Morning-after pill
From Academic Kids
The morning-after pill, more properly termed emergency contraceptive pills (ECPs), is the use of high doses of the hormones found in regular oral contraceptive pills which, when taken after unprotected intercourse or sex in which a contraceptive failure (such as a torn condom) occurs, may prevent pregnancy from occurring. There are several ways ("mechanisms of action") by which emergency contraceptive pills may work. Depending on the time during the menstrual cycle that they are taken, ECPs may inhibit or delay ovulation, inhibit tubal transport of the egg or sperm, interfere with fertilization, or alter the endometrium (the lining of the uterus), thereby inhibiting implantation of a fertilized egg. In this respect, emergency contraceptive pills work by triggering the same hormonal changes in the body as regular birth control pills (only they require a higher dose and are less effective than ongoing hormonal contraceptives) or even breastfeeding.
The phrase morning-after pill is a misnomer that is falling out of use due to the fact that it can be effective for up to 120 hours after sexual intercourse. Emergency contraception or "emergency contraceptive pills" is more accurate and preferred by the medical community. "Emergency contraception" may also refer to methods other than pills, including the Copper-T IUD (intrauterine device), which is 99% effective in preventing a pregnancy for up to five days after intercourse.
The morning-after pill should not be confused with abortifacient pills, such as mifepristone (aka RU-486) or methotrexate, which cause an abortion after implantation has occurred. Emergency contraception does not cause an abortion. In fact, emergency contraception prevents pregnancy and thereby reduces the need for induced abortion. Implantation begins five to seven days after fertilization (and is completed several days later), and fertilization itself can occur up to three or even five days after sexual intercourse. Emergency contraceptives work before implantation (and primarily before fertilization, see controversy below) and not after a woman is already pregnant. When a woman is already pregnant, emergency contraception does not work. Emergency contraception is also harmless to the fetus and the mother.
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Types of emergency contraception
Emergency hormonal contraception is available in two main forms; the original version is the combined or Yuzpe Regimen which uses large doses of both estrogen and progesterone taken as two doses at 12 hour intervals. This technique is believed to be approximately 75% effective depending on how soon it is taken after unprotected intercourse. Examples of Yuzpe Regimen emergency contraceptive pills include Preven (United States - no longer on the market), Schering PC4 (United Kingdom) and Tetragynon (France). This regimen is less effective, and causes more side effects, than the progesterone-only method. The progesterone-only method uses the progesterone levonorgestrel in a dose of 1.5 mg, either as two 750 microgram doses 12 hours apart, or more recently, as a single dose. This method is now known to be more effective (up to 89 percent) and better tolerated than the Yupze method, and is available in the U.S. and Canada as Plan B, in the UK as Levonelle, and in France as NorLevo.
"Dedicated products" such as Plan B and Levonelle are specifically designed and marketed as emergency contraceptive pills. It is also possible to obtain the same dosage of hormones, and therefore the same effect, by taking a number of normal birth control pills; see Yuzpe Regimen for some examples.
International availability
As of early 2001, women of age 16 and higher may obtain the morning-after pill in the United Kingdom without prescription. This was challenged by an anti-abortion group, but the High Court of Justice of England and Wales let the rule stand in April 2002.
In 2000, the American Medical Association issued a non-binding recommendation that morning-after pills be available over the counter without prescription in the U.S. On December 16, 2003, an advisory committee to the Food and Drug Administration (FDA) recommended that the pill be made available over the counter.[1] (http://www.cnn.com/2003/HEALTH/12/16/morning.after.pill/index.html) The committee voted 23 to 4 that the drug should be sold over the counter and 27 to 0 that the drug could be safely sold as an over-the-counter medication. However, in May of 2004 the FDA refused this strong recommendation and prohibited over-the-counter sale. The FDA claimed that this was due to limited experimental data on the effects of such pills on girls under 16 years of age, but critics have accused the FDA of basing the decision on political pressure. [2] (http://www.washingtonpost.com/ac2/wp-dyn/A6766-2004May6?language=printer) One year later, a new application from the makers of Plan B requested over-the-counter status for women aged 16 and older, but the January 2005 deadline for the FDA decision on this application has come and gone without a decision or any indication that a decision would be forthcoming. However, in the United States, as of June 2005, seven states (California, Washington, Alaska, Hawaii, New Mexico, Maine, and New Hampshire) had passed laws permitting trained pharmacists to dispense emergency contraception without a doctor's prescription.
