The Side Effects of Emergency Contraception / FAQS / Orlando Women’s Center.
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What are the side effects of emergency contraceptive pills?
Do emergency contraceptive pills increase the incidence of ectopic pregnancy?
Do women using the Intrauterine Device for emergency contraception have a higher chance of developing Pelvic Inflammatory Disease?
What factors influence the risk of Pelvic Inflammatory Disease (PID) among IUD users for emergency contraception?
What is the mechanism of how IUD insertion for emergency contraception increases the incidence of Pelvic Inflammatory Disease?
Does Intrauterine Device (IUD) placement for emergency contraception prevent sexually transmitted disease (STD) or HIV?
Does the Intrauterine Device (IUD) placement for emergency contraception save lives?
When does bleeding occur after taking emergency contraceptive pills?
If there are no side effects that occur after taking emergency contraceptive pills, does it mean that they were not effective or failed to work?
What are Plan B side effects?
After taking emergency contraceptive pills, when should the next menstrual cycle (menses period) occur?
What are morning after pill side effects regarding emergency contraception?
What are the side effects of emergency contraceptive pills?
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More Frequently Asked Questions
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Emergency contraceptive pills (morning after pills, day after pills, post coital contraception, day after contraception, Plan B) are not associated with any long term permanent or serious side effects. Progestin-Only Pills (levonorgestrel, Plan B, Next choice) have fewer side effects and are more effective in reducing the incidence of unwanted pregnancy compared with combined oral contraceptive pills (estrogen and progesterone).
Nausea occurs in 50% and vomiting occurs in 23% of women taking combined oral contraceptive pills compared to levonorgestrel (Plan B, Next Choice) with an incidence of 14% to 23% for nausea, and 1% to 6% vomiting. If a woman vomits within 2 hours of taking Emergency Contraceptive pills, they should take another dose as soon as possible.
To prevent nausea and vomiting, an anti-nausea medication called meclizine or Dramamine can be taken (two 25 mg tablets taken 1 hour prior to taking the Emergency Contraceptive Pills reduces the risk of nausea by 27% and vomiting by 64%. About 1/3 of people become tired and sleepy after taking this medication.
An Intrauterine Device (IUD) should be strongly considered for women who experience persistent vomiting with oral Emergency Contraceptives. They should be advised there is a small risk in developing a pelvic infection the first 20 days after insertion. The infection rate after the first month is the same as the general population who do not have IUDs in place.
Other side effects include headache, fatigue, tiredness, dizziness, breast tenderness, lower abdominal and pelvic pain, and ankle swelling.
Disturbances in the menstrual cycle are quite common with both levonoretrel (progestin-only, Plan B, Next Choice) or combined oral contraceptive pills used for Emergency Contraception. 16% or women experienced bleeding unrelated to expected menses in the 7 days following treatment in a study conducted by the World Health Organization. 50% of women menstruated a few days earlier or later than their expected time of menses.
Ectopic pregnancies have occurred after using combined oral contraceptives, Plan B (levonorgestrel, morning after pills, day after pills, post coital contraceptives, day after contraceptive) and the placement of the IUD as forms of Emergency Contraception. There is no evidence that the use of Emergency Contraception causes or increases the incidence of ectopic pregnancies. Women should always be counseled on the risk of ectopic pregnancy and the signs and symptoms to watch for.
Do emergency contraceptive pills increase the incidence of ectopic pregnancy?
Ectopic pregnancies have been noted following administration of Emergency Contraceptive pills (morning after pill, day after pill, post coital contraception, day after contraception, Plan B) in several studies. The overall risk of ectopic pregnancies are not increased but rather slightly decreased following Emergency Contraceptive pill usage.
Symptoms of ectopic pregnancy include vaginal bleeding, pelvic and lower abdominal pain which is similar to what is seen with taking Emergency Contraceptive pills which is why patients should remain in close contact with their Physician or Medical person that distribute Emergency Contraception.
Do women using the Intrauterine Device for emergency contraception have a higher chance of developing Pelvic Inflammatory Disease?
Side effects of the IUD when used for Emergency Contraception are similar to what occurs when used for long term birth control.
