Health Conditions

Whether it is the result of a broken condom or a sexual assault, unprotected (without contraception) sexual intercourse may occur. To avoid a possible unwanted pregnancy, emergency contraception may be utilized. Although emergency contraception is often called the “morning after” pill, it is not a method to use routinely. It should be restricted to just what the name indicates - emergencies.

Currently several methods are used for emergency contraception. The most common methods work by preventing conception. Another way is to force the elimination of a fertilized egg.

In 1999, the FDA approved for use in the United States a contraceptive that is used only to prevent conception in an emergency situation. Under the brand name Plan B, the product has 2 tablets containing the progestin, levonorgestrel. Depending on the time of the woman’s cycle when it is taken, it prevents conception by interfering with ovulation, fertilization, and/or implantation. To use it, the first dose should be taken as soon as possible. A second dose is then taken 12 hours after the first dose. According to study results, Plan B may be up to 95% effective, if the first dose is taken within the first 24 hours and the second dose is taken on time. If the first dose is delayed until 72 hours, effectiveness decreases to about 89%. After 72 hours, effectiveness decreases significantly. Although its manufacturer has asked the FDA to make Plan B a non-prescription product, it is still a prescription drug. Currently, however, it may be obtained without a prescription from designated pharmacies in the states of Alaska, California, Hawaii, Maine, New Hampshire, New Mexico, and Washington.

Taking high doses of certain regular COCs may also prevent conception after unprotected sex. Like Plan B, however, this method also loses effectiveness if it is not started quickly. Each dose consists of 2 to 4 tablets of certain COC brands. A woman who needs to use this method, which may also be called the Yuzpe Method, should check with a physician or pharmacist for recommendations on the brand of COC to use and the number of tablets to take. As with Plan B, the first dose of the COC should be taken as soon as possible within 72 hours. A second dose is then taken 12 hours after the first dose.

Common side effects from either Plan B or high doses of COCs may include breast tenderness, headache, nausea, pain in the abdomen, and tiredness. Because many women using Plan B or high dose COC also experience vomiting, an anti-nausea drug may be recommended before taking the first dose. If vomiting occurs within one hour of taking the COC, the dose should be repeated. Neither Plan B nor high doses of a COC can end a pregnancy if a fertilized egg has already implanted in the uterus.

For emergency use, a copper IUD can also prevent fertilization and/or implantation if it is inserted no later than 5 to 7 days after the incident. It is left in place at least until the start of the next menstrual period, but it may be left in place for 5 years or longer, if it is chosen as continuing contraception. With pregnancy prevention nearing 100%, inserting an IUD is more effective for emergency situations than taking oral forms of emergency contraception. IUDs are much more expensive, though, and they have to be inserted, checked, and removed by a doctor. They are not recommended for women who may have or who may have been exposed to an STD. IUDs may cause abdominal cramping and vaginal bleeding in the first few days or weeks after their insertion.

Another method of emergency contraception ends a pregnancy. Sometimes known as a “medical abortion”, this method requires that two different drugs be taken. First, one 600 mg dose of mifepristone (Mifeprex) is taken as soon as possible within 49 days of the missed menstrual period. Two days later, one 400 microgram dose of misoprostol (Cytotec) must be taken. Mifepristone, commonly known as RU-486, blocks the effects of progesterone, which is necessary to maintain a pregnancy. Misoprostol belongs to a group of drugs known as prostaglandins, which cause the uterus to tighten. Usually, uterine contents (such as a fertilized egg) are forced out of the uterus. Women who use this form of emergency contraception must follow-up with a physician 14 days after taking misoprostol to determine whether the treatment was effective. Mifepristone/misoprostol is available only through specific physicians who must be able to perform abortive surgery if the treatment is ineffective.

Women with an IUD in place, those taking medications to prevent blood clotting, and those who have taken certain steroid medications for long periods of time cannot use mifepristone/misoprostol. This method also should not be used for women who have or have had:

• Adrenal gland dysfunction
• Allergic reactions to mifepristone or misoprostol
• Bleeding disorders
• Ectopic pregnancy (a fertilized egg that has implanted outside the uterus)
• Tubal pregnancy (a fertilized egg that has implanted inside the fallopian tube)

Between 80% and 90% of women who use mifepristone/misoprostol experience abdominal cramps and/or heavy vaginal bleeding. Other common side effects from mifepristone/misoprostol include diarrhea, dizziness, headaches, nausea, and tiredness.

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Note: The above information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist, or other healthcare professional. It is not intended to diagnose a health condition, but it can be used as a guide to help you decide if you should seek professional treatment or to help you learn more about your condition once it has been diagnosed.