Emergency Contraception: Now Available for Everyone – Did you know it always was?

The l960s brought us birth control pills, giving millions of women the power to decide if and when they wished to become pregnant. Over the years, it was discovered these same combination pills of estrogen and progestin could be used as emergency contraception protection (ECP) when given in high doses. This technology has been available for over 20 years, but only about one percent of American women have ever used it. In l997, the Food and Drug Administration (FDA) finally gave its endorsement to this now common application of oral contraceptives and even specified six brands of birth control pills as safe and effective for this purpose. On September 1, l998, the FDA approved PREVEN™ by Gynetic, the first product packaged and marketed solely as an emergency contraception method. You simply ask your doctor or nurse practitioner to prescribe it. Then you keep it in your medicine chest in case of…. well, just in case.

Half of the 5.4 million pregnancies occurring annually in the U.S. are unintended. In May of l997, the CDC estimated that half of these unintended pregnancies are due to contraceptive failure. Some experts estimate that generalized use of ECP could lower that rate by 50 percent and prevent more than 800,000 abortions per year. Sharon Camp, Ph.D., president of Women’s Capital Corporation and former coordinator of the International Consortium for Emergency Contraception, believes it is time for the U.S. to catch up to the nearly 40 countries (including Great Britain, Denmark, Sweden, Switzerland, Germany, Finland and New Zealand) that already sell prepackaged contraceptive pills for emergency use. “We believe American women need more contraceptive options,” says Dr. Camp. “Emergency contraceptives are uniquely important for women’s health because they are the only method women can use after sex to prevent pregnancy.”

A national survey of American women by the Kaiser Family Foundation found that:

Only 33 percent of women have ever heard of emergency contraceptive pills.
96 percent have never discussed ECP with their health care professional.
50 percent said they would like to use ECP.

While it may not shock many that the highest rate of unintended pregnancies occurs in the 15-19 age group (78 percent), it might surprise you to learn the next highest group is the 40 to 44-year-olds (51 percent). By income, the highest percentage of unintended pregnancies occurs in the population making more than $34,000 yearly (43 percent).

The pills are taken according to the Yuzpe regimen, named after the Canadian physician who developed it in the l970s, which is well-documented in clinical research to reduce the number of pregnancies from approximately 8:100 to less than 2:100. Until now, you had to purchase a month’s worth of pills, the only way they are packaged, and remember your doctor’s instructions on how many and when to take them. After taking the pills you needed from the pack, you would throw the rest away. PREVEN™ eliminates that waste and offers women a complete package to safely prevent pregnancy. The kit consists of :

A pregnancy test (to make sure she isn’t pregnant from earlier in the month or a previous month),
Two doses (of two pills each) of contraceptive pills,
A detailed patient information/instruction book.

You will soon see ads for this product in Entertainment Weekly, People, Glamour, Cosmopolitan, Redbook and hear them on the radio. Health professionals can read the information in medical journals such as Obstetrics and Gynecology.

Though we have nicknamed this treatment “the morning after pill,” in reality, the first dose of ECP needs to be taken within 72 hours of having sex. The second dose follows 12 hours later. Reported side effects are nausea (16-50 percent), vomiting (less than 30 percent), cramping, breast tenderness, headache and fluid retention. One study reported no side effects in 75 percent of the participants. For women who suffer from nausea and vomiting or who cannot take estrogen for some reason, there is more promising news. The Women’s Capital Corporation has announced that it plans to submit a new drug application to the FDA within the next few months for a progestin-only ECP. Until then, progestin only birth control pills (so-called “mini-pills”) can be substituted, but you have to take 20 pills for each dose.

Emergency contraceptive pills are not abortive agents like RU-486 (the so-called abortion pill), which disrupts an established, i.e. implanted, pregnancy. The pills work on the same premise as normal birth control pills. They inhibit ovulation and prevent the endometrium, the lining of the uterus, from becoming hospitable to implantation. The difference, and cause of some controversy, is in the timing. If you are taking the oral contraceptives daily from the start of your cycle, you won’t ovulate. However, if you’re taking the pills on an emergency basis, you might not know you had already ovulated, in which case preventing a potentially fertilized ovum from implantation in the endometrium could be the method of birth control. Some religious groups are not willing to risk this possibility and will not approve of this method. ECP, like oral contraceptives taken daily during the month, have not been shown to interrupt an established pregnancy, nor will they protect you from pregnancy resulting from any future sexual activity during the rest of that cycle.

Emergency contraceptive pills are hard on a woman’s body, and few health care providers would prescribe them routinely. “You cannot do this all the time. It’s for emergency use only,” says Teresa Zephro, RN, an educator with Planned Parenthood. ” Women can’t always wait for doctor’s appointments. This gives them help right at their fingertips, at their own disposal.” It should also be noted that ECP provides no protection for any sexually transmitted diseases, including HIV transmission.

What’s in the future? Current projects include a clinical study for a progestin-only patch; a program in Washington state training pharmacists to distribute ECP under a physician’s protocol; a study to examine alternatives in the Yuzpe regimen, such as a change in dose or timing; and a study of anti-emitics to prevent nausea associated with the Yuzpe Regimen. The recent proliferation of new products in the field of emergency contraception means that methods available for a woman to prevent pregnancy are increasing in number, and the window of opportunity for when she acts is widening. Whether you have been a victim of sexual assault or a broken condom, this technology is available to you right now.

Ivanhoe asked Orlando doctor Sherry Brooks, M.D., to comment on ECP:

“I’ve been aware of and have used this method of contraception in my practice for past 15 years. It is not used for routine birth control because the side effects are real and uncomfortable. Most of my patients did experience nausea and some vomiting, but in a special situation for emergency use it’s a helpful addition to a woman’s options.”

Emergency Contraception World Wide Web Server operated by the Office of Population Research at Princeton University
Provides comprehensive information, instructions, methods of ECP including IUDs, links to other sites, clinics, news and research materials.

PREVEN™ (Gynetic)
Information on the company and the product. They also provide a hotline for anyone needing information or having questions. 1-888-PREVEN2 (1-888-773-8362)

Planned Parenthood
This site contains information on ECP, IUD, as well as hormone pills, instructions, side effects, costs, products, how and where to get treatment, and links to other sites. They have a hotline, which will give you the five nearest sites where you can get ECP. Call 1-888-NOT-2-LATE.

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