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Emergency Contraception

Ella® or Postinor®-2: How Are They Different and Which Emergency Contraception Is Better?

Ella® or Postinor®-2- How Are They Different and Which Emergency Contraception Is Better?
Image credit: Siena Health

Accidents happen, like the condom broke during sex, or you missed a birth control pill. This is when the morning-after pill, also known as emergency contraception, comes to mind. 

We all want our medications to work but many factors can affect the effectiveness of our medications. With emergency contraception, we will understandably be more concerned as the stakes are much higher.

Emergency contraception is available in two types: Ella® and Postinor®-2 (also known as Plan B). Some questions may then surface: What is the difference between Ella® or Postinor®-2? Which one is better at preventing pregnancy after sexual intercourse? Which one is more suitable for me?

In this article, we will discuss the main differences between Ella® and Postinor®-2.

Differences Between Ella® and Postinor®-2

There are 3 main differences between Ella® and Postinor®-2:

  1. Effectiveness and when they are most effective;
  2. Active ingredient; and
  3. Body Mass Index (BMI)

Effectiveness and when they are most effective

The key difference between Ella® and Postinor®-2 is the effectiveness at preventing pregnancy and when they should be taken after sexual intercourse to experience the maximum benefit.

Ella® is 98% effective at preventing pregnancies up to 120 hours (5 days) after unprotected sex and does not lose effectiveness over that time.

Postinor®-2 is only effective up to 72 hours (3 days) after unprotected sex and is less effective the later you take it in that 72-hour window:

  • 95% effective if taken within first 24 hours
  • 85% effective if taken within between 24-48 hours
  • 58% effective if taken within between 48-72 hours

Ella® reigns superior in terms of effectiveness and longevity. In comparison, Postinor®-2 is most effective only when it is taken within 24 hours after sexual intercourse.

Nevertheless, it is still recommended to take emergency contraceptive pills as soon as possible after sexual intercourse, to reduce the likelihood of pregnancy as much as possible.

Active Ingredient

The greatest difference between the two pills is the active ingredient used. Though using different modes of action, both pills ultimately prevent pregnancy.

The active ingredient present in Ella® is ulipristal acetate, a Selective Progesterone Receptor Modulator (SPRM). It suppresses the release of progesterone, a hormone involved in the menstrual cycle, for an extended duration. This results in a delay or inhibition in the release of an egg (ovulation). During this period, sperms which have entered the woman’s body will die. Over time, when the effects of Ella® wane and progesterone levels increase to release an egg, there is no remaining sperm to fertilise it.

On the other hand, levonorgestrel in Postinor®-2 is the active ingredient that prevents pregnancy. Levonorgestrel is a progestogen, which mimics the effects of progesterone. With higher levels of progesterone, effects include:

  • Inhibiting implantation of the fertilised egg on the uterine lining;
  • Stimulating the motility of the fallopian tube;
  • Increasing the viscosity of the cervical mucus, preventing the sperm from reaching the egg.

Body Mass Index (BMI)

Another important factor to consider when deciding between Ella® and Postinor®-2 is BMI. Differences in treatment effectiveness are significant for women with higher BMI.

Evidence has shown that, in general, the risk of pregnancy is much greater in obese women with BMI above 30 as compared to women with normal BMI. Comparing Ella® and Postinor®-2 in obese women, the risk of pregnancy is greater for those taking Postinor®-2.

Which Emergency Contraception Is Better?

There is no definite answer to this question.

Though both Ella® and Postinor®-2 are effective at preventing pregnancy, it is important to consider your circumstances, needs and preferences to decide which emergency contraceptive pill is better suited for you.

How To Get Emergency Contraception In Singapore?

In Singapore, regardless of age, women can only obtain emergency contraception with a valid prescription by a doctor (usually a general practitioner can help).

Need emergency contraception? As a MOH-approved digital health clinic, Siena offers online emergency contraception consultation with one of our friendly doctors, all from the comfort and privacy of your home. If prescribed, the emergency contraception will be delivered in discreet packaging to your doorstep, in 4 hours.

