Is it safe for a woman of reproductive age to take the ipill (levonorgestrel) every month after unprotected sex during ovulation as a regular form of contraception?

Using iPill (Levonorgestrel) Monthly is NOT Recommended as Regular Contraception

Levonorgestrel emergency contraception should not be used as a regular, ongoing contraceptive method because it is significantly less effective than standard contraceptive options and is designed only as a backup for contraceptive failure or unprotected intercourse. 1, 2

Why Monthly iPill Use is Problematic

Effectiveness Issues

• Emergency contraception prevents only about 7 out of 8 expected pregnancies (approximately 80% efficacy), which is substantially lower than regular contraceptive methods 1, 2
• Levonorgestrel works primarily by delaying ovulation when taken before the LH surge, but has little to no effect if taken after ovulation has already occurred 3
• If you're timing use to ovulation, you may already be past the point where levonorgestrel can work effectively, as research shows all three pregnancies in one study occurred when women took the pill after ovulation (Days +1 to +2) 3

Mechanism Limitations

• The drug only delays or blocks ovulation temporarily; it does not prevent fertilization or implantation if ovulation has already occurred 2, 3
• Taking it during ovulation means you're likely in the window where it will be ineffective 3

Not Designed for Repeated Use

• The FDA label explicitly states: "Levonorgestrel tablet should not be used as a regular birth control method, because it's not as effective as regular birth control" 1
• CDC guidelines emphasize that emergency contraception consists of methods used "after sexual intercourse" as a backup, not as planned ongoing contraception 4

What You Should Do Instead

Switch to Effective Regular Contraception

• Combined oral contraceptives, IUDs, implants, or depot medroxyprogesterone acetate provide far superior pregnancy prevention with typical-use effectiveness rates of 91-99% 5
• These methods work continuously to prevent ovulation or fertilization, unlike emergency contraception which only works for a single episode 4

If You Need Emergency Contraception Occasionally

• Use it only as a true backup when regular contraception fails or after genuinely unprotected intercourse 1, 2
• Take it as soon as possible within 72 hours for maximum effectiveness, though it can work up to 120 hours 6, 7
• Consider ulipristal acetate (30mg) instead of levonorgestrel if you weigh >165 lbs or if it's been 3-5 days since intercourse, as it's more effective in these situations 6

Most Effective Emergency Option

• Copper IUD insertion within 5 days of unprotected intercourse is the most effective emergency contraception (<1% failure rate) and can then remain in place for up to 10 years as highly effective ongoing contraception 4, 6, 8

Important Safety Considerations

Side Effects with Repeated Use

• Common side effects include menstrual cycle disruption, nausea, abdominal pain, headache, and breast tenderness 1
• Repeated monthly use will likely cause irregular bleeding patterns and unpredictable cycles, making it difficult to know if the method is working 1

When to Suspect Failure

• If your period is delayed by more than one week, you should take a pregnancy test 1
• Severe abdominal pain could indicate ectopic pregnancy and requires immediate medical attention 1

No Protection Against STIs

• Levonorgestrel does not protect against HIV or other sexually transmitted diseases 1

Clinical Bottom Line

The rational approach is to establish effective regular contraception rather than relying on monthly emergency contraception. Studies show that while advance provision of emergency contraception increases its use, it does not reduce pregnancy or abortion rates at the population level because it remains less effective than regular methods and is often not used optimally 2, 9. Schedule an appointment with a healthcare provider to discuss appropriate ongoing contraceptive options that match your needs and provide reliable pregnancy prevention 10.