GLOBAL HEALTH OPTIONS
ONE OF AMERICA'S BEST KEPT BIRTH CONTROL SECRETS
Emergency Contraception (EC) is a group of birth control methods. These methods can prevent a pregnancy hours and even days
after you have unprotected sex. This is in contrast to the other groups of birth control which can only prevent a pregnancy
if you use them before, or during sexual intercourse
You use EC after unprotected sex to prevent an unintended pregnancy.
Of course, if you do not wish to become pregnant, you should never have unprotected sex on purpose. But, sometimes accidents happen--you forget to take the pill, the condom breaks, or the diaphragm slips out. Other times, regretably, violence happens and the unprotected sex is coerced; EC is also used in case of rape.
Like all birth control methods, EC acts to prevent a pregnancy. It has no effect on an established pregnancy
If you are already pregnant, EC will not be able to cause a termination (an abortion).
EC is easy to use
, it's very effective
, and has few side effects.
It can be, and is, safely used as an over-the-counter product
Studies done in countries where EC has been available over-the counter for years show no misuse or overuse trends.
EC has been available since the 1960's. The original regimens
consisted of high doses of the hormone estrogen, but these have been now replaced by newer regimens.
There are 5 main groups of emergency contraceptives. If we identify each group based on one particular characteristic of that group, it'll be easier to remember it. They are, the:
Often, the pills used for EC are confused with the pills used for Medical Termination of Pregnancy (MTP)
. So, before we proceed with our EC discussion, let's clarify the distinction between EC and MTP.
EC is a birth control method, while MTP is a non-surgical method of pregnancy termination.
EC acts to prevent a pregnancy, while MTP acts to terminate a pregnancy.
Pill regimens are used for both EC and MTP, and these regimens are easy to use, very effective and have few side effects. However, there is one essential difference between the EC pills and the pills used for MTP:
EC pills can be safely used as over-the-counter medications. MTP pills should never be used without the close medical supervision of a qualified doctor.
The reason for this difference is this. EC pills act before there is a pregnancy, so the potential side effects are minor. In contrast, the MTP pills act after there is a pregnancy. Once there is a pregnancy, even an early one, serious complications can occur. For example, there could be an ectopic pregnancy
, or an incomplete termination, which may require a surgical intervention.
If you are interested in a more detailed discussion on the difference between drugs that act as birth control (contraceptives) and drugs that act to terminate a pregnancy (abortifacients): Contraceptives vs. Abortifacient
. To continue reading about Emergency Contraception: EC
CONTRACEPTIVE vs. ABORTIFACIENT
A drug that acts as birth control is called a Contraceptive
. Once a pregnancy has been established, a Contraceptive has no effect on it.
A Contraceptive prevents the formation of a pregnancy.
A drug that acts to terminate a pregnancy is called an Abortifacient
. The name "Abortifacient" comes from "abortion" which is the medical term for a pregnancy termination. An abortion can be spontaneous or induced. The lay term for spontaneous abortion is "miscarriage" .
An Abortifacient ends an already established pregnancy.
If we briefly review the steps involved in the formation of a pregnancy, the difference between birth control and abortion should become clearer. The review that follows discusses birth control and abortion from a strictly medical perspective. The political, religious, and/or moral definitions of birth control and abortion will not be explored.
The 4 steps leading to the establishment of a pregnancy are:
Insemination--the release of sperm inside the woman's genital tract
Fertilization--the union of the egg and sperm
Implantation--the burrowing of the fertilized egg into the lining of
Embryo formation--the acquisition of individuation
The first 3 steps are the preembryo
stage, and the last step is the embryo
stage. The preembryo
stage lasts about 14-16 days.
The fact that the first 3 steps have already occurred, does not mean that a pregnancy can become established. Of course, you might be wondering why not, since the egg has been fertilized and it has already implanted in the uterus. The answer is: because the preembryo
has to acquire the ability to become an individual human being before a pregnancy can exist.
Think of the preembryo
as a car stuck in the express lane of a busy highway. And think of pregnancy as the final destination of that car. Just because the car is on the highway, that doesn't mean that the car can and will reach its final destination. The car has to get out of the express lane, and it has to be able to take the right exit off the highway to reach its final destination.
Something similar occurs with the preembryo
and pregnancy. The preembryo
has to undergo a few final transformations before it's able to become a pregnancy. These transformations are called "the acquisition of individuation".
