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Emergency Contraception

The morning after pill. You have probably heard of it. But how much does the average woman know about them? For example, when they can be used; how they work; who can and can't use them; how and where to obtain them. You'll find the answers to these questions and more.

Emergency contraception, as it is more accurately called, is something every woman should know about and how to obtain - before an emergency arises!

Most of us get our contraceptive information from our gynecologists, or clinics such as Planned Parenthood. Who have a tendency to push one form of birth control or another. I have read, (not knowing this for fact) that medical students receive only a few hours of training on available family planning methods, and are apparently taught nothing about emergency contraception (E.C.)!

There are several forms of E.C to choose from. Many birth control pills already on the market can be used as emergency contraceptives at increased dosages, the mini pill also at an increased dosage can be used; an IUD; and the RU486, which is not yet available to the general public in the U.S.
Information on using an IUD as emergency contraception. Emergency IUD: copperT

Where: Many gynecologists and women's clinics offer and prescribe E.C. If not they should know where to obtain it. There is also a regularly updated list on the World Wide Web, maintained by Princeton University. The address is:

How: Emergency contraception does not cause abortion or miscarriage. It works by preventing the fertilized egg from implanting in the uterus. Thus preventing pregnancy.

After ovulation the egg is capable of being fertilized for up to 24 hours. Four to five days after ovulation-fertilization the egg enters the uterus. The follicle that released the egg has begun producing progesterone to prepare the uterine lining to receive the egg.

A woman can get a positive reading from a sensitive pregnancy test as early as 8 days after unprotected intercourse.

Emergency contraceptive pills must be used within three days of unprotected sex in order to be effective. There is not time to wait for a test.

E.C.P. cause a short burst of hormones, which disrupts the normal hormonal patterns of conception. With this interruption pregnancy cannot begin.

Scientists aren't sure exactly how the pills work. Though I'm sure it is any of the following has the potential to be true, depending on the individual and where she is in her cycle.

Possible ways emergency contraceptives may prevent pregnancy:

  • By inhibiting ovulation.
  • By disrupting the functioning of the corpus luteum (the follicle from which the egg came, which produces progesterone.) By interfering with the ovary's production of progesterone, thus preventing the uterus from preparing the uterine lining to receive the fertilized egg.
  • The pills may also make the cells in the uterine lining less receptive to estrogen and progesterone, hormones essential in preparing the uterine lining for implantation of the fertilized egg.
  • Another possibility is that the pills may alter the speed at which the fertilized egg passes through the fallopian tubes, so the egg would reach the uterus at the wrong time.

    **Update** An emergency contraceptive kit has been recently approved by the FDA and made available via prescription. It works in the same 72 hour window as the birth control pill emergency contraceptives do.

    Here are some links for more information and service providers:
    Find Emergency Contraception Near You by Princeton University
    Plan B (levonorgestrel)

    Choices: There are two varieties of pills available in the U.S.. Birth control pills containing estrogen and mini pills containing only progesterone.

    All that is needed to obtain emergency contraceptive pills is a carefully detailed medical history. A pelvic exam is not usually required, though if you haven't had one in a long time the practitioner may decide to do one.

    Emergency contraceptive pills are not as effective as an ongoing form of birth control. E.C. pills reduce the risk of pregnancy by 75%, while most forms of birth control are 80 - 99% effective. And for this reason emergency birth control should be used as an emergency backup to your regular method of birth control.

    Birth Control Pills - Cost: Estrogen containing pills generally cost around $20. for a pack. The kinds of B.C.P.s studied for E.C. use are as follows:

  • Orval: 2 tablets within 72 hours of unprotected sex, followed by 2 more tablets 12 hours later.
  • Lo-Orval, Nordette, or Levlen: 4 tablets within 72 hours of unprotected sex, followed by 4 more tablets 12 hours later.
  • Triphasil or Tri-Levlen: (yellow pills only) 4 yellow tablets within 72 hours of unprotected sex, followed by 4 more yellow tablets 12 hours later.
  • Don't take any extra pills. More won't decrease your risk of pregnancy. Though it will increase your nausea, possibly causing you to vomit, thus requiring another dose.

