editor’s note: The following was originally published in Diary From a Week in Practice in the February 15, 2004, issue of American Family Physician: KS felt that she had failed this 16-year-old young woman, who had just discovered that she was pregnant. The teenager had been in the office twice during the previous year, each time for a mild upper respiratory infection. Both times she admitted to being sexually active. KS had counseled her about birth control methods, including condoms, which have the added benefit of preventing sexually transmitted diseases. On the previous visit, she had written a prescription for birth control pills, although the patient now admitted she had never filled it. At the time, her parents did not know that she was sexually active. KS had volunteered to talk to the girl’s mother, but the young woman had refused. “Now my mother knows,” she admitted ruefully. KS wondered sadly what more she could have done.1
to the editor: The doctor in this vignette1 could have done more. Emergency contraception (EC) could have been an answer for this teenager. Health care professionals who work with women concerning reproductive issues need to educate their patients that they have an option for preventing pregnancy if a condom breaks or if they have unprotected intercourse for any reason. Physicians can provide prescriptions or actual tablets that constitute emergency contraception whenever regular oral contraception or condoms are dispensed.
At our office, we have developed preprinted prescription pads for the three most common types of emergency contraception available to our patients: levonorgestrel (Plan B), the Yuzpe regimen (Preven), and Lo/Ovral. (It should be noted that Preven is no longer manufactured, but is available while supplies last.2) These prescription pads are kept in the usual places, including next to the boxes of condoms that we distribute, with a sign that reads: “Giving Condoms? Think EC!” to prompt staff to remember. Our nurses are trained in an emergency contraception telephone protocol, enabling them to gather an appropriate history and to order prescriptions with physician approval when indicated.
The use of emergency contraception in adolescent populations may be one reason for the recent decline in births to teen mothers.3 In general, users of emergency contraception are not substituting this for regular contraception.4 In some states, pharmacists dispense emergency contraception packs directly to patients.5 Although the U.S. Food and Drug Administration recently has rejected over-the-counter approval of emergency contraception, the arguments for its safety were not in question; the decision was widely thought to be based on political considerations.
Emergency contraception is safe and effective. Family physicians who provide contraception always should include discussion of the use of emergency contraception with patients who are or could potentially become sexually active.