Studies in the 1970s and early 1980s overestimated the risk of Pelvic Inflammatory Disease (PID) from IUD use. Many studies did not take into account the overestimate:
- The studies included barrier methods and oral contraceptives which both decrease the incidence of PID.
- Factors that affect the risk of PID were not accounted for-number of sexual partners, history of PID or age
- Risk for specific types of IUDs particularly the Dalkon Shield IUD were not separately analyzed. The higher risk with the Dalkon Shield (due to its multifilament string vs. monofilament string on today’s IUDs) inflated overall risk estimates for all IUDs.
Studies since the mid-80’s show a much lower risk of PID in patients who use IUDs. A review of 12 randomized trials covering close to 23,000 IUD insertions identified a low overall rate of PID of 1.6 per 1000 woman-years. A six fold increase was identified in the 20 days following IUD insertion though the overall risk was low. Following the first 20 days after insertion, the incidence of PID in patients who have IUDs inserted is the same as the population of people who do not have an IUD inserted which ranges from 1 to 2 percent a year. A WHO study of multiparous women using copper IUDs reported a cumulative rate of removal for PID of less than one per 100 women after six years of use. In a European study involving many young unmarried women at higher risk for PID, the 5 year removal rate was seven per 100 women.
What factors influence the risk of Pelvic Inflammatory Disease (PID) among IUD users for emergency contraception?
A number of factors influence the risk of Pelvic Inflammatory Disease for patients who use the Intrauterine Device for Emergency Contraception.
- Insertion. A woman is most likely to develop PID in the first 20 days after insertion where there is a 6.3 fold increase in incidence. After the first 20 days, the incidence of PID remained at a constant low level – 1.4 per 1000 woman years throughout 8 years of use. The Women’s Health Study found the greatest risk of developing PID was during the first month after insertion of the IUD with a relative risk factor of 3.8. By 12 months the relative risk factor was 1.1 which is nearly the same as for women using no contraceptive method. Careful infection prevention practices are essential during IUD insertion and removal since this is the highest incidence of PID occurring. The 4 steps to prevent infection are 1) washing hands and putting on gloves, 2) cleaning the cervix and vagina with chlorhexidine gluconate or betadine, 3) Using the no touch insertion technique, 4) after insertion washing hands again and properly sterilizing instruments.
- Infections have been treated before IUD insertion and the infection prevention methods as described above were associated with no increase in PID associated with insertion of IUDs. Women should be made aware of symptoms and signs of PID and the possibility of pelvic infections. They should be urged to seek medical attention promptly if symptoms appear.
- If a woman has a lower genital tract infection such as a mucopurulent (contains pus and mucus) vaginal discharge that comes from the cervix, gonorrhea or chlamydia infection, or PID, an IUD should not be inserted. The common clinic signs of genital infection and PID are the following:
- Lower Genital Tract Infections:
a) Ulcers, swelling, or sores in the groin
b) Discharge from the urethra or cervix containing mucus and pus
c) Dysuria (pain with urination), urgency (feeling having to urinate constantly), and frequency (having to urinate many times) - Pelvic Inflammatory Disease:
a) Temperature of 100.4 or higher
b) Lower abdominal or pelvic pain
c) Pelvic and Abdominal Pain on movement of the cervix on pelvic exam
d) Lateral pelvic tenderness during palpation of the Adnexa (fallopian tubes and ovaries on both sides)
- Lower Genital Tract Infections:
What is the mechanism of how IUD insertion for emergency contraception increases the incidence of Pelvic Inflammatory Disease?
Infection related to IUD insertion for Emergency Contraception probably occurs because the instruments or IUD carry organisms in the vagina and cervix into the uterus and fallopian tubes. Checking for symptoms of pelvic infection, mucopurulent cervical discharge, frequent urination, burning with urination are important to look for and ask about. Over 50% of patients who have Chlamydia or Gonorrhea have no symptoms. Patients less than 25 years old should be screened once a year for Chlamydia and Gonorrhea, as they have a high incident of causing PID and infertility in women who then in turn suffer from chronic pelvic pain, and dysparunia (painful intercourse).
Does Intrauterine Device (IUD) placement for emergency contraception prevent sexually transmitted disease (STD) or HIV?
