Sunday, August 29, 2010

Go to Health: Unwanted Pregnancy & Ella, the new emergency contraceptive

Have you noticed that sex scenes in movies almost never include any discussion of whether the woman is using the pill or an IUD, and whether the man has a condom? Stopping to talk about AIDS doesn’t happen either. Film producers are getting better about cigarettes, but apparently condoms are too risqué. There is even controversy about requiring actors in pornographic movies to be protected by condom use. Our inability to get real about sex and to make protection available translates into our high rate of unintended pregnancies. It is not surprising that the US has a higher rate of unintended pregnancy than other developed countries. In France, about one third of pregnancies are unintended. In the US our rate is close to 50%; married and unmarried women are included in this number. Of the 800,00 pregnancies in teenagers per year, over 80% are reported as unintended. One third end in abortion. Teens who become mothers are less likely to finish high school or find decent jobs, and more likely to live in poverty.

The most rational plan for sexually active females and males is to talk about contraception ahead of time and use highly effective methods such as the pill, the IUD and condoms. Teenagers need to rehearse the way they will handle such talks, as they are not easy at first. Since sexual desire often overtakes rational thinking, a ‘plan B’ is needed to prevent unintended pregnancy. It’s called emergency contraception, and the foremost pill on the market is called ‘Plan B’!

Plan B One-Step contains levonorgestrel, a progesterone-type hormone that is used in many birth control pills. It prevents pregnancy primarily by stopping ovulation (the maturation and release of eggs from the ovaries) or by preventing fertilization of the egg if ovulation has already occurred. Plan B One-Step also alters the lining of the uterus, making it less receptive to a fertilized egg. Plan B One-Step is available without prescription to women and men 17 and older; it consists of a single pill that should be taken as soon as possible after unprotected intercourse, or if the condom breaks or pills have not been taken regularly. (Men don’t take Plan B,, but can buy it for their partners.) Girls younger than 17 can get Plan B One-Step with a doctor’s prescription. Women who have been raped should ask for Plan B One-Step in the emergency room. Plan B One-Step can be used up to 5 days after sex but loses some of its effectiveness after 3 days. Other emergency contraceptive pills on the market are Plan B and Next Choice. These both contain two pills, with instructions to take them 12 hours apart. However, studies have shown that both pills can be taken together.

Ella: In mid August, 2010, the FDA approved a new emergency contraceptive that has been used in 22 European countries since October 2009 and is said to be considerably more effective than Plan B. Ella works by preventing ovulation – the release of an egg from the woman’s ovaries, and probably also by changing the uterine lining to make it less receptive. It is similar in chemical configuration to RU 486, and thus has aroused opposition from groups who oppose abortion. Studies have shown Ella to be more effective that Plan B, and useful for up to 5 days after sex. Ella should be available by prescription by October or November of 2010. The approval of Ella by the FDA has been seen as evidence of a shift in the influence of political ideology at the FDA. Approval of Plan B, on and then off prescription, was very slow and controversial, while the approval of Ella was faster and unanimous. Ella and Plan B should not be used if the woman is already pregnant, or breastfeeding.

The Copper T IUD is the most effective way to prevent pregnancy after unprotected sex, It can be inserted within 5 days after sex and is said to be 99% effective in preventing pregnancy. It can remain in place for 10 years, This method is not the best birth control for women who may be at risk for sexually transmitted diseases, as infections in the pelvic organs can occur with IUDs. However, for monogamous couples, the IUD is an excellent choice.

Final Thoughts: If you are reading this column and it doesn’t apply to you, pass on the information to a young person who may need it.

If anyone can explain to me why film-makers find it impossible to include the question of contraception in sex scenes, please leave me a message and let me know. Films have enormous influence on our consciousness, and could do a lot of good by being honest on this subject. The scenes could be made as funny or poignant as real life.

Sadja Greenwood, MD, MPH Past issues on this blog


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