Kathmandu : “I took the 72-hour pill. What harm can it cause?”
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| source:ctgpt |
This was a question sent to obstetrician and gynecologist Dr. Dija Khanal. The woman had taken the pill several times before and reported experiencing irregular menstruation multiple times within a year.
Similarly, a 32-year-old woman told the doctor she experienced health issues after taking the emergency pill.
• Obstetrician and gynecologist Dr. Dija Khanal says that repeatedly taking the 72-hour emergency contraceptive pill can cause hormonal imbalance and health problems.
• The 72-hour pill contains a high dose of progestin that prevents ovulation, interferes with fertilization, and alters the uterine environment to prevent pregnancy.
• Doctors warn that the 72-hour pill is not a substitute for regular contraception, and frequent use may lead to small ovarian cysts.
She said, “Five days after taking the 72-hour pill, I noticed 4–5 drops of chocolate-colored blood. It has been 10 days since the spotting started.”
She felt physically weak. “I bought a pregnancy test kit,” she said, “but it showed negative. Why?”
An ultrasound was performed. Small cysts were seen in the ovaries, the endometrium was thin, and hormonal imbalance was clearly evident.
This is a common issue among many married women, something Dr. Dija hears almost daily.
Similarly, if regular pills are missed or a condom breaks, unintended pregnancy may occur.
In such cases, what can be done?
There are pills available in the market that reduce the risk of pregnancy. These are called emergency contraceptive pills and must be taken within 72 hours after unprotected intercourse.
“The sooner it is taken,” says Dr. Dija, “the more effective it is.”
Why Is It Called Emergency?
Dr. Dija explains, “Emergency contraceptive pills contain a high dose of a synthetic hormone called levonorgestrel (a type of progestin).”
Compared to regular birth control pills, the dose is much higher, which produces an immediate effect. That is why it is recommended only in emergency situations.
Gynecologist Dr. Upama describes it as being like a “fire extinguisher.”
She says, “Many women consider the 72-hour pill an easy option. But its role is not to provide regular protection. It is like a fire extinguisher — used to put out a fire after it starts, not to warm the house. Therefore, it should not be used repeatedly.”
According to her, it is an emergency safety net, not a long-term family planning option.
How Does It Prevent Pregnancy?
Pregnancy depends on three biological stages: ovulation, fertilization, and the uterine environment. The pill affects these in different ways.
First Stage: Preventing or Delaying Ovulation
In the middle of the menstrual cycle, the pituitary gland in the brain releases luteinizing hormone (LH), which causes the ovary to release an egg — this is called ovulation. If unprotected intercourse occurs during this time, the chance of pregnancy is high.
Dr. Dija explains that the high-dose progestin in the 72-hour pill signals to the brain that there is already enough progesterone in the body. This prevents the LH surge from occurring.
“When this hormone surge does not happen, the egg is not released. If no egg is released, it cannot meet sperm, reducing the chance of pregnancy,” she says.
If the pill is taken before ovulation, it is highly effective.
Second Stage: Interfering With Fertilization
If ovulation has already occurred, the pill still offers some protection.
Dr. Dija clarifies, “High-dose progestin thickens the mucus at the cervix. Normally, when estrogen levels are high, cervical mucus is thin and slippery, helping sperm reach the egg easily. Thick mucus slows down sperm movement, making it difficult for them to reach the egg.”
It may also reduce sperm lifespan and mobility, decreasing the chances of fertilization.
Third Stage: Changing the Uterine Environment
In rare cases where fertilization has already occurred, the pill can affect the endometrium (the inner lining of the uterus).
Normally, balanced estrogen and progesterone make the endometrium thick and soft so that an embryo can implant easily. However, the high progestin dose in the 72-hour pill may disrupt this balance and thin the endometrium.
Dr. Dija says, “When the endometrium is thin, it is not suitable for implantation. But if the embryo has already implanted, the pill cannot remove it.”
Possible Side Effects
Initial effects after taking the 72-hour pill are usually mild and temporary.
Dr. Dija explains, “Because it contains a high dose of progestin, it suddenly changes the body’s natural hormonal cycle. So, some unusual symptoms may appear for a few days.”
Common side effects include irregular periods, nausea, mild vomiting, headache, breast tenderness or heaviness. Some women may experience lower abdominal pain or bloating.
“Some women get their period earlier than 10 days, some later, and some experience prolonged chocolate-colored spotting,” says Dr. Dija. Such spotting may be a reaction to the pill rather than normal menstruation.
“These effects usually subside within a few days. However, if there is excessive bleeding, severe abdominal pain, or absence of menstruation for two to three months, immediate medical evaluation is necessary.”
What Happens With Repeated Use?
