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No medical reason to deny teens emergency contraception: up to 95% effective.

CAMBRIDGE, MASS. -- Although controversy rages about whether emergency contraception should be available without a prescription in the United States, as it is in 25 other countries, "medically, there's no reason it shouldn't be over the counter," Dr. M. Sheila Desmond said at a meeting on primary care pediatrics sponsored by Harvard Medical School.

"It's extremely safe. There are virtually no contraindications to its use, and there's no abuse potential," said Dr. Desmond of the Chelsea (Mass.) HealthCare Center. The regimens are easy to dose and to use. There are no important drug interactions.

Every sexually active adolescent who desires it should be offered a prescription for emergency contraception, in Dr. Desmond's opinion. "You can tell girls to think of this as their fire extinguisher--it's something she can have easily available to put a fee out."

A pilot project in Washington state examined the implications of over-the-counter emergency contraception there from February 1998 to June 1999. After a 3-month media campaign introducing the project, 130 pharmacies offered emergency contraception on demand. The 1,500 participating pharmacists were trained to dispense the drugs through physician-pharmacist partnerships. Usage was reviewed quarterly. Patients paid $30-$40 for the pills.

Almost 28,650 women obtained emergency contraception during the study period. Abortion rates for that period decreased by 5%, and teen pregnancy rates decreased by 7% (Family Planning Perspectives 33[4]:172-75, 2001.)

Emergency contraception consists of several tablets of high-dose birth control pills. Taken within 24 hours of unprotected sex, the drugs are 95% effective; taken after 24 hours, but before 72 hours, they are 89% effective. They work in several ways: by suppressing ovulation, disrupting endometrial development to prevent implantation, and altering the effectiveness of tubal transport of the ovum.

A pregnancy test may be indicated before prescribing emergency contraception because the high doses of hormones are contraindicated in pregnancy. "Before you prescribe it, ask the girl when her last period was and if it was normal," said Dr. Desmond. "If she isn't sure when the period was, you can do a pregnancy test."

Any oral contraceptive can be used for emergency contraception; the dose varies with the type of pill used. (See chart.) However, two packaged emergency contraception products are now available: Preven and Plan B. Preven consists of a prepackaged pregnancy test and four tablets of Ovral equivalent. Plan B consists of two tablets of levonorgestrel 0.75 mg.

Girls should be told to use their emergency contraception as soon as possible after they have had intercourse unprotected by any barrier method, if they suspect barrier method failure, or if they have missed three or more tablets of their oral contraceptive.

The most common side effects are nausea and vomiting. Dramamine 25-50 mg, taken 30 minutes before the first dose, can decrease these problems, she said.

Plan B causes much less nausea than the other regimens and it is much more effective than high-dose birth control pills, she said. "It can be taken up to 5 days after unprotected intercourse, but, like the other regimens, it's much more effective if taken earlier. The faster, the better."
Doses of Emergency Contraception

Oral                 First       Second Dose
Contraceptive        Dose      (12 hours later)

Ovral              2 tablets      2 tablets
LoOvral            4 tablets      4 tablets
Levlen             4 tablets      4 tablets
Triphasil          4 tablets      4 tablets
Tri-Levlen         4 tablets      4 tablets
Necon 1/35         4 tablets      4 tablets
Alesse             5 tablets      5 tablets
Levlite            5 tablets      5 tablets

Source: Dr. M. Sheila Desmond


Mid-Atlantic Bureau
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Title Annotation:Children's Health
Author:Sullivan, Michele G.
Publication:Family Practice News
Geographic Code:1USA
Date:Feb 1, 2004
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