The As and Bs of Emergency Contraception Methods

Aida: Did you have unprotected sex in the last few days?

Leila: (laughs) Oh my god! What do u mean, what do you mean by unprotected sex?

Aida: Did you have sex without using any contraceptive methods? (laughs)

Leila: No, but I am comfortable continuing like this, but what do you mean?

Aida: We can start over

Leila: no, no need to start over, but what do you mean by unprotected sex?

Aida: I am not going to edit this (laughs)

Leila: No I don’t think so, but I think this is the question, what is the definition of “unprotected sex”?

Aida: When we say unprotected sex we mean sex…, but depends on what we are trying to protect ourselves from. If it’s unprotected sex because we don’t want to end up pregnant then it’s sex where one is not using any contraceptive method throughout. If it’s unprotected sex from sexually transmitted infections, then it could be that one isn’t using a condom generally, external or internal condom.

Leila: Or sex that is unprotected from emotional symptoms or romantic side effects. What can you use to protect yourself from those? Tinder? (laughs)

Aida: Tinder, right.

Leila: Great. Maybe, why are you asking?

Aida: I am asking because I would like to talk about one of the solutions that can be used, not for the romantic symptoms or for sexually transmitted infections, but can be used in case we are worried of getting pregnant

Leila: Okey, so we are talking about contraceptive methods if you weren’t using any method before having sex. I mean in case the sex happened randomly and wasn’t expected or planned for.

Aida: Or even was expected, but things got heated and you preferred not to use a condom

Leila: Or for example he was using a condom, then there was some confusion, then the condom got ripped, then we realized there is no other condom, then we decided to continue with no condom, then…

Aida: Or the condom got stuck inside and we couldn’t remove it

Leila: Yih (laughs) okey yeah it got stuck for example. Or we can list other options, for example I was using a contraceptive method but I started taking antibiotics, the heavy kind, because they also decrease the efficiency of contraceptive methods. Especially the antibiotic used for Tuberculosis like Rifampin, and those antibiotics cancel the efficiency of contraceptive methods, not only do they decrease it.

Aida: Or in case you were taking your daily contraceptive pills and you forgot a couple of pills and had sex

Leila: Or

Aida: (laughs) All the options

Leila: Or for example you didn’t know you’re going to see your ex and you started talking about life and asked him Kifak enta (Lebanese for How are you)

Leila, Aida: Malla Enta (Lebanese for Look at you) (Joke)

Aida: Or it can be something more tragic. If someone got sexually assaulted or raped

Leila: This is not sex, here we are talking about assault. So this is a list of scenarios where one could be in a situation where an emergency contraceptive method might be needed. Let’s discuss them now since we mentioned all of these scenarios, and I am sure there are more scenarios that we can’t think of right now. There are many methods that one can use, there are pills, right? And there are more methods, like an IUD (Intrauterine device) that can be used as a long term contraceptive method, like a hormonal IUD. Oh I forgot to mention my name is Leila (laughs). My name is Leila, and your name?

Aida: I am Aida and this is Fasleh’s podcast from The A Project

Leila: To go back, what does an IUD look like? There are 2 types of IUD that can be used for long term and of course can be changed. A copper IUD can be changed every 7 to 10 years depending on which brand is used. And for the hormonal IUD there is a brand that can be used for 3 years and another for 5 years. And these methods in general are offered as long term contraceptive methods but can also be used as an emergency contraceptive method like in the situations we mentioned earlier. And for them to work, they should be used in the first week after having unprotected sex. If we insert an IUD in the first week after, it cancels any possibility of pregnancy and it’s 2 in 1, meaning that you can keep it after for a long period of time, for future mistakes (laughs) of course I don’t mean mistakes because it happens and that is normal. So they can be used in the first week, and other methods can be used in a shorter period and we don’t need to keep using them, like contraceptive pills. Can you tell us more about them Leila?

Aida: My name is Aida

Leila: Yes, I said Aida!

Aida: Oh I heard Leila

Leila: Oh sorry! Sometimes I say my name without noticing. I love my name (laughs). Yes Aida…

Aida: There is the pill that is usually marketed for as the ‘morning after pill’ or the pill that you take the day after having sex, but that is just for marketing purposes. Of course you can take it right after having sex, and depending on the brand you are using, you can take these pills up to 3 days after unprotected sex or up to 5 days after. These pills are hormone based.

Leila: Mostly progesterone. It’s supported by the government (joke)

Aida: It works on delaying ovulation, if the ovulation is happening the same day or in the next few days. Or if the ovulation already took place, it works on preventing fertilization and implantation on the uterine wall.

