By J. M. Anderson, M.D. published in Style Magazine April 2004

Last months’ article addressed birth control options for long term and continuous use.  This month I will address another option for women in the case of a contraceptive failure, various other sexual accidents, or in a case of assault.   Most people are familiar with the concept of the “Morning After Pill”.   The utilization of Emergency Contraception (EC) has been shown to be a safe and effective method for women to prevent unwanted and unintended pregnancies.  It is a way to avoid the emotional and moral decision of having to keep or terminate a potential pregnancy.  Also, from a public health perspective, EC has the potential to greatly reduce medical cost (whether a pregnancy is carried or aborted) at the public level, as well as the individual level. 

For women who are on a highly reliable method of birth control this idea may not be such an issue, however, some women are not candidates for long term oral contraceptive pill or IUD use and therefore have opted to use barrier methods.  In the event of a condom breaking, having an unplanned encounter, or in a case of rape, emergency contraception can reduce the chance of becoming pregnant by up to 85% if used in the appropriate time frame.   In the U.S. in the year 2000, estimates show that more than 50,000 elective abortions were avoided by providing EC at the time of unprotected intercourse. It is important to understand that EC is just what is says it is; a contraceptive measure, not an early pregnancy termination. Whether you are pro-life or pro-choice, preventing the number of unwanted pregnancies obviates the argument. 

There are multiple formulations of EC: 1) multiple doses of standard combination OCPs, 2) specially designed pills that contain both estrogen and progesterone (Preven), 3) and pills that are strictly progesterone (Plan B) which is usually better tolerated.  Although the formulations vary, the concept is the same - mega doses of hormone are given orally to interfere with the process of ovulation and tubal transport of the egg/sperm thereby preventing conception/implantation.   It is important to note that EC must be taken shortly after the episode of unprotected intercourse in order  to work (ideally within 72 hours but can still be effective up to 120 hours).   If a urine pregnancy test is positive, conception is established and any method of contraception fails. These hormones will not interfere with or harm an established pregnancy so it should not be viewed as an abortifacient.  Also, these mega doses of hormone(s) are safe since they are taken on an as-needed basis and not daily as with the oral contraceptive pill. 

All adult women should be receiving birth control counseling by their primary care physician, and emergency contraception is a safe and effective method in the event of traditional contraceptive failure.  Currently, in some states (Alaska, Hawaii, California, New Mexico, and Washington), it is legal for pharmacists to provide EC pills to women in need.  Until such laws are passed in Texas, I encourage all women to discuss with their Ob-Gyn whether an advanced prescription of EC is appropriate for them.  Having that advanced prescription allows for women to have the pills on hand to take in the required timely fashion, and in the event of EC failure, the patient-physician relationship has been established to address the options for the pregnant patient.

More and more women are finding out and inquiring about continuous or extended oral contraceptive pill use which results in having fewer periods than the conventional monthly schedule.  Depending on how prescribed, women essentially are in control of when they will experience their period, about once every three to four months.  It is also reasonable for some patients to omit periods altogether by following a continued pill regimen outlined by their gynecologist.  The contraceptive benefit is equal to that of a monthly regimen but extended cycles also can provide convenience of timed periods with less menstrual related problems (i.e. headaches and cramps).  Contrary to what most women believe, a period is not a mandatory part of hormonal contraception and neither is it unhealthy to prevent periods with extended use of OCPs. 

For more specific information on these and other forms of contraception, please contact your physician.  Each form discussed above has indications and contraindications to its use therefore it is important that each woman and her health care provider discuss her medical history before deciding on the most appropriate method.