E-pills for emergency only

When a 25-year-old Avantika (name changed) began to bleed, just a couple of weeks after her regular menstrual cycle, she panicked. After consulting her gynaecologist, she realised it was the result of taking emergency contraceptive pills frequently in a short span. 

Dr Kavya Krishnakumar, citybased obstetrician and gynaecologist, says that she often sees many patients like Avantika, who come to her complaining about sudden instances of bleeding after they complete their monthly cycle. “Some use it every other day, the morning after intercourse. They don’t understand that an emergency contraceptive, as the name suggests, must be used only when other contraceptives fail. They do not work like birth control pills,” she says. 

The World Health Organisation defines the emergency contraceptive as a ‘method of contraception that can be used to prevent pregnancy in the first five days after sexual intercourse. It is intended for use following unprotected intercourse, contraceptive failure or misuse (such as forgotten pills, or breakage or slippage of condoms), rape or coerced unprotected sex.’

A recent study published in the Indian Journal of Community Medicine, titled ‘Evaluation of pharmacists’ services for dispensing emergency contraceptive pills in Delhi’ has revealed that while these pills are available over the counter, there is very little awareness among sellers about its side effects. Of the 81 pharmacies studied, ‘a majority of them were unclear about side effects associated with emergency contraception (78.57%) or with anticipated changes in menstrual flow (78.57%); 85.71% did not know whether subsequent unprotected intercourse would be protected.’ 

The scenario is more or less the same in a city like Chennai, according to doctors. Without any questions asked from both sides, these pills, which are available over the counter, are consumed indiscriminately, sometimes as frequently as once in 10 days, they say.

Emergency contraceptive pills that have been touted as the morning-after pill, have been available across the country for over a decade now. Dr PM Gopinath, Director and Senior Consultant, Institute of Obstetrics and Gynaecology, SIMS Hospital, says that it comes in handy for several categories of women. “These are for those young women who do not use contraception or for married women who are not on contraceptives for various reasons. The pills are also a window option for women in the older age group when they have infrequent intercourse,” he says.

Doctors also warn that while the pill is a useful option, it doesn’t guarantee 100 per cent success, apart from being ineffective as a protection from sexually transmitted diseases. Dr Kavya says, “Many of my patients have become pregnant despite using it. They seem surprised that it has not worked, but I tell them that it does have a high failure rate.” 

A major side effect of frequent use of these pills is hormonal imbalance, adds Dr Kavya. “I suggest that my patients resort to them when other measures, like a condom, has failed. Even otherwise, they could go in for it once in six months,” she says. 

Dr Nithya Ramamurthy, senior consultant gynaecologist and obstetrician, Fortis Malar Hospital, says that people should be educated about any kind of contraceptive before using them. “They must take such measures under the proper guidance of gynaecologists. Apart from the regular condoms used by men, there are other options, like female condoms and traditional birth control pills. These must be considered first,” she says. Talking about the lack of awareness, Dr Gopinath says that recommending these pills comes with the social responsibility of informing users about the side effects and results.