Updated: Aug 21, 2019
“We have a tendency to look around at what others are doing and use them as a standard of comparison.” ― Barry Schwartz; The Paradox of Choice: Why More Is Less.
The morning-after pill business has soared in the past few years throughout the world. The CDC reported a 10% increase in the use of morning-after pill in the United States between 2000 and 2010.1 Further, the maximum use was in the age group 20-24 years, with 77% of them having used emergency contraception at least once.
It’s an EMERGENCY pill!
Women (girls) today forget that this called an “emergency pill” for a reason and pop it every time they “feel” they had unsafe sex. The most commonly used morning-after pill contains a progestrogen called Levonorgestrel. The concentration of Levonorgestrel in the morning after pill is almost 20 times more than its concentration in the regular contraceptive pills. So, the adverse effects are 20 times more as well.
Here are some more fun facts about Levonorgestrel that everyone consumes so eagerly:
It is a “Synthetic Progestrogen” that mimics the effects of the natural hormone progesterone and binds to its receptors.2
Its effects are stronger than progesterone, not only on the ovaries but also on all other organs which have progesterone receptors, androgen receptors or glucocorticoid receptors. (The list of these organs is LOOOOOONG including skin, breast, lungs, adrenal glands etc.)3 The result? More Side Effects!
Levonorgestrel prevents ovulation by disrupting the follicular development and peaking of Luteinizing Hormone (LH) within the ovaries. However, once the ovulation has occurred or the concentration of LH has peaked, the pill cannot prevent pregnancy and implantation. What does that mean? The window period of its action is small! It will work only if it’s taken between 7-14th day of the menstrual cycle (counting the first day of the period as day 1).4 (See Image below)
Image courtesy: https://commons.wikimedia.org/wiki/File:MenstrualCycle.png
4. Levonorgestrel has a high androgenic property. So, it affects androgen receptors as well, leading to male pattern body hair, hair fall, balding etc.5
5. Long-term use of Progestrogens can impair glucose tolerance and insulin sensitivity (Read as increased risk for obesity and diabetes). This risk is compounded in those suffering from PCOS (Polycystic Ovarian Syndrome).5
6. Other side effects: In a study by United Nations to identify the side-effects of infrequent but regular use of Levonorgestrel, nearly 30% of the 295 participants dropped out before 6 months citing menstrual problems and bleeding irregularities. Other complaints (in the range of 2.5-20%) were Nausea, breast tenderness, fatigue, weakness, bloating, abdominal pain, loss of sex drive, vomiting and depression.6
Well, the emergency pill doesn’t look cool anymore. Does it?
Unwanted pregnancy is a real scare and this fear is driving the sales of the morning-after pill. However, knowing the basic physiology can be enough to take the right call.
What’s your take home?
1. Keep a track of your cycle! Download an app or use a calendar to remember the dates and the fertile days. This way you can choose when to have sex.
2. Emergency pills are for emergencies only: Like, if the condom breaks between the 7th and 14th day of your cycle.
3. Always use condoms: They not only prevent pregnancy but also prevent sexually transmitted diseases. The failure rate of condom typically is between 10-20% depending on the correctness of its use but they do not cause any hormonal problems in men or women.7
4. Use routine oral contraceptive pills (OCPs) if you are uncomfortable with condoms or are brave enough to sacrifice your health for your partner’s. Long term use of OCPs does cause hormonal imbalance and metabolic disturbances but at least they have a much lower concentration of hormones (50µg versus 750µg). Also, they do much less damage in the long run as compared to the regular intake of emergency pills.6
5. Insertion of intrauterine devices (like copper-T) has shown to be more efficient than emergency pills (Failure rate 0.08% when Cu-T is used as an emergency contraception). Also, they can be placed intrauterine for longer periods providing long-term contraception. They do cause cramps, excessive abdominal bleeding, among other side-effects, but they do not cause hormonal imbalance.8
The unfortunate thing about contraception today is that all hormonal methods have a dire effect on women’s health. It is best if we can make the wise choice today than suffer tomorrow. Remember: “Your health is your responsibility.”
2 Jayabarathan A. In it for profit? Canadian Family physician (2007); 53: 29-30.
4 Gemzell-Danielsson K. Mechanism of action of emergency contraception. Contraception (2010); 82: 404-409.
5 Nader S & .Diamanti-Kandarakis. Polycystic ovary syndrome, oral contraceptives and metabolic issues: new perspectives and a unifying hypothesis. Human Reproduction (2007); 22: 217-322.
6 United Nation developmental program. Efficacy and side effects of immediate postcoital levonorgestrel used repeatedly for contraception. Contraception (2000); 61: 303-308.
8 Mittal S. Emergency contraception: Potential for woman’s health. Indian Journal of Medical Research (2014); 140(Suppl 1): S45-S52.