Download Benefits/pitfalls of the morning after pill

The “Morning After Pill”
Ashley Blevins-Griffith
Master’s Project
Spring 2007
Definition
• The Morning After Pill (a.k.a. “Emergency
Contraception): A form of medication taken
within 72 hours of sexual intercourse to
prevent pregnancy.
Controversy of Abortion
• According to the National Institute of Health’s
definition of when life officially begins,
determines that emergency contraception is NOT
considered an abortifacient.
• However, at the beginning of the decade, 20% of
women practitioners in California’s health
maintenance organization considered EC an
abortifacient.
• By the end of the 1990’s approximately 39% of
primary care providers also considered it as such.
Regimens of “The Morning After
Pill”
• Yuzpe
– The most accepted mechanism is that the hormones prevent proliferation
of the endometrium; therefore preventing the fertilized egg from attaching.
• Mifepristone (RU-486)
– 2 possible mechanisms of action:
• Some believe that it works as a progesterone antagonist. Progesterone
is essential for the proliferation of the endometrium, so this would
allow the pill to work in the same way as the Yuzpe regimen.
• Others believe that Mifepristone causes a decrease in leptins, which in
turn causes a reduction in FSH secretion. This will prevent ovulation
and decrease the chance of an unintended pregnancy.
Yuzpe vs. Mifepristone
• Which is better?
– When comparing a single dose of Mifepristone with the
Yuzpe regimen, 402 women received Mifepristone and
398 received the Yuzpe regimen. Of the 402, zero
became pregnant. On the other hand, 4 of the 398
women on the Yuzpe regimen became pregnant.
– Women who took Mifepristone experience less side
effects such as breast tenderness, nausea and vomitting
than those who took Yuzpe.
Benefits of “The Morning After
Pill”
• Decreases the number of unintended pregnancies.
• Has been shown to not cause miscarriages.
• If the method is not effective, there is no increased
chance of birth defects.
• Effective up to 72 hours after sexual intercourse.
• Does not increase clotting factors or clot
formation.
• Patients can be evaluated over the telephone or in
non-office settings
Pitfalls of “The Morning After
Pill”
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Contraindicated in pregnancy because it will not work.
Not successful as the primary method of preventing pregnancy.
Adverse side effects.
Not 100% effective.
Efficacy of the medication drastically decreases with the time a woman waits
between sexual intercourse and the initial dose.
Main cause of ectopic pregnancy.
Possible tubal pregnancies.
Inadvisable for women who experience crescendo migraines or frequent
migraines with severe neurological deficits.
Does not protect against STD’s.
Unavailability.
Most Physician’s will only prescribe this medication to victims of rape or
incest.
OTC Availability
• Practitioners are concerned about making
EC available OTC because of 4 reasons:
– Lack of consultation
– EC is not the most safe or effective type of long
term contraceptive.
– Pharmacy is not appropriate for selling this
medication.
– Women would abuse its availability.
Results of EC being made
available OTC in England
• No significant increase in the number of
women who used the morning after pill or
who participated in unprotected sexual
intercourse.
• The only significant finding was where the
women obtained the medication. (More
OTC and less from Practitioner).
Either way….
• An increase in the number of sales of “The
Morning After Pill” or any other emergency
contraception will only lead to a decrease in
the number of unintended pregnancies.
In the Future
• Trials are being conducted to see if
emergency contraception will be effective
after as much time as 120 hours after
unprotected sexual intercourse.
• Also, trials are being conducted to see if
lower doses of Mifepristone will be as
effective as the higher doses.
For Help…
• For women who want to understand the benefits and
risks of EC, the Reproductive Health Technologies
Project in Washington, DC, along with the Office of
Population Research at Princeton University sponsored
a toll free emergency number (1-888-NOT-2-LATE) in
1996. There is also a website available that was
constructed in 1994.
• The website and number are confidential and available
24/7 in Spanish or English.
• These resources also offer the names and numbers of
practitioners in the caller’s area who can schedule a
consult and prescribe the medication.
Conclusion
• The benefits and pitfalls of emergency
contraception are outlined and will need to be
considered by every female patient that wishes to
prevent an unintended pregnancy.
• The topic of emergency contraception
encompasses far more than just the scientific
studies of effectiveness, and mechanism of action,
its use depends on morals, customs, and social
beliefs.