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. 

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