In 1974, a Canadian professor, Albert Yuzpe, was the first to develop an emergency hormonal contraceptive; his plan has been referred to as the Yuzpe regimen. Yuzpe used a high dose of combination birth control pills to inhibit pregnancy after unprotected intercourse. This practice became the standard for emergency contraception (EC; also referred to as “morning after” contraception, or ECPs—emergency contraceptive pills). Emergency contraception is designed to prevent pregnancy after unprotected vaginal intercourse—in case of unanticipated sexual intercourse, contraceptive failure, or sexual assault. It is estimated that half of the women who seek emergency contraception did not use any contraception, 35% had trouble with a condom or other barrier method, and the remaining 10% missed a birth control pill, experienced a rape, or were not able to use withdrawal (F. Stewart, Trussell, & VanLook, 2004). The typical user of emergency contraception is single, without children, and between the ages of 15 and 25.
Two types of emergency contraception have been approved by the FDA. Plan B, a progestin-only method, was approved in 1999. Preven, a combination of estrogen and progestin, was approved in 1998, but the manufacturer ceased its production in 2004. Some physicians have also adapted standard oral contraceptives for emergency contraceptive use and copper IUD insertion within 5 days of unprotected intercourse (F. Stewart, Trussell, & VanLook, 2004).
When a woman is given emergency contraception within 72 hours of unprotected intercourse, her risk of pregnancy is reduced by 75% (Trussell, 2004), and there is some evidence that this may be effective up to 120 hours after unprotected intercourse (Ellertson et al., 2003). The earlier these methods are begun after unprotected sexual intercourse, the higher the effectiveness rates. IUD insertion has a 99% effectiveness rate (F. Stewart et al., 2004). The IUD insertion method is used much less frequently than ECPs, mainly because women who need emergency treatment often are not appropriate IUD candidates (F. Stewart et al., 2004). Emergency hormonal contraception costs approximately $25 plus the cost of an office visit and lab tests.
Emergency contraception has been available worldwide for over 2 decades (Wertheimer, 2000). Although a prescription is necessary to obtain emergency contraception in the United States, it is available over the counter in many other countries. In fact, women in 37 countries, including Denmark, Finland, France, Israel, Norway, Portugal, South Africa, Sweden, and the United Kingdom, can obtain emergency contraception over the counter, and in France EC is free (F. Stewart, Trussell, & VanLook, 2004).
It has been recommended that EC be available over the counter in the United States as well, although this has been very controversial. The schism became very clear in 2005, when the FDA postponed indefinitely a decision on whether emergency contraception should be available without a prescription—a ruling that came after clinical and scientific evidence had shown that the drug was safe and effective (Neergaard,
2005) . Some proponents of emergency contraception argued that the FDA let politics overrule science. The FDA expressed concern over the drug getting into the hands of younger teenagers.
Hormonal emergency contraception methods have several side effects, including nausea, vomiting, cramping, breast tenderness, headaches, and abdominal pain (these side effects are less common in women who take Plan B, because it has no estrogen). Sometimes the nausea and vomiting can be so severe that an additional hormonal dosage is necessary. The majority of these symptoms disappear within 1 to 2 days after treatment. Overall, women who use ECPs are satisfied with the method and would recommend it to other women in similar situations (Harvey et al., 1999).
Other methods of emergency contraception include early abortion procedures (also called menstrual extraction). This procedure involves the removal of uterine contents
What options are available for emergency contraception? How do these methods work?
prior to a positive pregnancy test. Menstrual extraction has a high likelihood of incomplete abortion and physicians recommend waiting until at least 7 weeks’ gestation. Today various drugs are used to induce early abortion. We will discuss these drugs later in this chapter.
An ingredient in cottonseed oil that, when injected or implanted, may inhibit sperm production.