Emergency Contraception

July 13, 2011

Each year there are millions of unplanned, and often unwanted, pregnancies due to lack of contraception or contraception failure. We have all read about the epidemic of teen pregnancies in the United States and other countries.

Each year there are millions of unplanned, and often unwanted, pregnancies due to lack of contraception or contraception failure. We have all read about the epidemic of teen pregnancies in the United States and other countries. Unplanned pregnancy can occur with other age groups as well, particularly women in their 40s. Although effective contraception is readily available there are times when, for example, a condom will break or a woman forgets to take her birth control pills. Emergency contraception provides a safe and effective emergency method for birth control in these situations.

There are a number of emergency contraception methods available. Each method is effective, but requires use within 72 hours (3 days) of sexual intercourse. Furthermore, although effective, none of these methods is as effective as the regular use of birth control, such as oral contraceptives, Depo-Provera, or condoms, so emergency contraception should not be used as a routine contraceptive method. In fact, daily use of the birth control pill prevents 97-99% of pregnancies, while the emergency method prevents about 75% of pregnancies. Thus, as the name implies, emergency contraception is for "emergency" use only.

When a woman is concerned about contraceptive failure, or has unprotected sexual intercourse, there are a few basic steps necessary before emergency contraception is taken. Patients who are already established with a physician or other health care provider should simply phone the office that day (or the next morning) and request emergency contraception. Most doctors will require a pregnancy test to insure you are not already pregnant from intercourse that occurred over the past few months. Some will require a physical exam, but this is not universal. Patients without a doctor may consider calling a local Planned Parenthood or similar office to receive a prescription for the medication. Another alternative is to visit the Web site at http://ec.princeton.edu/  or call the Reproductive Health Technologies Project at their 24-hour, toll-free number: 1-800-NOT-2LATE for information on emergency contraception providers in your area. Both of these resources are currently free and provide information in both Spanish and English. Please note that since this method is effective within 72 hours that it is almost never necessary to visit the emergency department or phone your health care provider right after the unprotected intercourse just to obtain emergency contraception. Simply phone when the office opens, or, on weekends, contact the answering service during the day.

The most common method of emergency contraception is the "Yuzpe" method, named after a Canadian gynecologist. This method involves taking a specific number of birth control pills 12 hours apart. It is thought to work in two ways. The first is to render the inside lining of the uterus inhospitable to the egg. The microscopic egg passes out of the body unnoticed. This method also may block ovulation so that the ovary does not release an egg at all. Therefore, although the Yuzpe method may prevent an egg from being released, there are some cases where an egg is already fertilized and is prevented from implanting in the uterus. This may have personal or religious implications for the patient considering this method. As this method is quite safe, any woman who is not already pregnant can use this method within 72 hours of unprotected intercourse. Women taking other medications or being treated for medical problems should always discuss new medications with their doctor.

All medications have potential side effects. The Yuzpe method can cause nausea in some women, so you may wish to ask your physician or health care provider for an anti nausea medication just in case. You should expect a menstrual period within 21 days of taking the pills, and if one does not occur then there is a chance the medication did not work and you are pregnant. In this case a thorough evaluation is in order to rule out pregnancy. An important point is that even after taking emergency contraception you should strongly consider resuming, or starting, regular contraception, as emergency contraception is not nearly as effective as the regular use of birth control.

Regular use of contraception is the best form of birth control other than sexual abstinence. However, the Yuzpe method of emergency contraception can theoretically prevent almost 2 million unplanned pregnancies each year in the United States alone. Experts predict that increased public knowledge of this method will lead to about 800,000 fewer medical abortions each year. Hopefully increased knowledge of emergency contraception will prevent many unplanned pregnancies.