Frederick R. Jelovsek MD
Revised 1/7/2000
Emergency contraception is a recent term for the morning-after
pill. Its a
dose of estrogen and progestin (birth control pills) , or progestin only
that, if taken within 72 hours of having sexual intercourse,
helps to decrease the chance of getting pregnant from that one
unplanned episode. Right now, in most countries, this is only
available by prescription. Since medical consultation is not
easily available on short notice and many women are embarrassed to
ask their physicians for emergency contraception, this is a very
underutilized method of birth control.
Many countries, including the U.S., have made emergency contraception available. It is not yet over-the-counter without a
prescription but there are many trials of cooperative arrangements between pharmacists and physicians that are making the medication more readily available upon request.. There are many arguments against making it just and over-the counter, non prescription medication. Pharmacists are concerned about minors buying
it, drug companies worry about liability, many of the public
believe that its availability will discourage the use of more
reliable contraception, and that it may encourage promiscuity and
unsafe sex. One of the biggest medical concerns is how it will be
used by women. Will there be side effects? Will it really reduce
unintended pregnancies?
An Edinburgh study, Glasier A, Baird D:The effects of self-
administered emergency contraception. N Engl J Med 1998;339:1-
4, looked at how women (549) might respond if they had emergency
contraception readily available at home to use as they saw fit.
The control group of women (522) had to get the prescriptions
from their doctors. Of the women who answered detailed questions
at followup, 47% of the study group and 27% of the control group
used emergency contraception at least once over a two year
period. There were no adverse effects of the medication, and 98%
of the study group used the medication correctly.
As far as pregnancies, there were 18 unintended pregnancies in
the study group and 25 in the control group. This was not a
statistically significant difference, but it was consistent with
the literature of pregnancy occurring in 3% of the cycles in
which it was used.
Overall there are studies to show that up to 30% of all births
are unintended and in women under 20, as many as 65% are
unintended. The question becomes as to whether easier access to
morning-after-pills is in the best interest of the health of
women. What do you think?
More information about emergency contraception is available at
at site maintained at Princeton University:
Emergency Contraception
* emergency contraception using birth control pills involves at
least 1.5 mg levonorgestrel taken within 72 hours of intercourse in divided doses 12 hours apart or its equivalent.
Different regimens include:
Plan B®, levonorgestrel, 0.75 mg tab immediately then 0.75 mg tab 12 hours later
Preven®, two blue tabs immediately then two more tablets 12 hours later
Levlite® five tabs immediately then five more tablets 12 hours later
Levora® four tabs immediately then four more tablets 12 hours later
Levlen® four tabs immediately then four more tablets 12 hours later
LoOvral® four tabs immediately then four more tablets 12 hours later
Nordette® four tabs immediately then four more tablets 12 hours later
Ovral® two tabs immediately then two more tablets 12 hours later
Trilevlen® four yellow tabs immediately then four more yellow tablets 12 hours later
Triphasil® four yellow tabs immediately then four more yellow tablets 12 hours later
Trivora® four pink tabs immediately then four more pink tablets 12 hours later
Conjugated estrogens (Premarin®) 10 mg each day for 5 days
Estrone® 5 mg twice a day for 5 days
Copper IUCD insert within 5 to 7 days of exposure
| 
