When did contraception fail and is there a chance of pregnancy?
That may be the case with:
- sexual intercourse in the fertile period if no contraception is used
- forgetting one or more pills in the week prior to or following the stop week if unprotected sexual intercourse took place in the 7 days * prior to forgetting the pill (s) (see also general advice and precautions)
- putting on a condom too late or tearing or slipping of a condom during the fertile period if no other method of contraception, eg the pill, is used other than the condom
- errors in fertile day calculation when applying natural methods of birth control
- withdrawing the penis from the sheath too late if coitus interruptus is the chosen method of contraception
- the absence of menstruation
If pregnancy is not desired then the choice of treatment depends on the time when the failure of the contraception becomes known:
- the morningafter pill Norlevo®, also called an emergency pill, can be taken up to 3×24 hours after coitus
- up to 5×24 hours after coitus a morningafter IUD can be placed. Only the copper IUDs are suitable for use as a morningafter IUD.
- after the absence of menstruation, if there is a starting pregnancy, an overtime treatment or an abortion can be performed. An overtime treatment or an abortion must take place in an institution that is licensed to perform the treatment. Most hospitals have such a permit. Most interventions are performed in the Netherlands in specialized institutions for contraception, sexuality and abortion assistance. Morningafter IUDs are also placed in these settings.
Possibilities after failed birth control
The Norafevo® morningafter pill, also called an emergency pill, postpones ovulation for a few days if the pill is taken prior to ovulation. If the morning-after pill is taken on the day of ovulation or the day after, then the transport by the fallopian tubes of an evt. fertilized egg delayed and the womb lining changed so that a fertilized egg is difficult to implant. This means that the chance of an ectopic pregnancy is then increased.
A morning-after IUD or emergency IUD changes the womb lining so that implantation can no longer take place. Moreover, the copper is embryotoxic. This means that any fertilized egg will be broken down again. According to some there is then an abortion. The most common view, however, is that there is only beginning life when implantation into the womb lining has taken place.
Overtime treatment consists of either emptying the uterine cavity with a thin catheter on an empty syringe or swallowing the abortion pill. The treatment must take place before the amenorrhea is 6 weeks, corresponding to an actual gestational age of 4 weeks. This means that the treatment must be carried out within 2 weeks after the absence of menstruation. Overtime treatment may only take place in a hospital or abortion clinic with a permit in accordance with the Termination of Pregnancy Act (WAZ). With the exception of a few confessional hospitals, almost all hospitals in the Netherlands have such a permit. All approved abortion clinics also have such a license.
To terminate a pregnancy after 6 weeks of amenorrhea, but less than 12 weeks of amenorrhea in a nullipara (not yet given birth) and 14 weeks of amenorrhea in a multipara (previously had one or more births), termination of pregnancy can take place through a curettage or suction curettage. Hereby the uterine cavity is emptied with a blunt curette in the case of a traditional curettage or the uterine contents are sucked away at the suction curettage. The latter method is used the most. The procedure takes place under local anesthesia and the internal cervix is stretched sufficiently to allow the suction tube to be used to be inserted into the uterine cavity.
According to the WAZ, a cooling-off period of 5 days after the first visit to a care provider must be observed before the intervention can be started. The first care provider will usually be the general practitioner, who will refer to a gynecologist in a licensed hospital or to an abortion clinic. If the person referred to is not prepared to perform the procedure, he or she is obliged to refer the person requesting assistance to a care provider who is willing to perform the abortion. In this case, the legally required waiting time continues to commence on the day that the person requesting treatment has approached the first care provider, usually the family doctor, with the request to terminate the pregnancy. There is no statutory cooling-off period for overtime treatment.
The Norafevo® morningafter pill should be taken as soon as possible after the contraception has failed. In addition, a sexual barrier must be used in sexual intercourse until the next menstrual period to prevent pregnancy from occurring. See the barrier means.
The morningafter pill can be purchased in the Netherlands without a prescription at a drugstore, pharmacy or online. The morning-after pill is reimbursed to women younger than 21 years old on condition that the prescription is made via the pharmacy. Some insurers also reimburse the morningafter pill via an additional arrangement on the basic package. Even then only if a prescription is submitted to the pharmacy.
