Emergency Contraception: Still Not Too Late
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Emergency contraception is an effective, if underused, means of preventing pregnancy when unprotected intercourse has occurred. Why should physicians know about emergency contraception? Unwanted pregnancies exact a high price emotionally and economically.1 Inconsistent use of contraceptives, contraceptive accidents and sexual assault are all situations one wishes would never occur, but do. Emergency contraception offers a cost-effective chance to intervene in response to such unanticipated exposures. A major public health advantage of emergency contraception is that its appropriate use decreases reliance on abortion: it is estimated that emergency contraception would prevent one half of all unintended pregnancies, another one half of which would have ended in abortion.2
The underuse of emergency contraception may be related to a lack of marketing. Although the most common type of emergency contraception is nothing more than oral contraceptives given in high doses, manufacturers cannot promote their products for emergency use without specific labeling by the U.S. Food and Drug Administration (FDA). Now that there are two FDA-labeled, dedicated products, Preven (an emergency contraception kit with levonorgestrel 0.25 mg/ethinyl estradiol 50 μg [4 tablets]) and Plan B (levonorgestrel 0.75 mg [two tablets]), it is possible that physician and public awareness of emergency contraception will increase. Plan B appears to be even more effective than the Yuzpe regimen (the combined estrogen-progestin approach) and is significantly better tolerated.3 Change occurs slowly, however, and the politics of contraception may force the discussion and distribution of emergency contraception to maintain a low public profile. Preven and Plan B may not be universally available in pharmacies for some time.
Easy access to postcoital contraception is important because the first dose of emergency hormone must be taken within 72 hours after unprotected intercourse. Studies have shown that emergency contraception can be self-administered. In one study,4 women who used emergency contraception at home were more likely to use it than those who had received instructions about it but had to call a physician to obtain it. During the 12-month study period, the treatment group did not use emergency contraception more than once, suggesting that it was used appropriately—as an emergency measure, not as the sole method of contraception.
Physicians should do their part to ensure knowledge and to facilitate access to emergency contraception. Ideally, emergency contraception should be available without a prescription. In a pilot program in Washington state, women could obtain emergency contraception directly from pharmacists. During its implementation, almost 12,000 prescriptions were filled (personal communication, Kristin Marciante, March 15, 2000).
Although more like programs may be established in the future, what can physicians tell their patients in the meantime? First, physicians should incorporate education about emergency contraception into routine office visits—advising all patients of reproductive age about the available options, offering patients a prescription or a ready-made packet from the office so that they will have emergency contraception available if they need it.
Physicians can create emergency contraception packets by using the options listed in Table 2 of the accompanying article.5 Preven and Plan B can be obtained through federally funded clinics and college health centers and can also be ordered from a drug distribution house or over the telephone by qualified providers (to obtain Plan B, telephone 800-330-1271 or fax 877-407-3801).
An excellent Web site (http://ec.princeton.edu/) is available, and there is also an information line that will answer questions from physicians and patients (888-NOT-2-LATE). Emergency contraception is not an effective method of ongoing birth control. However, when used as indicated, it may prevent unintended pregnancies and reduce the number of abortions.
Dr. Wellbery is an assistant professor in the Department of Family Medicine at Georgetown University School of Medicine, Washington, D.C. She is also assistant deputy editor of American Family Physician.
Address correspondence to Caroline Wellbery, M.D., 3800 Reservoir Rd., NW, 212 Kober-Cogan, Georgetown University, Washington, DC 20007.
1. Trussell J, Ellertson C, Stewart F, Koenig J, Raymond EG, Shochet T. Emergency contraception: a cost-effective approach to preventing unintended pregnancy. Women's Health Prim Care. 1998;1:55–69.
2. Henshaw SK. Unintended pregnancy in the United States. Family Plann Perspect. 1998;30:24–946.
3. Task Force on Postovulatory Methods of Fertility Regulation. Randomised controlled trial of levonorgestrel versus the Yuzpe regimen of combined oral contraceptives for emergency contraception. Lancet. 1998;352:428–33.
4. Glasier A, Baird D. The effects of self-administering emergency contraception. N Engl J Med. 1998;339:1–4.
5. Wertheimer RE. Emergency postcoital contraception. Am Fam Physician. 2000;62:2287–92.
Copyright © 2000 by the American Academy of Family Physicians.
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