February 9, 2001
Contraceptive Pills: Not Just for the Morning After
By Kyre Osborn
hat do you have
in your medicine cabinet? Aspirin, Band-Aids, tampons, a thermometer?
Like most women, you're probably prepared for a headache, a cut
finger, your period, or a fever. You may also have birth control
at the ready -- maybe you have condoms or a diaphragm, a sponge
or a package of birth control pills stashed away.
You are less likely, however, to be ready for what to do in case
there's a mistake or failure in using your birth control, or in
case it is neglected entirely in a moment of revelry. With emergency
contraception, you could be. Deemed safe by the FDA, proven reliable
in tests, and with a relatively low price tag, emergency contraceptive
pills (ECPs) can prevent a pregnancy after sex has occurred.
Lindsay Parsons, 26, obtained ECPs after discovering that the condom
had broken during sex with her boyfriend. "I used the pills within
24 hours," says Parsons, who at the time was in Denmark. "When I
realized the condom had broken I completely freaked out and insisted
that we go to a hospital the next morning and talk to a doctor,"
Parsons recalls. "I had heard of emergency contraception and wanted
to see if we could get it. They had the pills at the hospital; I
was really glad they were available."
Stateside, you currently need a prescription to get emergency contraceptive
pills, and not every drugstore stocks them. That may change soon.
The Women's Capital Corporation, makers of an ECP product called
Plan B, is proposing a series of studies to the U.S. Food and Drug
Administration (FDA) that could lead to over-the-counter availability
of Plan B. The studies are to be completed in 2002.
Though many who are familiar with emergency contraception
refer to it as the morning-after pill, a woman can actually
begin the regimen directly after unprotected sex has occurred
-- or up to 72 hours later.
For now, though, the pills remain an obscure resource for American
women despite recent approval of a new ECP brand and the American
Medical Association's support for more access to these products.
Why? While most health care providers have no objections to ECPs,
only a small percentage take the initiative to inform their female
patients about them. What's more, many pharmacies do not stock the
products, saying demand is not high enough. Rx.com, for instance,
stocks only one brand of ECPs. But how can women avail themselves
of this option when they don't know about it? It's a frustrating
cycle for women who want more control over their reproductive life.
72 hours and counting
Diana Dell, M.D., past president of the American Medical Women's
Association and assistant professor of obstetrics/gynecology and
psychiatry at Duke University Medical Center, describes emergency
contraception as "a pregnancy-prevention technique." The regimen
works by providing a brief, intense burst of hormone exposure that
can perform any of the following functions: delay or inhibit ovulation,
inhibit fertilization, or inhibit implantation. The pills won't
harm an existing pregnancy. "Pregnancy occurs with implantation;
this is a method for ensuring that implantation doesn't take place,"
says Dr. Dell. Once the fertilized egg is implanted in the uterine
wall, ECPs are ineffective.
Though many who are familiar with emergency contraception refer
to it as the morning-after pill, a woman can actually begin the
regimen directly after unprotected sex has occurred -- or up to
72 hours later. Because ECPs act to prevent pregnancy, they should
not be confused with RU-486 -- the mifepristone pill that can terminate
a pregnancy of up to seven weeks - which was approved by the U.S.
Food and Drug Administration (FDA) in 2000.
Dedicated ECP products
Before dedicated ECP products hit the market, in the late 1990s,
emergency contraception consisted of a combination of birth control
pills. This method is still viable; a woman or her health care provider
can combine regular birth control pills for the proper dosage. The
pill-combination method and dedicated products work the same way.
Dedicated ECPs, however, ensure that the proper hormones and correct
dose are being administered for the most effective result.
The first dedicated product to be released in the United States,
the Preven kit contains a pregnancy test, patient information, and
four light-blue pills. The package costs $20-$25, plus the price
of a doctor's visit. The pregnancy test is performed before the
pills are taken to make sure the woman isn't pregnant already, in
which case the pills will be ineffective. The most common side effects
of Preven are nausea and vomiting; these can be treated with anti-nausea
medications. (If vomiting happens within two hours of taking a dose,
some health care providers recommend repeating that dose.) Preven
follows the traditional pill-combination method and is 75 percent
effective. While these are pretty good odds against pregnancy, the
odds are even better with the newest dedicated product, Plan B.
B: Plan B was officially put into distribution in August 2000.
Unlike Preven, the second dedicated product contains progestin-only
pills (also known as minipills). The Plan B kit consists of just
two pills -- the first to be taken within 72 hours after intercourse
and the next to be taken 12 hours after the first. Plan B is 89
percent effective, and studies show that it causes less nausea
and vomiting than Preven. In response to Plan B, the makers of
Preven are applying to the FDA for permission to market their
own progestin-only kit.
Both Preven and Plan B can be initiated for up to three days after
unprotected sex, but consumers are encouraged to take the pills
as early as possible. With all ECPs, the effectiveness declines
significantly as time passes. Plan B's effectiveness was shown to
shoot up to 95 percent when the first dose was taken in the initial
24 hours after intercourse.
Women may experience irregular bleeding after taking ECPs, and
some women have their period a few days early or late. If you don't
have a normal period within a month, you should get a pregnancy
test to make sure you're not pregnant.
Why are ECPs still unknown?
