EMERGENCY CONTRACEPTION

"oh no, what did I do!"

Emergency contraception is just that...emergency prevention of pregnancy following intercourse when errors in or lack of birth control occurred. It is not a substitute for responsible contraception. What if....

  • the condom slipped or leaked
  • I forgot to use my diaphragm
  • I didn't expect to have intercourse and there was no protection available
  • I forgot to take my pills this month
  • I was forced to have intercourse

 

TIMING IS CRUCIAL

72 hours with pills.....

5 days with IUD

The two most common forms of emergency contraception involve taking a preparation of steroid hormones or placing a copper IUD. The "morning after" or post-coital pill is a preparation of ethinyl estradiol and norgestrel or levonorgestrel...the steroid hormones commonly found in birth control pills. The pills must be taken in a 24-hour period within 72 hours after intercourse. After that time period all bets are off. This method, originally known as the Yuzpe method, has been extensively tested in clinical trials over the last ten years. The cumulative evidence suggest a 75% decrease in conceptions. It is felt that the unintended pregnancy rate could be lowered by nearly 1.7 million pregnancies per year and this would significantly impact and lower the number of abortions performed in the US. This is especially important in that the mechanism of pregnancy prevention is at the level of preventing conception and not implantation.

A pregnancy test should be checked before and three weeks after the pills are taken. Contraindications to using oral contraceptives include:

  • a history of thromboses(blood clots)
  • prior stroke
  • liver or gall bladder disease
  • known pregnancy

 

Side affects of the pills include nausea and vomiting, breast tenderness, headache and dizziness. Vomiting may decrease the effectiveness of the regimen therefore antiemetics such as Dramamine or prescription medicine may be recommended by your doctor. To date only one manufacturer, Gynetics, manufactures an emergency contraceptive kit known as Prevens. It is packaged together with a urinary pregnancy kit.

Insertion of a copper IUD within 5 days of unprotected intercourse has been shown to be effective in preventing pregnancy with a failure rate of 0.1% This method mostly works by preventing implantation so is in effect and abortifacient. Studies to date are small in number. Major contraindications include:

  • History of multiple partners
  • recurrent or suspected sexually transmitted disease or pelvic inflammatory disease
  • prior problem with an IUD i.e. bleeding, infection, perforation

Precaution should be exercised in women with valvular heart disease and prior ectopic pregnancies.

Mifipristone or RU486 is a single oral dose antiprogesterone with the major advantage of limited side affects especially nausea and vomiting. In two studies published in the New England Journal of Medicine a pregnancy rate of 0 was achieved in 1000 women. NEJM 1992, 305; 927

NEJM 1992, 327:1041 Contraception 1994 50:101