Monique Rainford - HER HEALTH

Dear Dr Rainford,

I have a question related to a form of birth-control pill commonly referred to as the 'morning-after pill', specifically Postinor. I have never taken any form of oral contraception and typically use condoms. However, after an incident where the condom burst, I decided to take the morning-after tablet.

I took it less than six hours after the incident but I still ended up pregnant, except it was ectopic. This would have been my first pregnancy. I am still in my 20s and have no history of sexually transmitted infections. Is it possible that the ectopic pregnancy was caused by the pill?

Avid reader

Dear Reader,

Thank you for your continued interest in my column. Your question allows for discussion of several topics which I will address. An ectopic pregnancy is a pregnancy which forms outside a woman's womb, and the term usually refers to a pregnancy which forms in a woman's fallopian tube (the most common site of an ectopic pregnancy). The short answer is that it is unlikely that the pill caused your ectopic pregnancy.

Progestin-only pill

The morning-after pill is also referred to as emergency contraception. Besides Postinor (a brand of progestin-only pill) which you mentioned, other methods include high doses of certain birth-control pills, other hormonal methods and the insertion of an intrauterine device. Emergency contraception is commonly used for the reason that you mentioned (the condom breaking). It is usually recommended that the medication be taken within 72 hours of intercourse but the medication can be started up to 120 hours after the act.

Data from several studies suggest that progestin-only emergency contraception such as Postinor prevents at least 75 per cent of pregnancies. That being said, this allows a significant risk for pregnancy, which occurred in your case, despite using the method correctly. There is no evidence at present that Postinor caused your ectopic pregnancy and, in fact, emergency contraception reduces a woman's overall risk of ectopic pregnancy by decreasing her chance of getting pregnant.

Ectopic pregnancy

However, there are theories that suggest the medication may have a role in ectopic pregnancies. The major cause of an ectopic pregnancy, which you have alluded to, is a history of infection of the tubes or pelvic inflammatory disease but almost half the time this is not found. A possible cause of an ectopic pregnancy is a hormonal imbalance. This can result from the body having higher-than-normal blood levels of either oestrogen or progestin, which may affect the function of the tubes.

Therefore, in theory, taking the emergency contraception could have increased the blood levels of progestin and affected your tubal function which led to the ectopic pregnancy. However, as I mentioned before, there is currently no evidence to prove that this actually occurs with emergency contraception.

Tubal ligation

Some conditions which put a woman at higher risk of developing an ectopic pregnancy include a prior ectopic, past surgery on her tubes including repair of tubes or tubal ligation and smoking. If a woman has an intrauterine device in her womb, her chance of becoming pregnant is very low. However, if she does become pregnant, she has a higher risk of it being an ectopic.

Dr Monique Rainford is a consulting obstetrician and gynaecologist; email: yourhealth@gleanerjm.com.