In contrast to male and female condoms, IUD placement for Emergency Contraception provides no protection against STD or HIV disease. HIV is found in semen, blood, and breast milk. Male and female condoms, and possibly other barrier protectors such as the diaphragm can protect against HIV and STDs. Other birth control methods cannot.
To protect against STDs or HIV, all women who are not sure whether they or their partners are infected should use condoms during every act of sexual intercourse. Any couple whose sexual relationship has not been or will not continue to be in a long term mutually faithful one faces a risk of exposure to STDs and HIV.
It has been calculated if everyone in the world were to get an HIV test and begin treatment with retroviral therapy and prevent the spread of HIV by using condoms, the epidemic of HIV and AIDS would die out by the year of 2050. It is estimated up to 25% of people in the U.S. alone do not know that they are HIV positive.
Does the Intrauterine Device (IUD) placement for emergency contraception save lives?
In contrast to male and female condoms, IUD placement for Emergency Contraception provides no protection against STD or HIV disease. HIV is found in semen, blood, and breast milk. Male and female condoms, and possibly other barrier protectors such as the diaphragm can protect against HIV and STDs. Other birth control methods cannot.
To protect against STDs or HIV, all women who are not sure whether they or their partners are infected should use condoms during every act of sexual intercourse. Any couple whose sexual relationship has not been or will not continue to be in a long term mutually faithful one faces a risk of exposure to STDs and HIV.
It has been calculated if everyone in the world were to get an HIV test and begin treatment with retroviral therapy and prevent the spread of HIV by using condoms, the epidemic of HIV and AIDS would die out by the year of 2050. It is estimated up to 25% of people in the U.S. alone do not know that they are HIV positive. .
When does bleeding occur after taking emergency contraceptive pills?
Intermittent bleeding that is not related to the menses is not uncommon after taking Emergency Contraceptive pills (morning after pill, day after pill, post coital contraception, day after contraception or Plan B). 16% of patients have bleeding within 7 days following treatment that is unrelated to the expected day of menses. Around 50% of women menstruate a few days before or after the expected time of their menses. Over 80% of patients bleed within 2 weeks of taking Emergency Contraceptive pills. It is difficult at times to make the distinction between breakthrough bleeding or actual menses. Similar signs that occur with taking Emergency Contraceptive pills (vaginal bleeding, abdominal and pelvic pain, dizziness and lightheadedness) can occur with an ectopic or intrauterine pregnancy. It is important to contract your health care provider if the abdominal pain, pelvic pain, light headedness, or dizziness gets worse or vaginal bleeding becomes heavier.
After taking emergency contraceptive pills, the following menses should come within the next month on time. It can occur the week prior or after the time it normally is expected. A pregnancy test should be done if the menses does not occur after a week of the expected time of menses.
If there are no side effects that occur after taking emergency contraceptive pills, does it mean that they were not effective or failed to work?
There are many women who after taking Emergency Contraceptive Pills (morning after pills, day after pills, post coital contraception, day after contraception, Plan B) experience no side effects. The most common side effects include nausea, vomiting, headaches, lightheadedness, fatigue, dizziness, breast tenderness, lower abdominal pain, lower back ache, ankle swelling, and vaginal spotting and bleeding. These symptoms should not last more than one or two days. The next menstrual cycle can come on time, be delayed, or even may come earlier.
Emergency Contraception reduces the incidence of unwanted pregnancies when exposed to one episode of unprotected intercourse (birth control failed, raped, condom split, forgot to take birth control properly) before 120 hours. The sooner the Emergency Contraceptive Pills can be taken, the higher chance of reducing the incidence of an unwanted pregnancy. Even a delay of 12 hours after unprotected intercourse doubles the pregnancy rate (0-12 hours, .9%; 13-24 hours, 1.8%). For each 12 hour delay up to 120 hours, the failure rate increases. There are no studies that show whether or not Emergency Contraception is effective after 120 hours.