Because there is no pregnancy yet at the preembryo
stage, any method that acts on these first 3 steps--Insemination, Fertilization, or Implantation--is a birth control method.
A birth control method prevents the formation of a pregnancy; it cannot cause an abortion because there is no pregnancy yet.
In contrast, any method that acts at the embryo
stage, when a pregnancy has already been established, is an abortifacient.
An abortifacient terminates a pregnancy; it can cause an abortion only if a pregnancy already exists.
EMERGENCY CONTRACEPTION ( "THE MORNING AFTER PILL" )
Before we look at the individual Emergency Contraception (EC) methods, let's just clarify two things about EC:
EC is sometimes called "the morning after pill". This is wrong because:
There are over 15 EC regimens
: some are pills, some aren't.
EC can be used up to 5 days after unprotected sex (although the sooner you use it the better)
A more appropriate name for EC is "The After Unprotected Sex Pill".
The reasons why EC
is called *Emergency* contraception rather than, for example, *After-Sex* contraception, are:
EC is designed to be used only occasionally, in an emergency, rather than on a regular basis.
Over time, EC is not as effective as the other, consistently used, methods of birth control.
Let's now review the individual EC groups. Recall that there are 5 EC groups:
1. THE TWO HORMONES PILL GROUP (Estrogen and Progestin Pill)
Preven (no longer available) Tetragynon(no longer available)
This first group of EC is a pill regimen, a combination pill. Each pill has 2 hormones.
The 2 hormones are an estrogen and a progestin. They are man-made "copies" of the natural estrogen and progesterone produced by our body. Progestin simply means a synthetic progesterone.
The combination EC pills work by delivering a high dose of the 2 hormones to the body. This inhibits ovulation, the release of the egg from the ovary. Since there is no egg, there can be no pregnancy. This is the main mechanism of action of the combination EC pills.
Other mechanisms include changes in the lining of the uterus, sperm penetration, and fallopian tubes. These changes inhibit implantation
These combination EC pills may sound familiar to you because they are similar to the regular combination birth control pills. What differs is the timing of the pills and the amount of hormones they contain.
Regular combination birth control pills have lower amounts of hormones, and you take them continuously, every day of the month. Combination EC pills have a higher dose of hormones and you only have to take two doses, after you've had unprotected sex.
This is how you take the two doses of combination EC pills:
take the first dose as soon as possible and, ideally, no later than 72 hours (up to 120 hours), after you have unprotected sex
take the second dose 12 hours after the first dose
After you take the second dose, you may expect to start your period
The exact start of the period will vary from woman to woman, and so will the flow--it may be heavier, lighter, or spottier. If your period is more than 3 weeks late, after the second dose, take a pregnancy test and talk to your doctor, to make sure you aren't pregnant.
of the combination EC pills is good--your risk of an unintended pregnancy is decreased by 75%. In other words, if 100 women have unprotected sex, statistically 8 would be expected to become pregnant. However, if combination EC pills are used, only 2 would be expected to conceive.
There are two very important thing you must remember about the effectiveness of these EC pills:
The sooner you take the first dose, the better protected you are. The highest degree of protection occurs if you take the first dose within 12 hours after the unprotected sex.
A full course (two doses
) only work against one single act of unprotected sex
. So, you must use a back-up birth control method, if you have sex again before the start of your next period. Barrier methods, like the sponge or the diaphragm are good back-up options.
Of course, combination EC pills do not protect against Sexually Transmitted Infections
The main side effects
of these pills are nausea and vomiting (due to the estrogen). To avoid this side effect, take a medication against vomiting (an antiemetic) 1 hour before each dose. If vomiting occurs within 2 hours of a dose, repeat that dose only.
Less common side effects include breast pain, dizziness, and headache. All side effects usually disappear within 24 to 48 hours after the final dose.
of combination EC pills is excellent
. There are no absolute contraindications to their use, other then a known pregnancy.
If you are already pregnant you should not take these pills because they will have no effect.
Even women who can't use regular combination birth control pills can use the combination EC pills, because the exposure is so brief.
Also, if you are already pregnant and you take these EC pills by mistake, they will not cause any birth defects.
The next page
has a Table
of the actual combination EC regimens, and the continuation of the EC discussion.
Copyright 2001-2004 GHO. All rights reserved.