No more rushing, no more panicking!

References

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Birth Control Emergency Contraception Health Sexual Health

Missed Birth Control Pills: What To Do If You Forget Your Pills?

Credit: Illustration by Siena Health

Realising you missed your birth control pills can be a scary and stressful experience, and we know that. So here’s a step-by-step guide on what you can do to ease your worries! 

Perhaps you were running late and in a moment of panic, you couldn’t afford to indulge in your regular morning routine. Or you didn’t purchase your refills in time and realised it was way too late. 

Whichever’s the case, missing your birth control pills can most definitely leave you in a flurry, especially when you have devoted yourself to it. But alas, it happens so don’t beat yourself up about it! Thankfully, there are ways to manage this (mini) crisis. 

If you missed your pills, your next line of action should take into consideration:

  • Number of pills you have missed 
  • When you missed the pill (how far in are you with your pack)
  • Type of birth control pill you’re on (combined contraceptive pill or the progestogen-only pill)

The information leaflet that comes with your contraceptive pills should also have stated specific instructions on the steps you should take regarding the specific brand of birth control you are on. 

Symptoms you may notice if you missed your pills 

If you aren’t 100% sure, there are several symptoms that are pretty clear indicators you missed taking your birth control pills. The most common side effect is light bleeding or starting your period. You may experience menstrual cramps and nausea associated with it. 

Typically, there’s nothing to worry about and everything should return to normal once you’re back on the contraceptive pills regularly!

Combined contraceptive pill

The combined contraceptive pill contains both estrogen and progestin. There is a great variety of combined contraceptive pills you can choose from but some of the common combination pill brand names include Yaz, Yasmin, Microgynon 30, Liza, Mercilon and Drospera. A combination pill is considered “missed” if you don’t take it for 24 hours or more after you were supposed to. 

If you are late (less than 24 hours) or missed (24 to 48 hours) an active pill

You’re still protected against pregnancy if you missed 1 pill anywhere in the pack or started a new pack 1 day (24 hours) late. 

Follow these steps:

  1. Take the late or missed pill immediately
  2. Continue taking the remaining pills at the usual time (even if it means taking two pills on the same day)
  3. Take the 7-day pill-free break as prescribed or if you’re on an everyday pill, take the inactive pills 
  4. Emergency contraception is not usually needed but can be considered if hormonal pills were missed earlier in the cycle or in the last week of the previous cycle
  5. No additional contraceptive protection (e.g. condoms) needed

If you missed two or more active pills (48 hours or more)

When this happens, it greatly increases your chances of ovulation. In this case, when you missed 2 or more active pills anywhere in the pack or started a new pack only after 2 days (48 hours) or more, you may not be protected against pregnancy. 

What you should do:

  1. Take the last pill that you missed immediately even if it means taking 2 pills a day 
  2. Discard any earlier missed pills 
  3. If the missed pill is within: 
    • Week 1 (pills 1 to 7) or Week 2 (pills 8 to 14) of the pack:
      • Continue to take the active pills in your current pack daily
      • Take the inactive (sugar) pills or a 7-day break
      • Begin a new pack the next day
    • Week 3 of the pack (pills 15 to 21): 
      • Continue to take the active pills in your current pack daily
      • When you have finished taking all the active pills, discard the pack
      • Don’t take the inactive (sugar) pills or a 7-day break, begin a new pack the next day
  4. Consider taking emergency contraception if you missed 2 or more pills during the first week of a pack and/or had unprotected sex in the last 7 days
  5. Use extra contraception (i.e. condoms) or abstain from sex for the next 7 days 

If you missed inactive pills 

If you miss 1 or more inactive (sugar) pills, simply throw away the missed pills and take the next pill at the usual time. Remember, you also have to stay on track with your active pills as there should be no more than 7 consecutive active pill-free days between packs.  