Repeated use can increase hormonal imbalance. According to Dr. Dija, the pill contains a high dose of progestin. Frequent use disrupts the natural estrogen-progesterone balance, leading to irregular menstrual cycles.
Possible effects include:
• Irregular menstruation
• Prolonged spotting
• Missed periods for 2–3 months
• Lower abdominal pain or heaviness
• Mood swings and fatigue
In some cases, ultrasound may show small ovarian cysts. These are usually temporary but indicate hormonal disturbance.
Another serious complication is the risk of ectopic pregnancy. If the pill is taken after 72 hours and pregnancy still occurs, the embryo may implant in the fallopian tube. If it grows there, the tube may rupture, which can be life-threatening.
Can It Cause Permanent Infertility?
Infertility and gynecology specialist Dr. Upama Basnet says many women worry about this.
According to current scientific evidence, occasional use of the emergency pill does not cause permanent infertility. Taking it once or twice in emergencies is unlikely to permanently affect fertility.
However, problems arise when it is used repeatedly instead of regular contraception. High-dose progesterone repeatedly shocks the natural hormone cycle, possibly temporarily stopping ovulation or causing irregular or missed periods.
If menstruation does not return for a long time or hormonal imbalance persists, medical evaluation is necessary. Sometimes underlying conditions such as PCOS or thyroid disorders may also be responsible.
Dr. Dija adds, “There is no evidence that it causes permanent infertility, but repeatedly giving the body high doses of artificial hormones is not a good practice.”
What Are Safer Alternatives?
There is no single “best” contraceptive method. It depends on age, health status, childbearing plans, breastfeeding, and lifestyle.
According to Dr. Dija, for women who want regular contraception and can take daily medication, oral contraceptive pills are very effective and safe. When taken correctly, they are up to 99% effective and may also regulate periods and reduce pain.
For longer birth spacing, Dr. Upama suggests long-term methods such as:
• Copper-T (IUD) — effective for 5–10 years
• Norplant (implant) — placed under the skin of the arm, effective for 3–5 years, removable anytime
• Depo injection — hormonal injection every 3 months
“These methods remove daily anxiety and do not cause the hormonal shock seen with the 72-hour pill,” says Dr. Upama.
Therefore, instead of making emergency pills a habit, it is best to consult a doctor and choose a suitable, regular contraceptive method.
• The 72-hour pill contains a high dose of progestin that prevents ovulation, interferes with fertilization, and alters the uterine environment to prevent pregnancy.
• Doctors warn that the 72-hour pill is not a substitute for regular contraception, and frequent use may lead to small ovarian cysts.
She said, “Five days after taking the 72-hour pill, I noticed 4–5 drops of chocolate-colored blood. It has been 10 days since the spotting started.”
She felt physically weak. “I bought a pregnancy test kit,” she said, “but it showed negative. Why?”
An ultrasound was performed. Small cysts were seen in the ovaries, the endometrium was thin, and hormonal imbalance was clearly evident.
This is a common issue among many married women, something Dr. Dija hears almost daily.
Dr. Dija says, “They tell me they had to take the pill due to various situations and constraints. But they are unaware that repeated use can cause serious complications.”
What Is the 72-Hour Pill? What Is Its Role?
The 72-hour contraceptive pill is an emergency contraceptive, commonly known as the “I-pill.”
Even when pregnancy is not desired, there is sometimes a risk of conception during sexual intercourse, especially if no contraceptive method is used.
What Is the 72-Hour Pill? What Is Its Role?
The 72-hour contraceptive pill is an emergency contraceptive, commonly known as the “I-pill.”
Even when pregnancy is not desired, there is sometimes a risk of conception during sexual intercourse, especially if no contraceptive method is used.
Similarly, if regular pills are missed or a condom breaks, unintended pregnancy may occur.
In such cases, what can be done?
There are pills available in the market that reduce the risk of pregnancy. These are called emergency contraceptive pills and must be taken within 72 hours after unprotected intercourse.
“The sooner it is taken,” says Dr. Dija, “the more effective it is.”
Why Is It Called Emergency?
Dr. Dija explains, “Emergency contraceptive pills contain a high dose of a synthetic hormone called levonorgestrel (a type of progestin).”
Compared to regular birth control pills, the dose is much higher, which produces an immediate effect. That is why it is recommended only in emergency situations.
Gynecologist Dr. Upama describes it as being like a “fire extinguisher.”
She says, “Many women consider the 72-hour pill an easy option. But its role is not to provide regular protection. It is like a fire extinguisher — used to put out a fire after it starts, not to warm the house. Therefore, it should not be used repeatedly.”
According to her, it is an emergency safety net, not a long-term family planning option.
How Does It Prevent Pregnancy?
