Tuesday, February 18, 2014

Emergency Contraception - The Morning-After Pill

Emergency contraception (EC) is birth control that can prevent pregnancy after sex; EC methods include pills and the copper IUD.  All sexually active young people should know about these methods.  EC can be used right away or up to 5 days after sex if a woman didn’t use birth control, a condom broke, or in a situation of rape. 

EC makes pregnancy much less likely, but is not as effective as regular contraceptives - the pill, IUD or condoms.  Parents who are worried about EC should know that the methods are safe, and extensive research has shown that their availability does not increase the likelihood that a teenager will engage in sexually risky behavior, such as inconsistent use of contraception or having multiple sexual partners.

Plan B One-Step and the generic Next Choice One Dose contain a progesterone-like compound – levonorgestrel – that is found in many birth control pills.  It does not harm an established pregnancy nor decrease future fertility.  EC is most effective when taken within 2 days after unprotected sex, but has some effectiveness up to 5 days later.  The EC pills are less effective for women who weigh more that 154 pounds.  Plan B One-Step and Next Choice One Dose are available without a prescription to females or males (males don’t take it – but give it to their partners!) age 15 or older.  Younger people must have a prescription.  The cost of Plan B is $40-$50 – probably less at a family planning agency. 

Princeton University has a website that explains EC in detail – ec.princeton.edu.  Some women feel side effects such as headache, fatigue or breast tenderness after EC pills- these symptoms generally go away in a day or two.  Unexpected bleeding or an early or late period may occur – these side effects are not dangerous.  Pharmacies such as CVS and Walgreens carry these pills in the aisles containing other family planning methods. 

Ella is a prescription EC pill that is more effective than Plan B. especially for obese women and in situations when more time has past since unprotected sex.  Its ingredient is ulipristal acetate, which will delay ovulation.  It may also work by preventing implantation of the fertilized egg.  Ella is available online for $40 (including shipping) at www.ella-kwikmed.com. A physician will take a history on-line and prescribe the  pill.  It will be delivered by FedEx within 1-2 days, signature required.  Ella should not be used if the woman has an established pregnancy. 

Copper IUD – this is the most effective form of EC.  The IUD must be placed within 5 days of unprotected sex; it is more effective than pills in preventing pregnancy and it can remain in place for as many as 12 years.  The Affordable Care Act (Obamacare) promises women contraception without copay.  However, the girl or woman must find a family planning agency (such as Planned Parenthood) or a clinician experienced in IUD placement. 

Medical Abortion Pills – Emergency contraceptive pills work before a pregnancy has started, so they do not create an abortion.  However, there are two compounds in current use that can be used for a so-called medical abortion.  Mifepristone – which used to be called RU486, or the French abortion pill, acts by blocking the action of progesterone, a hormone needed to sustain a pregnancy.  Misoprostol, otherwise known as Cytotec, is then taken to soften and open the cervix and cause uterine contractions, expelling the pregnancy.  These two drugs are used together in the first 9 weeks of pregnancy, under the supervision of a trained doctor or nurse practitioner.  Medical abortion is available in California at many family planning clinics.

In states such as Texas where many women’s clinics have been shut down, women are turning to misoprostol pills on their own for inducing an abortion.  They are getting the drug on line, or across the border in Mexico, where it is sold over the counter. They may have very little information as to proper dosage, but when bleeding begins they hope to go to a clinic or hospital for a suction procedure to complete the abortion.  Throughout Latin America, where abortion is mainly illegal, women are taking misoprostol in this manner.  It is tragic and disgraceful that the situation in our country has come to this. Women who are desperate to end a pregnancy should not be abandoned by the medical profession.

You can support Wendy Davis, Democratic candidate for governor of Texas, who has pledged to reopen family planning clinics if she wins.  Support her through Emily’s List, or on numerous Internet websites. 

Sadja Greenwood, MD   back issues on this blog.  Check out my novel – Changing the Rules – at bookstores or Amazon. 


