How to manage pregnancy risk after I vomited second pill?

Question

Hello doctor,

I just want to ask if there is a possibility of getting pregnant in the situation below:

I had unprotected sex with my husband last month. I took an emergency pill, the first dose (four trust pills) in the morning, then the second dose (another four pills) after 12 hours. However, I vomited within an hour after taking the second dose because I felt very dizzy at that time.

Is there a possibility of getting pregnant? I am expecting my period during the first week of this month, but I forgot the last day of my previous menstruation because I have an irregular cycle. So, I cannot exactly tell when my period will come. As of now, I am worried because I do not want to get pregnant again. I already have five children and underwent a caesarean section a few months ago.

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

In your case, since you had unprotected intercourse and took the emergency contraceptive pills (a combination of Ethinylestradiol and Levonorgestrel), approximately 48 hours later, the first dose was within the effective time window, which is ideally within 72 hours of intercourse.

However, vomiting within one hour of taking the second dose may have reduced the pill's effectiveness, as the body likely did not absorb the full dose. While the first dose still offers partial protection, the overall effectiveness of the emergency contraception is now uncertain, especially considering your irregular cycle and that you are just over a month postpartum after a cesarean delivery. This is a period when fertility can start to return, especially if not breastfeeding exclusively.

Given these factors, there is a possibility of pregnancy, though it may not be high. A repeat dose might have been warranted immediately after vomiting, ideally within one hour.

I recommend taking a urine pregnancy test if your period does not start within a week of its expected time or 21 days after unprotected intercourse. In the meantime, consider starting a reliable long-term contraceptive method as soon as possible, such as progestin-only pills, an intrauterine device (IUD), or contraceptive implants, especially given your history of multiple pregnancies and recent cesarean delivery.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.