Emergency+Contraception

Caitlin Pabst __ Emergency Contraception __ ** Emergency Contraception ** Emergency contraception (EC) is a method to prevent pregnancy in women that have engaged in unprotected sexual intercourse (Raine et al., 2005). EC is taken after sexual intercourse where no method of birth control was used, after a rape or sexual assault, when a condom breaks or a diaphragm slips out of place, or if the woman was inconsistent with taking her birth control pill (Storck, 2010). EC works by delaying or preventing ovulation. EC can be taken orally, or it can be administered in the form of an intrauterine device (IUD) (Jurow, 2011). The current US FDA currently approves the methods of the oral emergency contraceptive, the Yupze regimen, and the IUD (Raine et al., 2005). The approved oral ECPs are Plan B, Plan B One-Step, Next Choice, and EllaOne. Emergency contraception is currently available over-the-counter or by prescription for male and females. ** Common Alternative Names ** Emergency contraception is also commonly referred to as the “morning-after” pill, postcoital contraception, Plan B, and birth control – emergency (Storck, 2010). ** History **  It is estimated that approximately half of all pregnancies in the United States are unintentional (Ellertson et al., 2003). In 1995, the International Consortium for Emergency Contraception was established by international organizations in seven different countries, and was supported by the Rockefeller group. Its purpose was “to promote EC as part of a mainstream reproductive health care world-wide.” The first form of the progestin-only emergency contraception pill (ECP) was called Postinor-2 and was approved by the US Food and Drug Administration (Cameron, 2011). In 1997, the RDA rejected the proposal to make EC available over-the-counter because of the widely held belief that increased availability of EC would only promote risky sexual behavior (Raine et al., 2005). Plan B is one of the most popular choices of EC, and was approved by the US FDA in 1999. Since then, three other pill options, the Yupze regimen, and the intrauterine device have all been approved by the FDA (Jurow, 2011). It is estimated that the use of emergency contraception as a back-up method of birth control facilitated a 43 percent drop in abortion rates between 1994 and 2000 (Jurow, 2011). ** Emergency Contraception Pill (EPC) ** Ulipistal acetate (UPA) and levonorgestrel (LNG) are the active ingredients in EC pills. They can contain either a combination of estrogen and progestin, or progestin-only. Emergency contraception is effective up to 120 hours after having unprotected intercourse, but its effectiveness is lowered the longer one waits (Planned Parenthood, 2011). The oral ECPs approved by the FDA are as much as 89 percent effective when taken within 24 hours of the incident of unprotected sexual intercourse (Storck, 2010). Plan B package even states, “seven out of every eight women who would have gotten pregnant will not become pregnant.”   Plan B, Plan B One-Step, and Next Choice, and EllaOne are all available choices for emergency contraception, but they differ slightly. Plan B is an oral contraception consisting of two pills that must be taken separately, 12 hours apart. Each dose contains 0.75 mg LNG. Plan B One-Step is the more current version of Plan B, and is only one pill containing 1.5 mg of LNG (Planned Parenthood). Next Choice is also a one-time pill, and contains 1.5 mg of LNG. Ella is the only type of ECP that contains 30mg of UPA as its active ingredient rather than LNG (Planned Parenthood, 2011). EllaOne is the only oral EC that requires a prescription to obtain, while the others can be obtained over-the-counter and at family planning clinics. Men and women can obtain Plan B One-Step and Next Choice over-the-counter if they are 17 or older. Men and women can obtain Plan B over the counter if they are 18 or older. If they are younger, they must get a prescription from their provider (Storck, 2010). When taking EC, it is suggested that people take an anti-nausea medicine before taking an oral emergency contraceptive because it helps to alleviate some of the side effects. Side effects are often mild and those that experienced side effects reported having nausea (23%), abdominal pain (19%), fatigue (17%), headache (17%), change in menstrual flow (26%), dizziness (11%), breast tenderness (11%), vomiting (7%), and diarrhea (5%). Further, progestin-only emergency contraception have a lower rate of side effects than estrogen-progestin pills (Jurow, 2011). ** Intrauterine Device (IUD) **  The intrauterine device is inserted into the uterus to prevent pregnancy. There are two types of IUDs that are used, one being a copper-containing device and a