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9/04
The purpose of Emergency Contraception is to prevent unplanned pregnancies and decrease the monetary and emotional cost of unintended pregnancies. It is not to be used as an ongoing method of birth control, but rather it is to be used when other methods have failed such as a broken condom, a dislodged or forgotten diaphragm or a series of forgotten birth control pills or episodes of forced sex such as rape. Nurses practitioners, physicians assistants and physicians have a major role in the implementation of Emergency Contraception.
Health care organizations such as AWHONN (Association of Women's Health Obstetric Neonatal Nursing), is an example of one nurses organization providing information on Emergency Contraception in their publications so that nurses will be knowledgeable and therefore be able to provide this service to women in their practice setting. Washington DC. Emergency contraception is also endorsed by the American Medical Association.
Emergency contraception is a prospective method of pregnancy prevention when unprotected intercourse occurs.
Half of all the pregnancies in the United States are unintended, over three million a year. Presently emergency contraception has been used by only 1% of American women. Over three million women are not using birth control and are at risk for unintended pregnancy Emergency contraception use reduces the risk of pregnancy by about 75% or more. "This statement does not mean that 25% of women using ECP's will become pregnant. Rather, if 100 women have unprotected intercourse once during the second or third week of their cycle, about 8 would become pregnant; following treatment with ECP's, only 2 would become pregnant: a 75% reduction."
As a method of contraception, the legal aspects are the same as for any form of contracetpion such as the requirement that it be dispense by prescription in almost all states. There are a few exceptions. Nurse practitioners and physicians assistants will need to write or incorporate this form of contraception into their written protocols.
Practitioners must also decide whether to provide this treatment only to established patients or to new patients also. Would the practitioner be able to prescribe over the telephone or would a visit be required. Would the practitioner provide a prescription to patients who are using contraception such as barrier methods "just in case" the method failed? What about patients who "abuse" the method and use this method frequently?
Hormones in oral contraceptive pills temporarily disrupt ovarian hormone production and inhibit or delay ovulation and cause an absent or dysfunctional luteal phase hormone pattern. ECP's may prevent fertilization of an egg after ovulation. This results in an out-of-phase endometrium that is unsuitable for implantation. Hormone disruption may likewise interfere with fertilization and, cause disordered tubal transport.
Minerals (copper) in an IUD interfere with sperm transport and interferes with fertilization. The copper IUD probably causes an inflammatory response that makes the endometrium unsuitable for implantation. (Trussell, J. Emergency Contraception: A Cost -Effective Approach to Preventing Unintended Pregnancy. CT Conference, March 1998)
"As long as condoms break, inclination and opportunity unexpectedly converge, men rape women, diaphragms and cervical caps are dislodged, people are so ambivalent about sex that they need to feel swept away, IUDs are expelled, and pills are lost or forgotten, we will need emergency, post-coital contraception." (Hatcher, et al, )
"What can I do? I’m worried that I might get pregnant because the condom broke or my diaphragm slipped or I went on vacation and forgot my pills."
Pregnancy that might have occurred in the previous menstrual cycle.
Safety and General Information
Does emergency contraception cause abortion? No. Pregnancy occurs with implantation and emergency contraception works before implantation.
Pregnancies that are not averted are not at an increased risk of complications or anomolies. There is a long history of women continuing to take birth control during pregnancy because they did not realize that they were pregnant.
Cost
Previn and Plan B have been FDA approved for Emergency Contraception. Two doses of 100 ug of ethinyl estradiol and 0.25 mg of levonorgestrel. In addition the kit or product contains one urine hCG pregnancy test and detailed patient information and product labeling.