Missed birth control pills: a brief overview

ScenarioRecommended ActionsEmergency ContraceptionBack-up Birth Control
Late or missed 1 active pill– Take the late or missed pill immediately
– Continue taking the remaining pills at the usual time (even if it means taking two pills on the same day).		Consider only if you missed the pill earlier in the pack or in the last week of your previous packNot required
Missed 2 or more active pills– Take the last pill that you missed immediately even if it means taking 2 pills a day
– Discard any earlier missed pills 

If you missed the pill within week 1 – 2 of the pack (pills 1 to 14):
– Continue to take the active pills in your current pack daily
– Take the inactive (sugar) pills or a 7-day break, begin a new pack the next day

If you missed the pill within week 3 of the pack (pills 15 to 21):
– Continue to take the active pills in your current pack daily
– Skip the inactive (sugar) pills or 7-day break, begin a new pack the next day		Consider only if you missed 2 or more pills during the first week of a pack and/or had unprotected sex in the last 7 days.Use extra contraception or abstain from sex for the next 7 days 
Missed 1 or more inactive pills– Discard missed pills and take the next pill at the usual timeNot requiredNot required

Progestogen-only pill or mini pill 

Unlike the combined contraceptive pill, progestogen-only pills (aka mini pills) contain progestin and not estrogen. They are taken continuously without any hormone-free breaks. 

If you missed a pill within the 3-hour (mini pills) or 12-hour window period (desogestrel pill)

You will still be protected against pregnancy if you are: 

  • Less than 3 hours late in taking a progestogen-only pill
  • Less than 12 hours late in taking a desogestrel pill

What you should do: 

  1. Take your missed pill as soon as you remember 
  2. Take your next pill at the usual time 
  3. There’s no need for an additional form of contraception or emergency contraception even if you’ve had unprotected sex

If you missed a pill for more than 3 hours (mini pills) or 12 hours (desogestrel pill)

Heads-up, according to the National Health Service, you’re likely unprotected against pregnancy! 

What you should do: 

  1. Take 1 pill as soon as you remember even if you have missed more than 1 pill
  2. Take your next pill at the usual time – this may mean taking 2 pills in a day (1 when you remember and the other at the usual time) which is totally okay to do so 
  3. Continue taking your remaining pills daily at the same time 
  4. You may need emergency contraception if you’ve had unprotected sex in the last 5 days
  5. Use back-up contraceptives for the next 2 days (48 hours) after taking the missed pills or simply refrain from having sex 

Useful tips to help you remember to take your pills on time

Whether or not you’re trying out a new routine to remind yourself to take the pill or ensuring you’re way more well-equipped after your first “missed birth control pill” scare, the following list of tips we’ve compiled will definitely help you.  

  • Opt for another birth control method such as the patch as it only needs to be changed once a week 
  • Set a recurring alarm or reminder on your phone 
  • Use a birth control pill reminder application 
  • Incorporate it into your daily routine 
  • Place the pills in an easily noticeable spot (e.g. bedside table, beside your toothbrush)
  • Get your partner to remind you

Seek help if you need to

We totally get that it can be real confusing knowing you missed your pill and the follow-up steps taken vary depending on what type of birth control pill you’re on. But hopefully, this condensed guide can be your saving grace in times of need (and that you won’t be referencing it anytime soon!).

Feel free to reach out to Siena’s doctors, if you are unsure which instructions pertain to your oral contraceptive pills or to discuss any other concerns you may have with your birth control method. 

References:

Categories
Emergency Contraception Sexual Health

What to do if the condom tore, broke or slipped?

In Singapore, the male condom remains one of the most popular contraceptive options, experts say.

Yes, it happens.

Condoms do not break or slip often. In fact, it most commonly only happens when couples do not follow the recommendations on proper condom use. 

Though infrequent, there is a chance that they might occur and being armed with the knowledge is crucial in the event you find yourself in such a situation. 

How can you tell if a condom tears or breaks?

Obvious breakage

Sometimes condoms break in the packaging or while they’re being put in place, so it’s a good idea to quickly inspect the condom before putting it on.