The herbicide, atrazine, hit the news with an article in the New Yorker of 2/10/14, featuring the work of Professor Tyrone Hayes at the University of California, Berkeley.  Hayes, a brilliant and renowned researcher, has spent many years studying the abnormal sexual development of male frogs; they have been found to develop ovaries as well as testes, becoming hermaphrodites.  Hayes has experimental evidence that the herbicide atrazine is strongly implicated in these abnormalities and that atrazine, a probable endocrine disrupter, may also be related to the worldwide decline in amphibian populations.
Atrazine is made by the company Syngenta.  According to the New Yorker article, Syngenta has been trying to discredit Hayes and his work in multiple ways, detailed in the fascinating and frightening exposé in the New Yorker.
Atrazine is one of the most widely used herbicides in the U.S.  It is reportedly applied to more than half the corn raised in this country. A study by the EPA found that without atrazine the national corn yield would fall by 6%.  But the herbicide degrades slowly in soil, washes into streams and lakes, and breaks down slowly.  It is one of the most common contaminants of drinking water in the Midwest – an estimated 30 million Americans are exposed to trace amounts of this chemical.  Atrazine, widely believed to be an endocrine disrupter, has been banned by Italy and Germany since 1991 and by the European Union since 2003. The Natural Resources Defense Council (NRDC) and other environmental organizations have filed lawsuits against the EPA for failure to ban atrazine, so far without results.  In August, 2013, a coalition of more than 250 conservation, public-health and sustainable farming groups sent a letter to the EPA asking for a ban on atrazine.  According to the New Yorker article, the EPA is conducting another review of the safety of atrazine at this time. 
If you are upset by this column, you will be very disturbed by the article about Sygenta’s attempts to discredit Professor Hayes in the New Yorker.  Stay tuned – I will keep you informed on this story as more news becomes available. In the meantime, you can support the NRDC, the Center for Biological Diversity, or other environmental organizations that are working on this issue.
Sadja Greenwood, MD,MPH  back issues on this blog – use the index or search at the top left.  Check out my novel – Changing the Rules – at local bookstores or on Amazon

Monday, February 3, 2014


Ginger has been used in Asian, Indian and Arabic cooking and as a medicine for at least 4000 years! In herbal medicine it has been used to treat stomach upset, colic, diarrhea, nausea, motion sickness  arthritis, respiratory illness, headaches, and painful menstrual periods.  In the 21st century, ginger is being studied at various universities for these and other health conditions.  Here are some recent findings.

*Asthma has become more prevalent in recent years; the reasons for this increase are being debated and are obviously complex.  Air pollution may be a factor.  Asthma is characterized by a tightening of the bronchial tubes that carry air in and out of the lungs.  Medicines called bronchodilators are common types of asthma medicines; they work by relaxing the smooth muscles that line the airways.  Researchers at Columbia University have found that components of ginger can work with bronchodilators to relax the airways.  Compounds in ginger affect an enzyme in the lungs that prevents smooth muscle relaxation.  Researchers plan to determine whether aerosol delivery of ginger compounds may have a therapeutic potential in relieving asthma. People with asthma should not abandon their inhalers at this point, but drinking ginger tea might be helpful.  (Also – vitamin D deficiency is common in people with asthma.  Talk to your doctor or NP about  supplemental D if your level is below 30-40 ng/ml.)

*Muscle pain – researchers at the University of Georgia studied oral ginger in a randomized group of volunteers given arm exercises with heavy weights designed to cause muscle pain the following days.   Subjects pretreated with ginger capsules had a 25 % decrease in muscle pain on subsequent days.  This should be of interest to many people who exercise in gyms, on the soccer fields or engage in any sport that causes muscle soreness.   

*Nausea from chemotherapy – Ginger has long been used for nausea in pregnancy and is considered safe and somewhat effective.  Researchers at the University of Rochester Medical Center found that giving ginger supplements 3 days before chemotherapy treatment and 3 days after – along with prescription medicines for nausea – reduced nausea levels by 40% compared to patients just receiving prescription medicines for nausea. 

*Colon inflammation:  researchers at the University of Michigan looked at the ability of ginger supplements to reduce colon inflammation and thereby possibly act as a colon cancer prevention agent.  After 28 days of ginger use, subjects had statistically significant reductions in most markers for colonic inflammation, compared to subjects taking a placebo.  This is important, as colon cancer is the third most common cancer among men and women in the US.

*How to use more ginger- Buy ginger root, cut  a thumbnail size piece and dice it into small pieces, then add it to stir-fries and vegetable dishes.  Grate ginger into many dishes, including rice and quinoa, and in baked goods.  Buy ginger tea bags, or make your own ginger tea.  If you feel a little nauseated from eating too much, ginger tea will really help.  Researchers at Chang Gung University in Taiwan have shown that ginger accelerates the emptying of the stomach.

Sadja Greenwood, MD, MPH    back issues on this blog   Check out my novel, Changing the Rules, at local bookstores or Amazon.