A morningafter IUD is inserted by a doctor who is familiar with the technique of insertion. A morning after IUD can be removed at the next menstrual period, but it can also be decided to leave it as a reliable method of contraception. An overtime treatment or abortion takes place in an institution with a permit in accordance with the Termination of Pregnancy Act (WAZ).
How reliable are morning after products
The reliability of the Norafevo® morning-after pill depends on the time of taking after contraception has failed. If the Norlevo® is taken within 24 hours, the treatment will prevent 95% of the expected pregnancies. With intake between 25 and 48 hours this percentage is still 85% and with intake between 49 and 72 hours post-coitum only 58% of the expected pregnancies are prevented. Expected pregnancies are pregnancies that would occur on the day that contraception fails in relation to natural fertility at the time in the cycle compared to ovulation.
The morningafter IUD is the most reliable: more than 99% of the expected pregnancies are prevented.
The reliability of the overtime treatment and of an abortion is also almost 100%.
What are the side effects of the morning after products
After using the morningafter pill, the next menstrual period may come a few days later. On average that is two days. Sometimes slight bleeding may occur earlier. After the insertion of a morningafter IUD, there may be some blood loss or some brownish discharge until the next menstrual period.
In the event of an overdue treatment or abortion, blood loss can also be expected after both emptying the uterine cavity and after taking the abortion pill. Information about this is provided by your practitioner.
When to the doctor?
You can go to the doctor for a prescription for the morningafter pill and the morningafter IUD.
Morningafter pill, is it suitable for you?
The morning after pill can be taken up to 72 hours after unprotected sex and is suitable for every woman. The morningafter pill should only be taken if there is a thrombosis or a vein infection in the legs at the time of the need for treatment due to the failure of the contraception.
Overtime treatment or an abortion is suitable for every woman, provided that the term of pregnancy is not too long, unless there are serious health risks based on an illness or disorder. This will be discussed with you by your doctor or practitioner before the operation is performed.
General advice and precautions
After taking the morningafter pill, it is necessary to use a form of birth control in sexual intercourse prior to the next menstrual period. The use of a barrier agent is then most suitable.
Do not use a morning after pill too often and only if there is a clear reason for it. Consider using the morningafter pill more often than choosing a reliable form of birth control. You will receive just as many progestagenic hormones when you take the morningafter pill as if you swallow a whole pill strip.
The following rules apply for forgetting one or more pills:
- A forgotten pill is a pill that should have been taken 12 hours or more ago. If the forgotten pill is discovered within 12 hours, the pill can still be taken. The next pill must then be swallowed again at the normal time. This usually means that two pills must be swallowed on that day! There is then no increased pregnancy risk.
- If 2 or more pills are forgotten during the first week after the discontinuation week and there has been unprotected sexual intercourse for 7 days * prior to forgetting the pill even though it was during the discontinuation week, a morning after pill should be taken. Moreover, the pill strip must then simply be completed and additional contraception is provided during the first week. Barrier agents such as a condom are suitable for this.
- When forgetting 2 or more pills in the last week of the pill strip, the stopping week actually started on the first day the pill was forgotten. There are then two options. Stop taking the pill and start again at the latest with a new pill strip 7 days after forgetting the pill or swallow the pill and continue immediately with the next pill strip without a stop week. That strip does not have to be completely finished, but it may only be stopped if the pill is taken on time every day for at least 7 consecutive days.
- If you forget one or more pills (maximum 3) in the second week of the pill strip, there is no increased pregnancy risk. Take the last forgotten pill and finish the strip. No additional measures need to be taken.
- If 4 or more pills are forgotten in the second week of the pill strip, additional use of another form of birth control is required until the pill is taken again for 7 days. Take the last forgotten pill and finish the strip.
- If the stopping week has lasted longer than 7 days, there is an increased risk of pregnancy in sexual intercourse during the first week of the new pill strip and the additional use of another form of birth control is necessary for 7 days.
- If no sexual intercourse took place during 7 days prior to forgetting the pill, it will suffice to take the forgotten pill (s) after all. However, in the case of sexual intercourse in the 7 days after forgetting the pill, additional contraception, eg a condom, must be used.
The above advice applies to the most commonly used pill: the combination preparations.
Source : dokterdokter