Leila: Overall, ovulation happens once a month generally, and can happen more than once sometimes or in some cases during ovulation 2 eggs would be released from the ovary instead of 1 which can affect the process. It’s a possibility but it doesn’t happen regularly. Concerning the ‘morning after pill’, the name insinuates that sex only happens at night and in dark. It can be morning sex for example, like good morning, hello, you know like the pictures my grand mother sends on the Whatsapp group (laughs). If it’s a good morning sex, in that case you can say good morning and head out to the pharmacy (laughs) and tell the pharmacist good morning I need the pill, not the morning after pill, the hour after pill. And they will definitely look at you weirdly and ask what do you mean? In that case I advise our listeners to wear a wedding ring (laughs) because they won’t ask for your marriage documents or any other proof that you are in a legitimate relationship, and if you already are in a ‘legitimate’ relationship, then congratulations, you can walk in with your head up high and don’t be shy (laughs) and of course if you are not married, don’t be shy neither. This could limit the drama. Many women tell us on the hotline, which number is 76680620, it’s open everyday from 5 to 11 pm, Whatsapp enabled. There are many women who tell us on the hotline that some pharmacists start asking them questions like how and why. It happens, and they try to give them a moral lesson and moralities. Anyways the pills are available in most pharmacies, so if the pharmacist didn’t like it, you can leave (laughs) and go to another or just get in a fight and if you do go live and we will share it (laughs) definitely. Okey now I am little off topic. Sorry

Aida: It’s okey, it’s okey (laughs). And I want to add something to what Leila was saying, of course we are talking about the Lebanese context, in Lebanon the emergency contraceptive pills are available over the counter and without a prescription. So we can do a dance with the pharmacist (joke)

Leila: Tango, tango of hope (laughs)

Aida: In other countries in the region, like UAE, there are no after pills or emergency contraceptive pills and in many countries you need a prescription; in the US I think one needs a doctor’s prescription to get the pill.

Leila: Not so progressive of the US, ye? (laughs)

Aida: The country of civilization and progressivity, I don’t like their performance (laughs), but thank god we can get the pill in Lebanon

Leila: The country of pills (laughs)

Aida: The country of freedom, but definitely not out of respect for the rights of women to access these services, but things are chaotic here so they didn’t have the chance yet to put barriers for women to access those pills from a pharmacist.

Leila: A lot of people don’t know about the emergency contraceptive pills and feel that they should wait to see if they are going to get their next period or not. So we maybe thought of doing this episode to say that these pills exist and are available and not expensive. For example we have many emergency contraceptive pills brands that are available in Lebanon, and I don’t mean to advertise for any brand, not that I care, but what matters is to have Levonorgestrel in the pill. So we have Purple Line, and in the past we used to have Norlevo and I think now it’s out of stock or not easily available in the market and it’s for 20,000LBP. And there is another brand called Ella One, there is no Levonorgestrel in it and can be used the same way, it can be taken immediately after or up to 5 days after, meaning if one wasn’t sure or didn’t have the time to buy it they can go ahead and buy it after 4 or 3 days and it will decrease the possibility of a pregnancy. With Levonorgestrel, which is the chemical name not the brand name, the pills should be taken up to 72 hours after or 3 days and both types work and are highly efficient, and the efficiency would increase the sooner we use it. For example if we take it after 2 hours like we were saying, top, wow, bravo, if after 3 days that is okey but the efficiency would decrease a little but it still better than not using it. Those pills are 85% efficient, so even if we use it as soon as possible there is a 15% possibility of having an unwanted pregnancy and that can be annoying because we might think about whether or not we should keep the pregnancy. And I’ll remind you about the abortion episode, 2 episodes before this one, if you want to know more about it. And also if someone decided to take the emergency contraceptive pill then found herself pregnant and changed her mind and wants to keep the pregnancy that is okey and the emergency contraceptive pill wouldn’t affect the pregnancy just to assure you. If it didn’t do its job doesn’t mean that it messed up the pregnancy.

Aida: Many people worry about the side effects when we talk about a hormonal method, but the side effect you experience taking an emergency contraceptive pill are not to be compared with hormonal methods, because we take it once, even if we are taking it once every month the amount of hormone intake isn’t even to be compared to taking a pill every day, so you shouldn’t worry about it. There is also something else that people worry about, because we are taking hormones our next period could be affected, but not in an irreversible or bad way, we could have our period a week early or a week late or just few days not necessarily a week. Because that is something that worries us while waiting for our period to know that all is good, so if it’s a little late it doesn’t necessarily mean that it didn’t work, just as reassurance that in most cases the emergency contraceptive pill might delay our period. That is why it’s important after we take an emergency contraceptive pill to wait or expect a delay in our next period and if it’s late not to worry and to wait few days before we do a pregnancy test.

