen or not. The medication course is defined and cannot be altered without exposing the woman to decreased effectiveness.
In the first few months of starting oral contraceptives, it is not uncommon to observe spotting or irregular bleeding before noticing lighter, more regular bleeding. (3) Here, regular bleeding does not mean that the frequency of periods is monthly, and it depends on the individual and the concurrently used medication(s). Some common side effects are headaches, dizziness, nausea, breast tenderness, and changes in acne. (3) If the side effects become unbearable, contact your doctor to discuss the possibilities of changing to another brand or type of birth control pill.
Emergency Oral Contraceptives
Emergency Oral Contraceptives
Emergency birth control pills are also commonly referred to as “the morning-after pill”. They may contain a molecule called levonorgestrel (Plan B) or ulipristal (Ella). (4-5) While Plan B can be purchased over-the-counter at pharmacies (i.e., without a prescription), Ella is only accessible with a prescription. Women can opt to take this form of birth control if they are not already on birth control pills, and have experienced other birth control failures (e.g., broken condom) or unprotected sex within the past 72 (Plan B) or 120 (Ella) hours. It is strongly recommended that emergency contraceptives be taken as soon as possible. In fact, the sooner, the better. These pills will not prevent pregnancy for intercourse occurring more than 24 hours after it was taken. Existing pregnancies will not be terminated by these emergency oral contraceptives.
Levonorgestrel and ulipristal prevent or delay the release of an egg during the menstrual cycle. (3,6) Moreover, vaginal fluid to become thicker so that the sperm experiences difficulties reaching the egg (reduces sperm motility) and thereby cannot fertilize the egg. The drugs also change the lining of the uterus to prevent the fertilized egg from attaching. If ovulation has occurred (i.e., the egg has been released) and Plan B is taken, it is still possible to become pregnant. Women may not know when they are ovulating, so after taking Plan B, it is recommended to take a pregnancy test three weeks later.
The choice between Plan B, Ella, or its generics is affected by availability and the woman’s weight. While both medications have been proven efficacious as emergency oral contraceptives, Plan B’s effectiveness decreases for women with a body mass index greater than or equal to 26 kg/m2. (7) In these situations, women may be advised to take Ella or consider a copper intrauterine device as emergency contraceptives.
Emergency oral contraceptives contain comparably higher dosage of hormones than daily oral contraceptives. When women are finding themselves in situations where they are regularly taking emergency birth control pills, it is highly recommended that they should speak to their healthcare provider to consider alternative methods to contraception.
REFERENCES
REFERENCES
Lopez LM, Grey TW, Stuebe AM, Chen M, Truitt ST, Gallo MF. Combined hormonal versus nonhormonal versus progestin-only contraception in lactation. Cochrane Database Syst Rev. 2015 Mar 20;2015(3):CD003988.
CDC. Contraception. 2024 [cited 2022 Mar 27]. Progestin-Only Pills. Available from: https://www.cdc.gov/contraception/hcp/usspr/progestin-only-pills.html
WHO. Family Planning: A GLOBAL HANDBOOK FOR PROVIDERS; 2018. Available from: https://apps.who.int/iris/bitstream/handle/10665/260156/9780999203705-eng.pdf?sequence=1
Shen J, Che Y, Showell E, Chen K, Cheng L. Interventions for emergency contraception. Cochrane Database Syst Rev. 2019 Jan 20;1(1):CD001324. doi: 10.1002/14651858.CD001324.pub6. PMID: 30661244; PMCID: PMC7055045.
Whalen K, Rose R. Ulipristal (ella) for emergency contraception. American Family Physician. 2012 Aug 15;86(4):365-9.
Sondheimer SJ. Oral contraceptives: mechanism of action, dosing, safety, and efficacy. Cutis. 2008 Jan;81(1 Suppl):19-22. PMID: 18338654.
Stowers P, Mestad R. Use of levonorgestrel as emergency contraception in overweight women. Obesity Research & Clinical Practice. 2019 Mar 1;13(2):180-3.
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