In May 2004, Canada's Health Minister announced that Plan B would soon become available from pharmacists in all provinces without a prescription. This occurred on April 28, 2005. The new system would still require the person to buy the pills directly from the pharmacist.
In January 2000, France decided to dispense Emergency birth control in junior and high schools by school nurses without prescription, because of high rates of undesired pregnancies among teenaged girls; after strong opposition from the Catholic Church, and much debate around the fact the teenager could later suffer from the doubt of not knowing whether fertilization had occurred or not, the decision was overruled by a court in July 2000. The French parliament changed the relevant law in October 2000 and now school nurses are again able to dispense the drugs. The emergency contraceptive pill NorLevo is now available in France without prescription, without parent authorization and for free for teenagers under the age of 18 since the 9th of January 2002.
Emergency contraception is available without prescription in the following 41 countries: Albania, Australia, Belgium, Benin, Cameroon, Canada, China, Congo, Denmark, Estonia, Finland, France, French Polynesia, Gabon, Ghana, Guinea-Conakry, Iceland, India, Israel, Ivory Coast, Jamaica, Latvia, Lithuania, Madagascar, Mali, Mauritania, Mauritius, Morocco, Netherlands, New Zealand, Norway, Portugal, Senegal, South Africa, Sri Lanka, Sweden, Switzerland, Togo, Tunisia, Turkey and the United Kingdom.
Use as a birth control method
Emergency birth control cannot be recommended as the main means of birth control because it is not as effective as any ongoing method of contraception. It also does not protect against sexually transmitted diseases. However, it is used by some as a back-up when other means of contraception have failed—for example, if one has forgotten to take her birth control pill or when a condom is torn during sex. It is also a first line of treatment for survivors of sexual assault.
An alternative to emergency birth control is the intrauterine device which can be used up to 5 days (In some cases 7 days [3] (http://www.plannedparenthood.org/library/BIRTHCONTROL/EC.html)) after unprotected intercourse.
Controversy in relation to abortion
Some groups claim that emergency contraception is an abortifacient because of the theoretical, unproven possibility that it may prevent implantation of a fertilized egg in the uterus. Although most medical authorities (including the US FDA, NIH, and the American College of Obstetricians and Gynecologists) define pregnancy as beginning with implantation, which is what triggers the hormonal changes in the body that allows it to recognize that it is pregnant (and turns a pregnancy test positive), some groups view the death of an embryo as abortion regardless of its implantation status. Recent medical studies in animals (the rat and the monkey) suggest that it is unlikely that emergency contraception works by preventing implantation; however, this mechanism of action cannot be ruled out in all cases, and it has been impossible to carry out this kind of study in humans. Therefore, women who have personal moral beliefs opposing the disruption of implantation may wish to avoid this method of contraception, as well as other methods of hormonal contraception (e.g. the patch, injectable contraceptives, and regular birth control pills) as well as the use of the IUD.
It is interesting to note that, in healthy women not taking any form of contraception or conception-enhancing drugs, the majority of fertilized eggs do not implant on their own. Thus embryo death is a frequent and undisputed natural occurrence.
Emergency contraception is not to be confused with RU-486, an undisputed abortifacient which ends a pregnancy by inducing a chemical abortion of an implanted embryo.
External links
- Not-2-Late.com, the Emergency Contraception Website (http://ec.princeton.edu)
- American Society for Emergency Contraception (http://www.emergencycontraception.org/asec/index.html)
- Get The Pill (http://www.getthepill.com) – Online Prescriptions for Emergency Contraception
- Go 2 EC (http://www.go2ec.org/) – Emergency Contraception News
- Planned Parenthood (http://www.plannedparenthood.org/ec/) – information on emergency contraception
- Plan B (http://go2planb.com/)
- The Emergency Birth Control Organization (http://www.emergencybirthcontrol.org) – Information on Emergency Contraceptionde:Pille danach
