health

How often can you take the emergency contraceptive pill?

While the use of emergency contraception has reportedly grown among young women over the past decade, the topic is still surrounded by questions and concerns about how it works and how it should be used.

One is a query we’ve probably all pondered at one point: is there a limit on how many times you can take the emergency contraceptive pill?

According to Kathy McNamee, Medical Director at Family Planning Victoria, the answer is no — but there’s an important caveat.

“We’d say you can take the levonorgestrel pill as often as you like, but it doesn’t work as well as something like a condom that you use beforehand. If you’re relying on it, it’s going to let you down at some stage,” she states.

In other words, it’s called “emergency” contraception for a reason.

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There's no limit on the number of times you can take the levonorgestrel pill. Image: iStock

The levonorgestrel pill is what's commonly (and erroneously) referred to as the "morning after" pill, and is sold under various trade names here in Australia. It contains the manufactured hormone levonorgestrel, which has a similar effect to the natural hormone progesterone.

As of last month, Australian women have access to a second emergency contraceptive pill called EllaOne, which has been available overseas for a number of years now. However, for the purposes of this article we're focusing on the former.

Dr McNamee says it's recommended to leave a gap of at least 12 hours from the time you took one levonorgestrel pill before taking another, but it's safe to take it more than once in one cycle.

"We usually don't know which act of unprotected sex you're at risk of an unintended pregnancy from, so we wouldn't limit it to once a cycle," she explains.

"The hormone in it has been around for a long time, so we feel quite confident that if someone did actually end up conceiving, it wouldn't be a risk to the foetus at all if they did conceive and wanted to continue with the pregnancy." (Post continues after gallery.)

Popular forms of birth control
Intrauterine deviceIUDs are small, T-shaped devices that are inserted into the uterus by a doctor in order to prevent pregnancy. There are two types of IUD: copper, which affects the movement and survival of sperm in the womb while changing the lining of the womb;and hormonal, which releases progestogen (a synthetic version of the naturally-occurring hormone progesterone) into the uterus. Although IUDs have a success rate of more than 99%, only around 2% of Australian women currently use one.
Contraceptive pillThe Pillis the most popular form of birth control. There are two types: the combined pill, containing two hormones, and theprogestogen-only, or mini, pill, which only contains one female hormone. The combined pill works by preventing the ovary from releasing an egg each month. The mini pill changes the mucus at the entrance of the uterus, which stops sperm from entering. Both are 99.7% effective; however, they don't offer protection from STDs.
CondomsThe male condom is a barrier contraception that prevents both pregnancy and the transmission of STDs. They work by collecting semen so it doesn't enter theman's partner's body. Condoms are 95 to 99% effective at preventing pregnancy.
The female condomThe female condom is a pre-lubricated sheath, which loosely fits inside of the vagina. The condom has a removable ring, which helps to insert the sheath and keep the condom in place. A larger ring remains on the outside to cover the opening of the vagina. They are designed to fit all women and can only to be used once. Due to misuse of the product it is only 79 per cent effective.
DiaphragmLike the male condom, the diaphragm is a barrier method of contraception. It's a shallow silicone dome that's inserted into the vagina andcovers the cervix, which is the entrance to the uterus. It's held in place by the pelvic muscles, and works by preventing sperm from entering the uterus. After sex, diaphragms need to remain in placefor another six hours, in which time the sperm inside the vagina die. This method is 88 to 94% effective at preventing pregnancy, although this rate increases with experience.
Birth control implantThis is a 4cm-longimplant that is inserted into a woman's upper arm, just under the skin, by a doctor. It releases a hormone called etonogestrel, which prevents ovulation and thickens the mucus in the cervix, which can stop sperm from entering. Contraceptive implants - usually sold as Implanon - are removed under anaesthetic every three years, and are close to 100% effective.
Vaginal ringVaginal rings are soft plastic rings that contain the same two hormones as the combined pill - oestrogen and progestogen. The ring is inserted into the vagina, where the hormones are absorbed into the body and then prevent the ovaries from releasing eggs. Once inside the ring can't be felt, and it needs replacing every three weeks (with one week's break in between). When used correctly, this method is more than 99% effective.
Depo ProveraDepo is a long lasting hormonal injection. The synthetic form of progesterone is administered every 12 to 14 weeks to woman, preventing pregnancy within this ongoing time period. The injection, which is given in the buttock or muscle of the upper arm, prevents ovulation and thickens the mucus in the cervix, helping to block sperm. The injections are 99 per cent effective but do not protect against STDs. Male contraceptive injections are currently being trialled
The morning after pillEmergency contraception (popularly referred to as the morning after pill) is used to prevent a pregnancy following unprotected sex. Other reasons include missing a contraceptive pill or a condom breaking. It is common in Australia to use the progestogen-only method. This entails a dosage of EC pills containing progestogen or the synthetic version. A doctor can prescribe the pill or they can be bought over the counter at a pharmacy without a prescription. Emergency contraceptionis 85 per cent effective in reducing the risk of pregnancy.
SterilisationSterilisation is a permanent form of contraception. For women there are two types of sterilisation: tubal ligation, in which clips are placed on the fallopian tubes, or tubal occlusion in which a device is inserted into the tubes. These methods work by preventing the sperm from reaching the egg. Tubal litigation is 99.5 per cent effective. The Vasectomy (for men) works by cutting and blocking the tubes called the vas deferens, preventing sperm from leaving the testicles. The chances of impregnation with a vasectomy are 1 in 1000.

As the World Health Organisation states, the levonorgestrel pill prevents pregnancy by delaying or preventing ovulation. It may also prevent an egg being fertilised by affecting the ability of sperm to bind to an egg.

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Like most forms of birth control, there are side-effects associated with the levonorgestrel pill — these include nausea, headaches and breast tenderness, Dr McNamee explains. Although these shouldn't increase with repeated use, it might heighten the disturbance to your menstrual cycle because of the repeated prevention or delaying of ovulation.

"Each time you delay ovulation you might be putting off when your period's going to come. Sometimes if people have a lot of it, it's really hard to work out where they are in their cycle," Dr McNamee says.

Ultimately, however, there are no known health risks associated with repeated use of the levonorgestrel pill. Dr McNamee adds that although there might be "a couple" of precautions, there aren't any cases where it would be unsafe for a woman to use it.

"The only contraindication would be a known pregnancy because it won't do any good, she'd be just wasting her time. But there's no strong reason why you wouldn't take it at all. It's even OK with breastfeeding," she says.

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The Plan B pill featured on Master of None. (Image: Netflix)

The important thing to remember is that the emergency contraceptive pill is not designed to be used as your primary form of contraception, so do not rely on it to serve this purpose. It's risky business.

"It will let you down eventually if you use it as your method of contraception," Dr McNamee reiterates.

In situations where emergency contraception is required, a copper intrauterine device (IUD) is actually more effective than either of the currently available pills. It needs to be inserted within five days of unprotected sex.

Finding the birth control method that works best for you is often a case of trial and error, and you won't necessarily pin it down straight away. So book in with your doctor to explore the available options, which include the Pill, IUDs, and contraceptive implants and injections.

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Featured image: iStock

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