Emergency Contraception and Ovulation: Key Questions Answered

Contraceptive issues?

Hello, Doctor.
I have been taking the oral contraceptive pill (Kylian) from July until this month.
However, this month I missed two days and took three pills on the third day, which led to ovulation.
Two days ago, after intercourse, I discovered that the condom broke.
I went to see a gynecologist and had an ultrasound that confirmed ovulation (but the exact timing of ovulation could not be determined).
I also took the emergency contraceptive pill (Yuntin) within three hours.
Here are my questions:
1.
How long does it typically take for an egg and sperm to combine to form a fertilized egg?
2.
I read online that taking emergency contraception after ovulation will not result in withdrawal bleeding.
Is this true?
3.
If I continue taking the oral contraceptive pill, will it still be effective?
4.
I saw online that if I have been taking the oral contraceptive pill for several months, I do not need to wait until taking seven pills to achieve contraceptive effectiveness.
Is this true?
5.
Currently, I am not taking the oral contraceptive pill.
In the past, I would get my period three days after finishing a pack of 21 pills.
If I stopped taking the pills two days ago, will I get my period in the next few days?
6.
What is the effectiveness of the emergency contraceptive pill taken within three hours after ovulation? Thank you, Doctor.

Lin, 10~19 year old female. Ask Date: 2023/02/17

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, when you forget to take your birth control pill, you should take it as soon as you remember, and continue taking the next pill at the regular time.
If you miss a dose of an effective pill for more than 12 hours, in addition to taking the missed pill, it is advisable to use an additional barrier method of contraception for the next seven days.
If you miss a dose for more than 24 hours, you should stop taking the current pack of birth control pills and refrain from taking them for seven days (including the days you missed), then continue with the next cycle.
If you miss a pill and do not experience expected withdrawal bleeding during the placebo period, you should suspect the possibility of pregnancy.
Emergency contraception primarily works by delaying or inhibiting ovulation to prevent the sperm from meeting the egg.
It may also alter cervical mucus to reduce the likelihood of sperm-egg fusion.
Sperm can survive in the female body for up to five days, with the highest fertility occurring in the first two days.
After ovulation, the egg can survive for a maximum of 24 hours.
If you take the medication before ovulation, it can delay the release of the egg, and by that time, the sperm may no longer be viable, thus achieving contraception.
However, if ovulation has already occurred and more than 24 hours have passed, the egg is likely dead, and theoretically, it would not matter whether you took the emergency contraception or not, but taking it may still yield "effective" results.
If you experience an LH surge (a signal of ovulation) just before taking the emergency contraception, the medication may be ineffective.
However, in clinical practice, since the timing of ovulation is difficult to confirm, first-generation emergency contraceptive pills contain Levonorgestrel.
Taking this medication within 72 hours after the incident has a success rate of 52–94%, with quicker administration yielding better results.
Second-generation emergency contraceptive pills contain Ulipristal acetate.
Taking this medication within 120 hours after the incident has a success rate of 98%, with even better effectiveness if taken within 72 hours.
In your case, if your period is more than a week late, it is recommended that you consult a gynecologist for evaluation.
Thank you! Wishing you peace and health.
Dr.
Zhang

Reply Date: 2023/02/17

More Info

When it comes to understanding emergency contraception and ovulation, there are several key points to consider based on your questions. Let's break down each of your inquiries to provide clarity on the mechanisms of contraception, the timing of ovulation, and the effectiveness of emergency contraceptive pills.

1. Timeframe for Fertilization: The process of fertilization occurs relatively quickly after ovulation. Once an egg is released from the ovary, it can be fertilized by sperm within 12 to 24 hours. Sperm can survive in the female reproductive tract for up to five days, which means that if you have unprotected intercourse in the days leading up to ovulation, there is a possibility of fertilization. Therefore, if you ovulated and had intercourse, the sperm could potentially fertilize the egg within that short window.

2. Withdrawal Bleeding After Taking Emergency Contraception: It is true that taking emergency contraception (like the one you mentioned, "韻婷") after ovulation may not lead to withdrawal bleeding. Withdrawal bleeding is typically associated with the hormonal changes induced by contraceptive methods, including regular birth control pills. If you take emergency contraception after ovulation, it may not be effective in preventing pregnancy, and thus, you may not experience the expected withdrawal bleeding.

3. Effectiveness of Continuing Regular Birth Control Pills: If you continue taking your regular birth control pills (like "祈麗安") after missing doses, they can still provide contraceptive protection, but their effectiveness may be compromised due to the missed doses. It is essential to follow the instructions provided with your birth control method, as missing doses can lead to ovulation and increase the risk of pregnancy.

4. Timing for Effectiveness of Birth Control Pills: If you have been taking birth control pills consistently for several months, the general guideline is that you do not need to wait for seven consecutive days for them to be effective, provided you have taken them correctly. However, if you miss doses, you may need to follow specific instructions regarding backup contraception until you have taken the pills consistently for a certain period again.

5. Menstrual Cycle After Stopping Birth Control Pills: When you stop taking birth control pills, it is common to experience withdrawal bleeding within a few days. If you typically have a withdrawal bleed three days after completing a pack, you may expect a similar pattern after stopping. However, individual responses can vary, and it may take some time for your cycle to regulate after stopping hormonal contraception.

6. Effectiveness of Emergency Contraception Taken After Ovulation: Taking emergency contraception within three hours after unprotected intercourse is generally considered effective, but its efficacy decreases if ovulation has already occurred. If you have confirmed ovulation through ultrasound, the likelihood of the emergency contraceptive preventing pregnancy is reduced, but it may still work by delaying ovulation or preventing fertilization.

In summary, while emergency contraception can be effective, its success largely depends on the timing of administration relative to ovulation. If you have concerns about potential pregnancy or the effectiveness of your contraceptive methods, it is advisable to consult with a healthcare provider for personalized guidance. They can help you navigate your options and ensure that you have the most effective contraceptive strategy in place.

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