hormone-containing device that releases progestogen. The copper intrauterine device (Cu-IUD) is effective because it deters sperm mobility, and the presence of a foreign object in the uterus irritates the lining and wall, making it almost impossible for the egg to implant. The most common Cu-IUD in the United States is Paraguard, and the most common hormone IUD is Mirena. IUD is 99.9 percent effective up to 120 hours after having unprotected sex, but is much less popular (Cameron et al., 2011; Storck, 2010). This is because unlike an oral EC, an IUD requires skilled medical staff to insert it, and there is a slight medical risk when undergoing any procedure. Further women tend to choose oral emergency contraception instead of an IUD because of financial costs since a majority of the population that use emergency contraception are younger and of lower income (Raine et al., 2005, Cameron, 2011). ** Yupze Regimen ** In 1974, Canadian Professor A. Albert Yupze is accredited with the Yupze regimen, which is a method of emergency contraception consisting of two doses of regular birth control pills that must be taken 12 hours apart exactly (Ellertson et al., 2003). Each dose consists of between two and five combined oral estrogen-progestin contraceptive pills (COCP) that contain ethinyl estradiol and levonorgestrel. The Yupze regimen promotes the off-label use of estrogen-progestin birth control pills in concentrated doses and is 74 percent effective (Jurow, 2011). The regimen must start no later than 72 hours after unprotected sex (Ellertson et al., 2003; . In 1997, the FDA recognized the use of birth control pills in concentrated doses as a form of emergency contraception, following the Yupze regimen, was both safe and effective. However, it is currently proven that progestin-only emergency contraception pills are more effective, and result in less severe side effects (Juro, 2011). ** Controversy and Misconception **  The availability of emergency contraception has been a debated topic in recent decades. Pharmacists and clinicians are concerned that increased availability of EC over-the-counter will cause patients to increase their sexual risk-taking pertaining to the frequency of sex and the number of sex partners, and it would thus increase the risk and spread of STIs, STDs, and HIV. However, research shows there is no positive correlation with the increased availability of EC and risky sexual behavior (Raine et al., 2005). A common misconception of emergency contraception is that some believe EC is the “abortion pill” and not just for preventing pregnancy, and this is wrong. The abortion pill is taken 4 to 7 weeks after the point of contraception, and is //not// the same thing as emergency contraception (Storck, 2010). Another misconception about EC is that if a person takes multiple doses of an ECP at the same time, that the dose will be more effective. Taking more pills than directed will not increase the percent effectiveness of active drug in the respective method of contraception. References: // The Morning-After Pill: Emergency Contraception. // Planned Parenthood. 2011. Retrieved from: [] Cameron, Sharon, MD, MRCOG et al. // LNG may still be the most cost-effective oral emergency contraceptive method: author’s response. //Journal of Family Planning and Reproductive Healthcare. Oct 2011. 37:2. Retrieved from: http://jfprhc.bmj.com/content/37/2/122.extract Ellertson, Charlotte, MPA, PhD, et al. // Modifying the Yuzpe Regiment of Emergency Contraception: A Multicenter Randomized Controlled Trial. // Obstetrics & Gynecology: June 2003. 101:6. P 1160-67. Retrieved from: http://journals.lww.com/greenjournal/Abstract/2003/06000/Modifying_the_Yuzpe_Regimen_of_Emergency.5.aspx Jurow, Ronna. // Gynecology in Practice: Contraception: Emergency Contraception. // Blackwell Publishing: 2011. P 123-32. Retrieved from: http://books.google.com/books?hl=en&lr=&id=ksjJcx1CeKcC&oi=fnd&pg=PA123&dq=Ronna+Jurow+Emergency+Contraception&ots=OBQd2kEb2H&sig=K8OZRPAX9tK0LakfpArqrfj0fr8#v=onepage&q=Ronna%20Jurow%20Emergency%20Contraception&f=false Raine, Tina R. MD, MPH. et al. // Direct Access to Emergency Contraception Through Pharmacies and Effect on Unintended Pregnancy and STIs: A Randomized Controlled Trial. //Journal of American Medical Association. 5 Jan 2005. 293:1. Retrieved from: http://journals.lww.com/obgynsurvey/Abstract/2005/04000/Direct_Access_to_Emergency_Contraception_Through.21.aspx Storck, Susan, MD, FACOG, et al. // Emergency Contraception. //U.S. National Library of Medicine: Webline Plus. 30 March 2010. Retrieved from: http://www.nlm.nih.gov/medlineplus/ency/article/007014.htm Image 1: Retrieved from: [|http://www.womanhealthproblem.com/] Image 2: Retrieved from: http://www.planbonestep.com