If the breakage happens when you’re in the moment, you’ll probably feel (immediate change in sensation for the one wearing it) or see the damage when you or your partner pull away.

However, many people don’t notice that a condom broke until after they’re done having sex. That’s why it’s important that you check the condom when you remove it for any obvious holes or leaks.

Microtear

Microtears are tiny tears not usually visible to the naked eye but can also allow viruses and sperm to pass through. This is rare, especially if you’re using and storing the condom correctly.

In some cases, microtears can be a manufacturer defect, though that’s extremely rare. Manufacturers put condoms through a series of tests to monitor for breaks and defects before selling them.

More often, user error causes microtears. Common mistakes that could lead to microtears include:

  • using an expired condom
  • opening condom wrappers with your teeth
  • putting a condom on the wrong way, then flipping it and reusing it
  • using a condom that was stored in an unsafe place, like a wallet
  • using a condom that was exposed to large temperature shifts, moisture, or direct sunlight
  • using a condom without lubrication, which results in friction that could make the condom break
  • using oil-based lubes, such as Vaseline, lotion, or coconut oil, which can break down the material the condom is made of (latex or polyisoprene condoms)

How to prevent pregnancy if a condom is torn, broke or slipped?

If you had sex within the last 5 days, you can take an emergency contraception (morning-after) pill, which delivers a high dose of hormones to delay ovulation and prevent a fertilized egg from implanting in your uterus.

The two common types of morning-after pills in Singapore are:

  • Ulipristal acetate (Ella®)
    • has to be taken within 120 hours (5 days) after unprotected sex
    • lowers your chances of getting pregnant by up to 98% throughout the entire five-day window; and
  • Levonorgestrel (Postinor®-2)
    • works up to 72 hours after unprotected sex but is generally not recommended after 24 hours
    • lowers your chances of getting pregnant by 95% if taken within the first 24 hours after unprotected intercourse but this declines to 85% if taken between 25 – 48 hours and 58% if taken between 48 – 72 hours after unprotected intercourse.

Generally, it’s important to remember that the EC pill works best the sooner you take it!

Where to get emergency contraception (morning-after) pills in Singapore?

In Singapore, emergency contraception is only available with a prescription.

With Siena, you can buy your emergency contraception online!

Consult one of our female doctors via a video call and have your emergency contraception pill delivered to your door.

No waiting time, free 4-hour discreet delivery.

How to prevent HIV if a condom is torn, broke or slipped?

If you believe that you or your partner are at risk of contracting HIV, speak to a doctor immediately to access your situation and suitability for Post Exposure Prophylaxis (PEP) treatment.

PEP is a 28-day course of anti-retroviral medication that can prevent HIV from infecting your body. PEP is only effective within 72 hours after exposure to HIV, but the earlier you begin treatment, the more likely it is to work in full effect.

After which, you will likely need to take HIV tests to ensure the medication has worked.

The bottom line

Condom breakage or slippage can be a stress-inducing accident, but they’re pretty rare, especially if you follow the recommendations on proper condom use.

More often than not, you’ll know if the condom broke — and that means you can quickly take measures to protect yourself.

Categories
Emergency Contraception

Morning-after Pill/Emergency Contraception in Singapore: What you need to know

Credit: Illustration by Yeji Kim

The morning-after pill, also known as emergency contraception (EC), is often an afterthought, something that comes to mind after accidents happen, or more colloquially “only when you need it”. Some couples though, do keep an extra pill at times because accidents do happen – condom broke during sex, you missed a birth control pill or no birth control was used.

If you’ve never taken emergency contraception before or have read up on it, it’s likely you’ll have lots of questions. What is it, how do you use it, are there any side effects (including fertility), how effective is it and how can I get it?

We understand it can get complicated, and we answer all these questions for you below.

What is the morning-after pill?

The morning-after pill is taken to prevent pregnancy for women who had sex without contraceptive protection  – either they didn’t use birth control, they missed a birth control pill, they were sexually assaulted or their primary birth control method failed (e.g. condom broke during sex).

