The “morning after pill”, or more precisely hormonal emergency contraception, is on the rise: sales have increased by 40% over the past two years, indicates a study by the DREES (directorate of research, studies, evaluation and statistics) published in September 2023. How can this increase be explained?
“Specific studies on contraception are necessary to interpret these developments,” believes the DREES. For Public Health France (SPF), they may be a sign of better knowledge by the population of the time limits for the effectiveness of emergency contraception, but the health agency points to a lack of awareness among young people. “We do not yet have enough perspective to know the origin of the increase in sales of hormonal emergency contraception,” explains Lucie Duchesne, sexual health researcher at Public Health France. But we can formulate hypotheses, such as the impact of public policies carried out for several years to facilitate access, the arrival of new compounds in the 2000s, free access for minors and then adults and finally the campaigns aimed at to make their 5-day effectiveness period better known.”
Emergency contraception has also probably benefited from the bad image associated with the pill. Delphine Rahib, sexual health study manager at Public Health France, notes that “since the pill crisis of 2012, the contraceptive landscape for women has changed and some women are turning to new methods of contraception, in different ways depending on social origin. The most advantaged women opt for an intrauterine device while women with less financial resources or those with shorter studies opt for condoms or less effective contraception, such as natural methods. This lesser effectiveness of certain methods used could explain part of the increase in the use of the morning-after pill.
Women taking the daily contraceptive pill but having forgotten a tablet can also use emergency hormonal contraception. However, for SPF, women have little knowledge about the interaction between their usual pill and hormonal emergency contraception. The Question Sexuality website gives the procedure to follow and the reflexes to adopt to remain well protected in the event of forgetting a tablet, taking into account the time elapsed since the forgetting and the type of pill. When emergency contraception is recommended, it is specified that condoms or other methods must be used until the end of the cycle.
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Hormonal emergency contraception is used in the absence or misuse of contraception, such as after a condom breaks. It is a single tablet to be used as soon as possible after unprotected or poorly protected sex, as the effectiveness decreases over time. Health insurance advises taking the pill within 12 hours of sexual intercourse, and it must be taken no later than 3 days after sexual intercourse for levonorgestrel, with 58 to 95% effectiveness, or 5 days for ulipristal acetate, which is 73 to 85% effective. It is advisable to take a pregnancy test if the onset of menstruation is delayed by 5 to 7 days. Of course, the capsule does not protect against sexually transmitted infections.
The emergency contraceptive is available free of charge without a prescription in pharmacies for any adult or minor. It is also distributed in sexual health centers for adults, in university health services, and secondary school nurses (middle and high school) can deliver it anonymously and free of charge to adults and minors. Dispensing the pill is generally associated with a space for discussion around means of protection and contraception with the professional.
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“Emergency hormonal contraception delays or prevents ovulation,” explains Lucie Duchesne. That is to say the moment in a woman's menstrual cycle when one of the ovaries releases an egg towards the ovarian tube. The molecule modifies the hormonal concentrations of the current cycle, and these modifications are responsible for the postponement of ovulation and the disruption of the development of ovarian follicles. “The next cycle becomes regular again in women whose cycles were already regular,” explains Lucie Duchesne.
On the other hand, emergency contraception does not prevent fertilization if ovulation has already occurred and sperm are present. Delphine Rahib further specifies that even if “among young people there may be confusion between emergency contraception and abortion, hormonal emergency contraception has no impact on an ongoing pregnancy”. Hormonal contraception does not harm the developing embryo and health insurance specifies that if it is taken while a pregnancy is already underway without the patient's knowledge, "it can be continued, the risk of malformation of the fetus with ulipristal and levonorgestrel has not been demonstrated. “Comparative studies show that pregnancies continue in the same way even if emergency contraception was taken after the start of the pregnancy, without malformations or miscarriages due to emergency contraception,” confirms Delphine Rahib.
On the other hand, taking emergency contraception often causes nausea, headaches and stomach aches, small bleeding and vomiting, sometimes accompanied by headaches, breast pain, dizziness or fatigue. However, it does not lead to the appearance of periods. Lucie Duchesne specifies that “repeated taking of emergency hormonal contraception like conventional contraception has no effect on health, apart from the irregularities of the current cycle”. “Hormonal emergency contraception does not increase, for the future, the risk of infertility, spontaneous miscarriage or ectopic pregnancy”, indicates for its part health insurance.
“The increase in contraceptive consumption is not a problem in itself,” believes Delphine Rahib. This means that women identify the risk and react to this risk, it is rather responsible behavior. However, “hormonal emergency contraception is a catch-up method which is not intended to be used regularly”, specifies health insurance. Other means of contraception exist, which are more effective, more reliable when there is several reports during the cycle, and which do not disrupt menstrual cycles, which can be unpleasant for women.