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The Latest on Emergency ContraceptionEmergency contraception is not medical abortion, which is defined as using medications instead of surgery to interrupt a pregnancy. EC prevents a pregnancy from starting in a risky situation, i.e., when unprotected intercourse has occurred in mid cycle (the second and third week of the menstrual cycle). One of the continuing mysteries of EC is how little it has been used, especially given that it is very safe and convenient. Perhaps EC has been pushed off the health radar screen by the sometimes confusing and bitter public discussion of abortion, contraception and their role in women's lives today? This is unfortunate not only because EC is a safe and effective method of contraception but also because widespread use of EC has the potential to reduce drastically the number of abortions performed in the U.S., perhaps the only common goal of most pro-life and pro-choice groups. The History
Known to medicine since the 1970s, EC uses the same ingredients, synthetic hormones, as conventional birth control pills. Nevertheless it was not until 1997 that the U.S. Federal Register saw fit to publish the doses of the two principal types of EC formulations. These are known as the Yuzpe regimen, which combines estrogen and progesterone, and the progestin-only regimen.(1) At that time in the U.S., women using EC had to find a doctor willing to prescribe and "mix and match" existing contraceptive pills. Now there are two products, Preven® and Plan B® , which are designed specifically for EC.
Acceptance of EC has been steady but slow. Surveys conducted in 1994 and 1995 showed that EC was not well known by consumers in the United States and was rarely prescribed by doctors. Even among obstetrician-gynecologists (OBGYNs), who had a high degree of knowledge about EC (99%) and a willingness to prescribe it, one survey indicated that a majority (75%) prescribed EC fewer than five times a year.(2)(3) Among women who might have need for EC, survey data showed that only 1% had ever used the technique, even though over one half of women at risk indicated they were interested in trying it. Fully two-thirds of the women surveyed did not know that anything could be done on an emergency basis to reduce the risk of an unplanned pregnancy. In the years since, however, some promising trends have emerged. The Kaiser Family Foundation's Third National Survey found a doubling of physicians prescribing more than six EC prescriptions per year (OBGYNs 16% to 31%, family physicians (FPs) 8% to 17% from 1995 to 2000). The Kaiser survey also documented that doctors noted a tripling of interest in EC on the part of consumers (OBGYNs 11% to 29%, FPs 6% to 17% from 1997 to 2000).(4) The Anti-Abortion Pill
EC has tremendous potential for reducing the number of induced abortions in the United States and may in fact already be doing so. From data collected in their 2000 — 2001 survey of women receiving abortions, the Alan Guttmacher Institute estimated that 51,000 fewer abortions were performed in the United States in 2000 because of the use of emergency contraception.(5) It has been estimated that half of the over 5 million pregnancies per year in the United States are unintended, and that half of these end in abortion (approx. 1,300,000 in the year 2000). There is no reason to think that widespread EC could not further reduce this number.
What Exactly Is EC?
There are two medically accepted methods of emergency contraception. The hormonal method consists of various formulations of the synthetic hormones estrogen and progestins, or progestins alone; the other is the emergency insertion of a copper-containing IUD (intrauterine device). The IUD can be used up to five days after unprotected sex and is highly effective. It has the added advantage of continuing to work as a contraceptive for up to ten years. Its use is limited by the fact that special training is needed for insertion, the high initial cost and the fact that some women are not candidates for the IUD for health reasons.
The Yuzpe Regimen
In the mid 1970s, Dr. Albert Yuzpe of Canada began publishing his research on a combination of an estrogen, ethinyl estradiol and a progestin called dl-norgestrel.(6) This medication is administered in two doses taken 12 hours apart, starting within 72 hours after unprotected sex. A number of studies have shown that this reduces the risk of pregnancy by 75%.(7) This means that of the expected eight pregnancies that would occur in 100 women after a single act of unprotected sex in mid cycle (second or third week), six would be prevented. The Yuzpe regimen consisted of 100 mcg of ethinyl estradiol and 1 mg of norgestrel in each of the two doses. One dose is taken immediately and one 12 hours later. The Preven® formulation is equivalent to the Yuzpe regimen but it contains levonorgestrel, which has twice the potency of norgestrel, so only half the milligrams, or 0.5 mg per dose, is needed.
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