Myth: Ipill vs Contraception

Myth: Ipill vs Contraception

Emergency Contraception (EC) refers to methods used after unprotected sex or contraceptive failure (e.g., condom break, missed pills) to prevent pregnancy. It is not intended for routine use and does not terminate an existing pregnancy.

When is it needed ?

1. Unprotected intercourse

2. Contraceptive failure (e.g., condom slippage, missed pills)

3. Sexual assault

4. Delayed or missed contraception initiation (e.g., starting pills late)

Types of emergency contraception

1. Emergency Contraceptive Pills (ECPs)

Levonorgestrel (LNG) Pill

Dose: 1.5 mg single dose of synthetic progesterone called levonorgestrel (e.g., Unwanted-72, i-Pill)

Time window: Most effective within 72 hours

Efficacy: ~85% if taken within 72 hours

Availability: OTC in India

Cost: ₹50–100

Ulipristal Acetate (UPA) (Not widely available in India)- is a selective progesterone receptor modulator

Time window: Up to 120 hours (5 days)

More effective than LNG, especially closer to ovulation

1. Copper Intrauterine Device (Cu-IUD)- when inserted intrauterine , it prevents fertilization and implantation

Insertion Time: Within 5 days of unprotected sex

Efficacy: >99% (most effective EC method)

Also serves as long-term contraception (up to 10 years)

Availability: Requires insertion by trained provider

Cost: Free in government facilities; ₹300–500 privately

Side effects of EC pills-

Side effects are mainly due to high dose of progesterone

1. Nausea, headache, fatigue, breast tenderness

2. Menstrual changes: early, delayed, or irregular bleeding

3. Generally mild and self-limited

Safety and limitations

Safe for all women, including adolescents

1. No effect on future fertility

2. Should not be used as a regular contraceptive method as they can cause repeated side-effects which bring down the quality of life and if used repeated can cause hormonal imbalance

3. Less effective in women >75 kg with LNG pills (UPA or IUD preferred)

Emergency contraception in India

1. Government-approved brands: Unwanted-72, i-Pill, Preventol

2. Available OTC without prescription

3. Copper-T available free under National Family Planning Programme

Contraceptive vs emergency contraceptive: Detailed comparison

Feature	Regular Contraception	Emergency Contraception (EC)
Purpose	To prevent pregnancy continuously with consistent use	To prevent pregnancy after unprotected sex or contraceptive failure
Timing	Used before or during sex, regularly (daily, weekly, monthly, or per act)	Used after sex, typically within 72–120 hours
Methods	Pills, condoms, IUDs, injectables, implants, sterilization	EC pills (Levonorgestrel, Ulipristal), Copper IUD
Mechanism	Inhibits ovulation, fertilization, implantation or sperm transport depending on method	Delays ovulation (pills) or prevents fertilization/implantation (IUD)
Efficacy	High with proper use (IUDs & implants >99%, pills ~91%, condoms ~85%)	EC pills: ~85% (within 72h); Copper IUD: >99%
Duration of Protection	Varies: daily (pills), monthly (injectables), 5–10 years (IUDs), permanent (sterilization)	One-time use only, no ongoing protection
Side Effects	Depends on method: hormonal changes, irregular bleeding, cramps (IUD)	Nausea, breast tenderness, delayed or early periods (temporary)
STI Protection	Only condoms offer protection	No STI protection
Accessibility in India	Widely available: free in government and private options	EC pills OTC; Copper IUD through trained providers
Examples in India	Mala-D, DMPA (Antara), Copper-T, condoms, Mirena, implants	Unwanted-72, i-Pill (pills); Copper-T (as EC)
Cost	₹0 (public) to ₹1000+ depending on method	EC pills: ₹50–100; Copper IUD: ₹300–500 privately

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References

1. WHO. (2018). Emergency Contraception Fact Sheet https://www.who.int/news-room/fact-sheets/detail/emergency-contraceptive

1. Atkins K, Kennedy CE, Yeh PT, Narasimhan M. Over-the-counter provision of emergency contraceptive pills: a systematic review. BMJ open. 2022 Mar 1;12(3):e054122.