Plan B, a Planned Parenthood product is 0.75 mg levonorgestrel. This product is more effective and causes less nausea than combined pills.
| Brand Name | Number of Tablets for Each Dose |
|---|---|
| Preven | 2 pills now and 2 pills 12 hours later |
| Plan B |
1 pill now and 1 pill 12 hours later |
Oral Contraceptives - Two doses of 100 ug of ethinyl estradiol and 2 mg of norgestrel or 1 mg of levonorgestrel 12 hours apart.
| Band Name | Number of Tablets for Each Dose |
|---|---|
| Ovral | 2 pills now and 2 pills 12 hours later |
| Lo/Ovral
(white pills) Nordette (orange pills) Levlen (orange pills) Triphasil (yellow pills) Tri-Levlen (yellow pills) |
4 pills now and 4 pills 12 hours later 4 pills now and 4 pills 12 hours later 4 pills now and 4 pills 12 hours later 4 pills now and 4 pills 12 hours later 4 pills now and 4 pills 12 hours later |
| Alesse (pink pills) | 5 pills now and 5 pills 12 hours later |
You may view the above oral contraceptive pills at http://opr.princeton.edu/ec/ecp.html.
| Ovrette (0.075 mg progestin) Note: take within 48 hours | 20 pills now and 20 pills 12 hours later |
Antiemetic, Over the Counter
| Medication | Dose | Time Regimen | Repeat Dose |
|---|---|---|---|
| Meclizine hydrochloride (Dramamine II) |
25 mg, sig #2 | 1 hour prior to each ECP (Emergency Contraception Pill) dose |
None |
| Diphenhydramine hydrochloride (Benedryl) |
25 mg, sig #1-2 | 1 hour prior to each ECP dose | PRN every 4-6 hours |
| Dimenhydrinate | 50 mg tabs, sig #1-2 | 1 hour prior to each ECP dose | PRN every 4-6 hours |
| 12.5 mg/5 mls syrup sig 2-4 tsp. |
1 hour prior to each ECP dose |
Antiemetic, Prescription
| Medication | Dose | Time Regimen | Repeat Dose |
|---|---|---|---|
| Meclizine hydrochloride (Antivert) | 50 mg | 1 hour prior to each ECP dose |
None |
| Prochloriperazine (Compazine) |
5-10 mg tab |
1 hour prior to each ECP dose | Every 6-8 hours PRN |
| 15-30 mg spansule sustained release caps | 1 hour prior to each ECP dose | None | |
| 5-25 mg suppository | 1 hour prior to each ECP dose | None | |
| Promethazine hydrochloride (Phenergan) | 25-50 mg tab | 1 hour prior to each ECP dose | Every 6 hrs PRN |
| 25 mg/5ml syrup sig 1-2 tsp. |
1 hour prior to each ECP dose | Every 4-6 hours | |
| 25-50 mg suppository | 1 hour prior to each ECP dose | Every 4-6 hours |
Primary Points - Oral Contraceptives
Intrauterine Device
Primary Points - IUD
The IUD should be used only for women at low risk for pelvic inflammatory disease and when the woman intends to continue use of he IUD for contraception.
Many clinics or providers make return appointments for all women who have been prescribed emergency contraception. Others require a return appointment if the woman has not had a menstrual period in 21 days (or one week late) or if the menstrual flow was less than 2 days or less than usual or any signs or symptoms of pregnancy.
Return for routine follow-up regardless of whether a menstrual period occurs or not.
You may copy and use these without copyright.
Emergency contraception is not thought to be associated with an increased incidence of abnormal outcome of pregnancy should pregnancy not be averted. There is a long history of women continuing to take birth control pills when they do not realize that they are pregnant. Emergency contraception does not always work.
Web Sites - When doing a search, use the descriptor Emergency Contraception or Contraception. Below are examples of important web sites.
- http://www.cc.columbia.edu/cu/healthwise/index.html
- www.opr.princeton.edu/ec/ This is the main Emergency Contraception Website
- www.plannedparenthood.org/ This is the Planned Parenthood Website that has information about many women's health, contraceptive and STD information. Look for the emergency contraception link.
All of these sources are available in English and Spanish.
Phone Numbers
1-800-NOT-2LATE, 1-800-230-PLAN or 1-800-9911.
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