Leila: Yes, if 2 weeks passed since you took the pill or a certain time have passed and you missed your period and you took a urine test and it came back negative, then in most cases it really is negative, you can try again after 2 or 3 days if it comes back negative again then it’s just that your period is late. This knowing that there was no other sexual activities, from the time you took the pill until you did the test, that may lead to a pregnancy. But what’s important to mention about emergency contraceptive pills, not IUD’s and other methods, we need to keep in mind that not everyone knows how to count their cycle, maybe because their cycle is irregular. In that case it’s better to use the emergency contraceptive pills if we had unprotected sex and we’re worried. Even for the people who know how to count their cycles and their cycles are regular, they can’t really know the exact day of ovulation because it only happens once per cycle and is usually 14 days before your next period. So if you don’t know when your next period will be you can’t really know when you will be ovulating because you can’t guess when you will have your next period. So, if you don’t know when you will have your next period and your cycle is irregular, then it’s always preferable you take an emergency contraceptive pill. And it’s also preferable if you take contraceptive pills everyday, and we can talk more about long term contraceptive methods in another episode, but if they don’t suit you and you’re not comfortable nor ready to make some sort of commitment then that is okey. A lot of people take some time to find a method that suits them best, and there are people who don’t find a method that suits them but they don’t know when they’re going to have their next period so they need them. And there are lots of people who work in the health system, or doctors or nurses or people who work in sexual health that always say that you shouldn’t use or over use emergency contraceptive methods or pills and that is a myth, a myth 2000000%, I can send you 2000000 academic, scientific articles that say we can use them multiple times, especially the one with Levonorgestrel that we were talking about, the one that can be used up to 3 days after. Now for the Ella One it’s preferable to be used once per cycle. But if we already used it once per cycle then we had unprotected sex and we were like Yih! What happened? You can take Levonorgestrel it’s also efficient and it works. Now if we went to the pharmacy and did the tango and danced and the pharmacist said they don’t have any and we live in countries where there is no emergency contraceptive pills, there are everyday contraceptive pills that could be used as emergency contraception. In Lebanon, I will give an example here in Lebanon because I don’t know what’s going on outside Lebanon, I’m stuck here (laughs). There is Microgynon, it’s a pill and it’s also called the breastfeeding pill, it’s used when the woman is breastfeeding because it’s not high in Estrogene but high in Progesterone so it’s taken in high quantities. It’s usually supposed to be taken once per day like any other contraceptive pill. After a not reassuring sexual activity if Levonorgestrel or Ella One are not found, we can go to a pharmacy and ask: do u have Microgynon? In that case they would say bravo you are taking a long term method, you are taking a pill everyday, you are taking care of yourself, they’ll be happy with themselves, but you know that you will be taking 4 pills and after 12 hours another 4 and the total quantity for that day is equivalent to one Levonorgestrel pill. There are side effects like not feeling well, feeling sick and some people feel dizzy but they will last for that day. And it’s also possible, like you said Aida, that it delays your next period. Also,  Microgynon is very affordable, it’s for 3000LBP or 5000LBP and some people use it regularly because Ella One, and I forgot to mention that it’s for 50,000LBP and I don’t know how much it’s for now with the economic crisis, and I don’t know how much it will be for if it will be supported by the government or if you will pay for it in installments, but Microgynon is way cheaper and a lot of people prefer it.

Aida: And there is another myth around emergency contraceptive pills, which is that a lot of people think we are talking about abortion

Leila: (laughs) What’s this! An emergency button abortion

Aida: Because everything you say you’re doing after having sex gives the conception that a fertilization took place and there is a life now, and all of that

Leila: Man! What’s this!

Aida: It’s very important to shed light on the fact that no, this is not an abortion. And the process that happens in the body is very different from anything related to an abortion, because we are preventing a pregnancy from happening in the first place. So if you have any worries or fear that you are doing something you don’t necessarily like doing, or if someone told you not to use those pills because it’s wrong or whatever, we must differentiate between the two and eventually both are rights.

Leila: People say it’s an abortion for everything, I don’t like kids, that is an abortion (laughs)

Aida: Abort the idea (laughs)

Leila: Abort the idea. But no definitely, they have nothing to do with one another, there are more people who think like this in countries where they have more laws and restrictions, or in catholic countries like Latin America where they say that emergency contraceptive methods are abortion methods but that is not true at all! For example, an abortion method is when the police throws tear gas on protestors, these cause abortions but abortion is criminalized in Lebanon

Aida: Depending on who’s doing it, the government, the police,….

Leila: True, true! Yes, for example I see tear gas as more of an abortion method than an emergency contraceptive method that only prevent fertilization and implantation of the egg in the uterine wall or delays the ovulation period. Which reminds me of something very important to say, if you took an emergency contraceptive method don’t assume that all is good now and that you can have sex after 3 days because you took an emergency contraceptive pill, no! Because it can delay your ovulation, and you would find yourself in the same situation again and would find yourself pregnant at the end of the month. So, you should use an external condom which is called male condom sometimes, or find other fun things to do that wouldn’t lead to a pregnancy.

Aida: There are lots of fun things to do

Leila: And this is another episode from Fasleh, and I believe so far we covered the topic of emergency contraceptive methods, and I hope you keep listening to our future episodes

Aida: And if you have any questions you can contact us on, you can comment or ask our hotline counselors

Leila: On 76680620 between 5 and 11 pm everyday. This was Leila and Aida, goodbye!