    Possible side effects: E.C.P.s are relatively safe. When regular birth control pills are taken in dosages for emergency contraceptive purposes they can cause side effects such as nausea, vomiting, headaches, breast tenderness, dizziness or fluid retention.

    When determining who should or should not use emergency contraceptive pills, a medical practitioner will take a detailed medical history, looking for contradictory medical problems. Examples would be women who have had cancer of the breast or reproductive organs; diabetes, liver, kidney, or heart diseases; severe migraine headaches, high blood pressure; or women who have given birth within the last 3 weeks; or smokers over age 35.

    Mini Pills - The progesterin only mini pill is ideal for women who cannot use E.C. pills containing estrogen. The mini pill is less likely to cause nausea and vomiting. But the window of effectiveness is smaller. The first dose of Ovrette (20 pills) must be taken with in 48 hours of unprotected sex. The second dose of 20 more pills must be taken 12 hours later. A total 40 pills (two packages) which cost about $50.

    In Europe and Asia women have access to a single progestin pill called Postinor. One pill is equal to 20 Ovrette pills. It can be used as a contraceptive by women who have sex infrequently. One pill is taken within one hour of unprotected sex. Exceeding 4 pills in one month is not recommended. It can cause menstrual disturbances with frequent use. Studies have found Postinor to be effective with relatively few side effects. Unfortunately, it is not yet available in the U.S.

    Mifepristone, also known as the French Abortion Pill, RU486, is a very effective emergency contraceptive. It causes less nausea and vomiting, and requires only one dose. It is more effective than any other emergency contraceptive pill on the market today.
    Though generally not available in the U.S., women do have access to it through clinical trials. (see Notes of Interest)

    Mifepristone (RU486) works by interfering with the naturally occurring events in the body, Like the other emergency contraceptive pills do. A single dose with in 3 days of unprotected intercourse prevents the fertilized egg from implanting by blocking progesterone receptor sites in the uterine lining.

    Mifepristone has the potential to eliminate the need for abortions by easily and conveniently preventing unwanted pregnancies before they even begin.

    RU486 is most well known for its pregnancy terminating ability. It becomes an abortificant when followed by a prostaglandin medication 48 hours later, which causes the uterus to contract and expel its contents. The abortion procedure, the RU486 is so well known for requires several visits to a clinic.

    Another very effective emergency contraceptive is an IUD, specifically the Copper T 380A (marketed as ParaGard). With an IUD there is a larger window, in which to prevent a fertilized egg from implanting, seven days compared to the two to three day window depending which pill is used.

    An IUD will provide birth control protection for 10 years. It is safe for women who are breast feeding. It's an good option for women who don't want children for a number of years and want a long term birth control method.

    Possible side effects: Small amounts of copper are released into the uterine cavity, the side effects of this? I don't know.

    There is an increased risk for Pelvic Inflammatory Disease (PID), which can result in perminate sterility. Some people believe the string acts as a pathway from the vagina, through the trap-door in the cervix, who's purpose is to keep bacteria and viruses out, and on into the uterus.

    Some women have increased menstrual cramps and bleeding. There is also a small risk of tearing the uterus during insertion.

    Women who have had a history of (PID) or are at high risk for STDs, are not good candidates for IUD insertion. Women who have not had children are also discouraged, because of the risk of sterility.

    How: As an emergency contraceptive the copper IUD works primarily by preventing implantation.

    When used as birth control the IUD works by inhibiting the sperms journey, and causing an inflammatory response, making the uterine lining unsuitable for implantation of a fertilized egg, should fertilization occur.

    Cost: To have an IUD inserted can cost as much as $400. A one time expense that can last as long as ten years. Much cheaper than 10 years of birth control pills.

    There are many options available for women who know they have had unprotected sex during an unsafe time. Options offered by the medical establishment are only half of the options really available to women who have the knowledge.

    Knowledge is the Key!

    For more information check out Prinston University's site on Emergency contraception. They are the Experts. The Emergency Contraception Website and the Feminist Women's Health Center has an extensive page, including dosages.
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