Pregnancy depends on three biological stages: ovulation, fertilization, and the uterine environment. The pill affects these in different ways.
First Stage: Preventing or Delaying Ovulation
In the middle of the menstrual cycle, the pituitary gland in the brain releases luteinizing hormone (LH), which causes the ovary to release an egg — this is called ovulation. If unprotected intercourse occurs during this time, the chance of pregnancy is high.
Dr. Dija explains that the high-dose progestin in the 72-hour pill signals to the brain that there is already enough progesterone in the body. This prevents the LH surge from occurring.
“When this hormone surge does not happen, the egg is not released. If no egg is released, it cannot meet sperm, reducing the chance of pregnancy,” she says.
If the pill is taken before ovulation, it is highly effective.
Second Stage: Interfering With Fertilization
If ovulation has already occurred, the pill still offers some protection.
Dr. Dija clarifies, “High-dose progestin thickens the mucus at the cervix. Normally, when estrogen levels are high, cervical mucus is thin and slippery, helping sperm reach the egg easily. Thick mucus slows down sperm movement, making it difficult for them to reach the egg.”
It may also reduce sperm lifespan and mobility, decreasing the chances of fertilization.
Third Stage: Changing the Uterine Environment
In rare cases where fertilization has already occurred, the pill can affect the endometrium (the inner lining of the uterus).
Normally, balanced estrogen and progesterone make the endometrium thick and soft so that an embryo can implant easily. However, the high progestin dose in the 72-hour pill may disrupt this balance and thin the endometrium.
Dr. Dija says, “When the endometrium is thin, it is not suitable for implantation. But if the embryo has already implanted, the pill cannot remove it.”
Possible Side Effects
Initial effects after taking the 72-hour pill are usually mild and temporary.
Dr. Dija explains, “Because it contains a high dose of progestin, it suddenly changes the body’s natural hormonal cycle. So, some unusual symptoms may appear for a few days.”
Common side effects include irregular periods, nausea, mild vomiting, headache, breast tenderness or heaviness. Some women may experience lower abdominal pain or bloating.
“Some women get their period earlier than 10 days, some later, and some experience prolonged chocolate-colored spotting,” says Dr. Dija. Such spotting may be a reaction to the pill rather than normal menstruation.
“These effects usually subside within a few days. However, if there is excessive bleeding, severe abdominal pain, or absence of menstruation for two to three months, immediate medical evaluation is necessary.”
What Happens With Repeated Use?
Repeated use can increase hormonal imbalance. According to Dr. Dija, the pill contains a high dose of progestin. Frequent use disrupts the natural estrogen-progesterone balance, leading to irregular menstrual cycles.
Possible effects include:
• Irregular menstruation
• Prolonged spotting
• Missed periods for 2–3 months
• Lower abdominal pain or heaviness
• Mood swings and fatigue
In some cases, ultrasound may show small ovarian cysts. These are usually temporary but indicate hormonal disturbance.
Another serious complication is the risk of ectopic pregnancy. If the pill is taken after 72 hours and pregnancy still occurs, the embryo may implant in the fallopian tube. If it grows there, the tube may rupture, which can be life-threatening.
Can It Cause Permanent Infertility?
Infertility and gynecology specialist Dr. Upama Basnet says many women worry about this.
According to current scientific evidence, occasional use of the emergency pill does not cause permanent infertility. Taking it once or twice in emergencies is unlikely to permanently affect fertility.
However, problems arise when it is used repeatedly instead of regular contraception. High-dose progesterone repeatedly shocks the natural hormone cycle, possibly temporarily stopping ovulation or causing irregular or missed periods.
If menstruation does not return for a long time or hormonal imbalance persists, medical evaluation is necessary. Sometimes underlying conditions such as PCOS or thyroid disorders may also be responsible.
Dr. Dija adds, “There is no evidence that it causes permanent infertility, but repeatedly giving the body high doses of artificial hormones is not a good practice.”
What Are Safer Alternatives?
There is no single “best” contraceptive method. It depends on age, health status, childbearing plans, breastfeeding, and lifestyle.
According to Dr. Dija, for women who want regular contraception and can take daily medication, oral contraceptive pills are very effective and safe. When taken correctly, they are up to 99% effective and may also regulate periods and reduce pain.
For longer birth spacing, Dr. Upama suggests long-term methods such as:
• Copper-T (IUD) — effective for 5–10 years
• Norplant (implant) — placed under the skin of the arm, effective for 3–5 years, removable anytime
• Depo injection — hormonal injection every 3 months
“These methods remove daily anxiety and do not cause the hormonal shock seen with the 72-hour pill,” says Dr. Upama.
Therefore, instead of making emergency pills a habit, it is best to consult a doctor and choose a suitable, regular contraceptive method.
