the Risks of Repeated Use of Emergency Contraceptives

High hormonal burden?

Recently, after having sexual intercourse with my boyfriend, I took "Norlevo tablets." In the patient information leaflet, it mentions: "It is not recommended to use this medication repeatedly within the same menstrual cycle, as it poses an unnecessary high hormonal burden on the patient." I would like to ask the doctor, if this medication is used repeatedly within the same menstrual cycle, what kind of effects would this high hormonal burden have on the body? Additionally, would the effects be the same if different types of emergency contraceptive pills are taken?

Xiao Ni, 20~29 year old female. Ask Date: 2003/04/28

Dr. Chen Changfu reply Obstetrics and Gynecology

Hello! Norlevo tablets are commonly known as "emergency contraceptive pills." It is important to understand that using emergency contraceptive pills is a form of emergency contraception and should not be used as a regular contraceptive method after every sexual encounter.
For regular contraception, one should use standard contraceptive methods such as intrauterine devices (IUDs), condoms, regular oral contraceptive pills, or calculating safe periods, among others.

In cases where a condom breaks or slips off, leading to semen leakage, if an IUD dislodges, if there is a missed dose of oral contraceptives, if the safe period is miscalculated, or if unprotected intercourse occurs during ovulation, emergency contraception may be necessary.
In such situations, taking emergency contraceptive pills as directed by a healthcare provider can achieve effective contraception.
Norlevo tablets contain a single high dose of progestin, and while the exact mechanism of its contraceptive effect is not fully understood, statistical data shows that repeated use of this medication within the same menstrual cycle does not result in a higher contraceptive rate.
Therefore, there is no need to use this medication multiple times within the same cycle.
Currently, there are no clear reports of significant adverse effects from high doses of progestin in clinical settings, but the absence of evidence does not guarantee absolute safety.
The principle of medical treatment is that it should be effective and not harmful to the body.
Some monthly oral contraceptives contain the same progestin as Norlevo tablets and can be used as emergency contraception.
However, they also contain high doses of estrogen, which may lead to excessive endometrial proliferation and irregular menstrual cycles, making them less ideal.

Dr.
Chen Chang-Fu, Department of Obstetrics and Gynecology, Qishan Hospital, Ministry of Health and Welfare, April 30, 2003, 3:30 PM.

Reply Date: 2003/04/28

More Info

Understanding the risks associated with the repeated use of emergency contraceptives, such as Norlevo (Levonorgestrel), is crucial for maintaining reproductive health. Emergency contraceptives are designed to prevent pregnancy after unprotected intercourse or contraceptive failure, and while they are effective, their repeated use within the same menstrual cycle can pose certain health risks.

Hormonal Burden
The term "high hormonal burden" refers to the increased levels of hormones introduced into the body when taking emergency contraceptives multiple times in a short period. Norlevo contains Levonorgestrel, a synthetic progestin that can disrupt the normal hormonal balance in the body. When taken repeatedly within the same cycle, it can lead to:
1. Menstrual Irregularities: Frequent use of emergency contraceptives can cause changes in the menstrual cycle, leading to irregular periods, heavier or lighter bleeding, or even missed periods. This is due to the hormonal fluctuations caused by the medication.

2. Hormonal Side Effects: Increased exposure to synthetic hormones can lead to side effects such as nausea, fatigue, headaches, breast tenderness, and mood swings. These symptoms can be exacerbated with repeated use.

3. Impact on Ovulation: Emergency contraceptives work primarily by delaying or inhibiting ovulation. However, if taken repeatedly, the body may not have enough time to return to its normal hormonal rhythm, potentially leading to ovulatory dysfunction.

Long-term Health Implications
While occasional use of emergency contraceptives is generally considered safe, repeated use can raise concerns about long-term health effects. Some studies suggest that frequent use may lead to:
1. Altered Fertility: Although there is no conclusive evidence that emergency contraceptives affect long-term fertility, repeated hormonal disruption may have implications for future reproductive health.

2. Increased Risk of Complications: There is a theoretical risk that repeated high doses of hormones could increase the risk of conditions such as ectopic pregnancy or other reproductive health issues, although more research is needed in this area.

Different Types of Emergency Contraceptives
If considering the use of different types of emergency contraceptives, such as Ulipristal Acetate (Ella), it is important to note that while they may have different mechanisms of action, the potential for hormonal burden remains. Each type of emergency contraceptive has its own side effect profile and risks, but the underlying concern about repeated hormonal exposure persists.

Recommendations
1. Limit Use: It is advisable to use emergency contraceptives only when absolutely necessary and not as a regular form of contraception. If you find yourself needing emergency contraception frequently, it may be beneficial to discuss more reliable long-term contraceptive options with a healthcare provider.

2. Consult a Healthcare Provider: If you have concerns about the effects of repeated use of emergency contraceptives, or if you experience significant side effects, consult a healthcare professional. They can provide personalized advice based on your health history and needs.

3. Monitor Your Cycle: Keep track of your menstrual cycle and any changes you experience after taking emergency contraceptives. This information can be helpful for your healthcare provider in assessing your reproductive health.

In conclusion, while emergency contraceptives like Norlevo are effective for preventing pregnancy, their repeated use within the same menstrual cycle can lead to hormonal imbalances and associated side effects. It is essential to use them judiciously and seek guidance from a healthcare professional for long-term contraceptive planning.

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