The morning-after pill is available in two types: 

  1. Ulipristal acetate (sold as Ella®); and 
  2. Levonorgestrel (multiple brands – ​Postinor®-2, others.).

The pill works primarily by preventing or delaying the ovaries from releasing an egg (ovulation).

While the pill is an effective option for preventing pregnancy after unprotected sex, it is intended for backup contraception only, not as a primary method of birth control and offers no protection against sexually transmitted infections (STI).

Is the morning-after pill a form of abortion?

The morning-after pill doesn’t cause abortion or miscarriage. It is not the same as mifepristone or misoprostol, also known as the abortion pill. The abortion pill terminates an established pregnancy — one in which the fertilized egg has attached to the uterine wall and has begun to develop.

How do you use the morning-after pill and what can you expect?

The morning-after pill should be taken as soon as possible after unprotected intercourse. You can take morning-after pills anytime during your menstrual cycle. The contraceptive pill can be taken up to 5 days after unprotected sex, depending on the type of pill you take. 

The morning-after pill does not offer lasting protection from pregnancy, do not have sex until you start another method of birth control. Having unprotected intercourse in the period after taking the morning-after pill exposes you to the risk of becoming pregnant.

Your period may be delayed up to a week. If you don’t get your period within 3 to 4 weeks of taking the morning-after pill, take a pregnancy test as soon as possible (you can purchase any test kit at pharmacies like Guardian or Watsons). 

How effective is the morning-after pill?

The efficacy of the morning-after pill decreases the longer the period after unprotected sex and the time of taking the pill.

There are two main types of morning-after pills prescribed by doctors:

  • Ulipristal acetate (Ella®) has to be taken within 120 hours (5 days) after unprotected sex and it lowers your chances of getting pregnant by up to 98% throughout the entire five-day window; and
  • Levonorgestrel (Postinor®-2) works up to 72 hours after unprotected sex but is generally not recommended after 24 hours. Postinor lowers your chances of getting pregnant by 95% if taken within the first 24 hours after unprotected intercourse but this declines to 85% if taken between 25 – 48 hours and 58% if taken between 48 – 72 hours after unprotected intercourse.

What stops the morning-after pill from working?

If you vomit within 2-3 hours of taking the morning-after pill, it is likely not to work.

What are the side effects of the morning-after pill?

Please make sure you’re not pregnant before using ulipristal as the effects of ulipristal on a developing baby are unknown. If you’re breastfeeding, ulipristal isn’t recommended as the effect on newborns/infants has not been studied. 

The levonorgestrel emergency contraceptive pill is safe to take at any time after having a baby. It will not affect your breast milk.

If you notice spotting that lasts longer than a week or develop severe lower abdominal pain 3-5 weeks after taking the morning-after pill, speak to your doctor. These can indicate a miscarriage or that the fertilized egg has implanted outside the uterus, usually in a fallopian tube (ectopic pregnancy).

Side effects of the morning-after pill, which typically last only a few days, might include:

  • Nausea or vomiting
  • Dizziness
  • Fatigue
  • Headache
  • Breast tenderness
  • Bleeding between periods or heavier menstrual bleeding
  • Lower abdominal pain or cramps

Does the morning-after pill affect fertility?

Misinformation about the morning-after pill is often spread unwittingly. 

The 2020 Fact Not Fiction survey in the UK found that 51% of the respondents said they believed you shouldn’t take emergency contraception more than once in the same cycle and 40% of respondents believed the morning-after pill can make you infertile if you use it too many times (fiction). 

The reality is using emergency contraception will not affect your future fertility and won’t stop you from getting pregnant in the future.

How to get the morning-after pill in Singapore?

In Singapore, emergency contraception is only available with a prescription and any woman, regardless of age, can get the drug from a doctor or GP subject to a consultation.

At Siena, we provide online emergency contraception consultation with one of our female doctors so that you can get access to the care you need from the comfort and privacy of your home. If prescribed, we deliver your emergency contraception right to your doorstep in a discreet packaging, in 4 hours.

No more rushing to the clinic!