Emergency Contraception: An Option To Remember

In an ideal world, contraceptives would be 100% effective, and they would be used correctly every time. But, like most things in life, birth control isn't perfect. Pills are missed; condoms break, are put on improperly, and sometimes are not used at all. And, unfortunately, situations occur in which women are forced to have intercourse against their will.

A woman may find that she was not protected from pregnancy at the most fertile time in her menstrual cycle, ovulation (release of the egg) which occurs 10 to 14 days after the last menstrual cycle started. But instead of waiting a few weeks to see if she misses her period and then taking a pregnancy test, she has another option: postcoital (after-intercourse) emergency contraception.

Although it may sound new, emergency contraception has been around since 1974, when gynecologist Albert Yuzpe showed that pregnancy after unprotected intercourse could be prevented 75% of the time by using a certain regimen of birth control pills. The Yuzpe regimen has been used for years by university health services, women s health clinics, and hospital emergency rooms, but it did not find widespread use by private practitioners, largely because it wasn't commercially promoted.

That changed in 1997, when the US Food and Drug Administration (FDA) announced that there was enough evidence confirming the safety and effectiveness of emergency contraceptives to warrant marketing them. In September 1998 the FDA approved PrevenTM, the first emergency contraceptive product to be cleared for marketing. This drug, available by prescription only, follows the original Yuzpe regimen: a woman takes two contraceptive pills (each containing the hormones ethinyl estradiol and levonorgestrel) within 72 hours of unprotected intercourse, and then two more pills 12 hours after the first dose.

Some other contraceptive pills can be used for emergency contraception in an off-label way that is, doctors can prescribe them for emergency use even though their manufacturers don t advertise them for that purpose but Preven provides women with detailed patient information and a urine pregnancy test, which should be taken before the pills are started to make sure a woman isn t already pregnant from earlier sexual activity. (The pills do not work if a woman is already pregnant.)

How Do the Pills Work?
Emergency contraceptive pills do not cause an abortion. Scientific evidence suggests emergency contraceptive pills work before pregnancy occurs by preventing or delaying ovulation. They may also prevent fertilization of an egg if one has been released from the ovary, or they may interfere with implantation of an egg.

Side Effects And Risks
The side effects and risks associated with use of emergency contraceptive pills are similar to those associated with oral contraceptives prescribed for daily use. Your doctor can discuss the risks and benefits of emergency contraception with you. The most common side effects of emergency contraceptive pills are nausea and vomiting.

Some women have health problems that may make the use of emergency contraceptive pills unwise. Ask your doctor about other options for emergency contraception, including the insertion of an intrauterine device (IUD) (see Other Emergency Contraception Options ).

Only for Emergencies
As the name implies, emergency contraception should be saved for emergencies. Even though the method is safe and effective, it should not be relied upon as routine contraception. Emergency contraception is not as effective as a daily regimen of birth control pills, and is associated with more uncomfortable side effects, such as nausea and vomiting.

And remember, like all birth control pills, emergency contraceptive pills do not protect against sexually transmitted diseases, including HIV, the virus that causes AIDS.

For more information about Preven and emergency contraception, call 1-888-PREVEN2 or visit the manufacturer's Web site at www.PREVEN.com.

Other EC Options
Emergency contraception (EC) can also include the insertion of a copper-T intrauterine device (IUD) (Paragard®) within 5 days of unprotected sex. Insertion of this IUD is even more effective than emergency contraception pills: it can prevent implantation of a fertilized egg 99% of the time, and can be left in place for up to 10 years if long-term contraception is desired. Ask your doctor if you are a candidate.

Women who desire long-term oral contraception but cannot tolerate estrogen-containing birth control pills can be given a regimen of minipills (progestin-only birth control pills) or the synthetic hormone danazol (Danocrine®), which is used to treat gynecologic problems.

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Originally published in The Female Patient Waiting Room Edition -- January, 1999

© Copyright, 1999 Quadrant Publishing, All Rights Reserved. Reprints are not allowed without the expressed written consent of Quadrant Publishing.