Plan B (levonorgestrel, morning after pills, day after pills, post coital contraception, day after contraception, Next Choice) side effects are generally minor with most of them going away in one to two days. There are no long term side effects with the use of Plan B as an Emergency Contraceptive method. Plan B is used to reduce the incidence of an unwanted pregnancy after being exposed to one episode of unprotected sex. Plan B is slowly replacing the use of combined oral contraceptive pills as the primary method of Emergency Contraception in the U.S. and other countries due to it being more effective in preventing unwanted pregnancies and there are fewer side effects.
Plan B reduces the incidence of unwanted pregnancies by 89% if taken in 72 hours or less. If used within the first 24 hours, the chance of pregnancy is reduced to 95% of what the expected pregnancy rate would be. Combined birth control pill (estrogen and progesterone) used for Emergency Contraception can reduce the incidence of pregnancy by 75% if taken within 72 hours of unprotected intercourse. Nausea, vomiting, and headaches are the three most frequent side effects noted after Plan B and other Emergency Contraception is used. Nausea and vomiting with Plan B occurs much less than with taking combined oral contraceptives. (Plan B nausea and vomiting-14%, 1%; combined oral contraception nausea and vomiting-50%, 23%). If a woman vomits within two hours of taking Emergency Contraceptive Pills, then she should repeat the dose. If vomiting is consistent, then an IUD should strongly be considered as the Emergency Contraceptive method of choice.
Other side effects with Plan B are breast tenderness, abdominal bloating, constipation, lightheadedness, dizziness, breast tenderness, abdominal and pelvic pain, intermittent vaginal bleeding, delayed or early onset of menses, heavy or lighter menses. There are some people that have no change in their menstrual cycle. Ectopic pregnancies are not increased with the use of Plan B though they do occur. Studies show that there is a slight decrease in the incidence of ectopic pregnancies when taking Plan B for Emergency Contraception.
After taking emergency contraceptive pills, when should the next menstrual cycle (menses period) occur?
What are morning after pill side effects regarding emergency contraception?
A normal menses should occur within the month of taking the Emergency Contraceptive Pills (morning after pills, day after pills, post coital contraception, day after contraception, Plan B). Taking combined oral contraceptive pills (birth control pills that contain estrogen and progesterone), or progestin-only pills (levonorgestrel, Plan B, Next Choice) for Emergency Contraception can change the menstrual cycle such that it may occur early, be on time, or delayed. The bleeding may be the same, lighter, or heavier.
Several studies were done to determine the effect of levonorgestrel (progestin only, Plan B, Next Choice) had on the bleeding pattern of menstrual cycles. Though all the results came out slightly different on when bleeding started or stopped, how long bleeding lasted, and the effect that the pills had on the following cycle and when, the consistent thing is that Emergency Contraception does and can in many cases cause intermenstrual bleeding, cause delay in or early onset of menses, and cause intermenstrual bleeding. In a lot of cases, there is no change in the bleeding patterns after taking Emergency Contraceptive Pills. It also seems that the timing of when the Emergency Contraceptive Pills are taken in the cycle depends on how the cycle is affected. The earlier in the cycle that levonorgestrel (Plan B, Next Choice) is taken, the sooner in the cycle menses will begin. The closer to ovulation that the pills are taken, the less effect that they have on when the menstrual period starts. The following menses can start on time, be early, or delayed.
What are morning after pill side effects regarding Emergency Contraception?
Morning after pills are not associated with any serious long term side effects. The side effects that occur generally only last 1 to 2 days and then go away. Morning after pills, Day after pills, Emergency Contraception, post coital contraception, day after contraception all are names that mean the same thing and are used interchangeably. There are no contraindications to using morning after pills. Morning after side effects include headaches, nausea, vomiting, lightheadedness, dizziness, fatigue, abdominal pain, low back pressure or discomfort, lower abdominal pain, pelvic pain, ankle swelling, pressure or discomfort in the upper thigh, irregular vaginal bleed, early or delay in menses, lighter or heavier vaginal bleeding.
Morning after pills have been found to be safe and effective in reducing the incidence of unwanted or unintended pregnancy if taken within 5 days or 120 hours of unprotected intercourse. The incidence of pregnancy is reduced to 1 to 2 out of 8 pregnancies that are predicted to occur in 100 women that are of reproductive age and not using any form of birth control.
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