Even with two ECP kits on the market, experts say emergency contraception
is still underutilized. Although 100 percent of obstetrician-gynecologists
surveyed believe ECPs to be safe and effective, only 10 percent
of these doctors regularly tell their patients about them. In turn,
women don't know to ask for emergency contraception -- and so the
Sharon Camp, CEO of the Women's Capital Corporation, says that
women have to lead the way toward easier access to ECPs. "Women
don't know they have a right to ask for this," Camp says. "We need
to educate women and healthcare providers and insurance companies
and pharmacies, and then [emergency contraception] will become mainstream.
But women have to drive the process."
The feds, the drug companies, and the A word
In 1997, the FDA asked drug companies to begin developing dedicated
ECPs and approved the use of the traditional pill-combination method.
Stating that this method was safe and effective, the agency even
publicized the instructions online for creating the proper hormonal
combination. (See link below.)
Even after the FDA's request for more ECP dedicated products, however,
drug companies didn't rush forward to research or manufacture them.
In fact, pharmaceutical companies shied away from packaging birth
control pills for use as emergency contraception, due in large part
to the fact that some consider emergency contraception to be a method
Such a perspective, however, is not supported by the mainstream
medical community, including the World Health Organization and the
AMA. The mechanism of ECPs is actually similar to a function that
common birth control methods -- including the pill, Norplant, and
IUDs -- can perform. While these methods are primarily meant to
suppress ovulation or fertilization, they can also act after sex
has occurred to prevent implantation, like ECPs.
For many women, including Lindsay Parsons, there is a clear distinction
between the abortion procedure and emergency contraception. "Every
woman has her own beliefs about abortion; for me, it would have
bothered me on a personal level to end a pregnancy, even though
I am very pro-choice. I preferred to use emergency contraception,"
ECPs without a prescription?
Emergency contraception is available by prescription only, and
it can take several days to see a doctor and find a pharmacy that
carries ECPs -- potentially long enough for the 72-hour window of
opportunity to close. To address this problem, the state of Washington
pioneered a system whereby women can go directly to a pharmacist
for ECPs, rather than to a doctor. Using what is known as a collaborative
drug-therapy agreement, Washington physicians delegated authority
to pharmacists to prescribe ECPs to women who meet certain assessment
criteria. This streamlined system makes it easier for a woman to
start the pills after a crisis over the weekend or on a holiday.
But needing a prescription isn't the only thing that makes ECPs
hard to obtain. Sheila Greene, 32, visited her doctor the day after
she and her boyfriend had a contraceptive accident. "I called my
doctor, and she had me come in and sign a release form to get the
prescription," Greene remembers, "and that part was easy. I thought
getting the prescription would be hardest, but actually, filling
the prescription was way more difficult. I couldn't find even
one pharmacy to do it." Greene called more than 20 pharmacies in
her hometown of Austin, Texas, and none of them had Preven on their
shelves. At one pharmacy Greene was met with the retort, "We don't
carry that here" after she asked the pharmacist if the store
carried ECP kits.
Where to Get ECPs
The easiest way to find ECPs is to visit the
directory at the definitive emergency contraception
website. The site gives a broad geographical overview
of ECP providers -- you can search by area code, zip
code, or city and state; or you can search a map of
the United States. Not-2-Late.com even lists some providers
in Canada. The directory includes hospitals, private
doctors, women's health clinics, and others. For those
without Internet access, Not-2-Late has a companion
Your local Planned Parenthood can also provide you
with emergency contraception. You can find out where
yours is located by visiting their
website or by calling 800-230-PLAN.
"I am an educated and an assertive woman," Greene says, "and I
couldn't get my hands on emergency contraception when I needed it.
What does it take?" Greene did her research on the Internet and
discovered how to combine birth control pills -- which she had in
the house because she was about to start taking the pill. She couldn't
find information about the brand she had but decided to approximate
the ECP dose; she took the pills over the course of two days. Greene
says she experienced vomiting and nausea, but that "there were no
seriously negative effects, and soon afterward I got my period and
knew I wasn't pregnant."
Many experts feel that offering the pills over-the-counter is the
only way to increase the availability of ECPs. Even the American
Medical Association (AMA) supports making emergency contraception
easier to obtain. In December 2000, the AMA released a strongly
worded statement supporting the use of ECPs and recommending much
wider access for women. The AMA stated that it intends to "intensify
efforts to improve awareness and understanding about the drugs,
and to enhance efforts to expand access to them, including making
them more available through hospitals, clinics, emergency rooms,
acute care centers, and physicians' offices."
Despite the AMA's support, however, your local health facility
may not stock ECPs. Through increasing acquisition of public and
private hospitals and clinic systems, the Roman Catholic Church
is now the largest private health care provider in the United States.
Most Catholic-owned hospitals do not provide female patients with
emergency contraception, even in cases of rape or sexual assault.
The Vatican has referred to emergency contraception, which went
on sale in Italy in the year 2000, as "a form of abortion by chemical
means," and a "new hidden form of aggression" against human life.
You can find out which hospitals have ECPs by searching the provider
list at Not-2-Late.com. (See sidebar).
A second chance
On any given night, it is estimated that 10 million fertile women
are having sexual intercourse. And of the roughly 60 million American
women aged 15 to 44, almost half have had at least one unintended
pregnancy. Only 1 percent of these women have ever used emergency
contraception. How many women (and men) -- those who have had a
condom break or for some reason failed to use birth control -- didn't
wish they could have a second chance? For preventing unwanted pregnancy,
emergency contraception pills can be that second chance.
on this article.