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Birth control options for women - Emergency Contraception

Description

An in-depth report on the birth control options available to women.

Alternative Names

Contraception

Emergency Contraception:

Emergency contraception is available to prevent pregnancy:

After sexual assault
After consensual intercourse in which contraception is not used
When contraception is used but fails (for instance, when a condom breaks or a diaphragm dislodges)

Basics of Emergency Contraception

Emergency contraception, also called the “morning after pill,” uses the levonorgestrel progestin hormone found in some birth control pills to prevent either fertilization or the implantation of a fertilized egg in the uterine lining. The morning after pill is not the same thing as the "abortion pill."

In 2006, the Food and Drug Administration approved the Plan B brand as the first over-the-counter emergency contraception. It is available without a prescription at pharmacies and health clinics for adults 18 and older, with proof of age. Anyone younger than age 18 needs a prescription from her doctor. Plan B is taken in one or two doses within 72 hours of unprotected sex.

Side effects of Plan B may include:

Nausea and vomiting
Headaches
Dizziness
Breast tenderness
Fluid retention
Changes in the timing or flow of the woman's next menstrual period.

Immediate side effects typically subside within 1 - 2 days of taking the second dose. Family planning experts warn that emergency pill use should not be treated as a substitute for regular contraception.

Copper-Releasing Intrauterine Device. An alternative emergency contraception relies on insertion of a copper-releasing intrauterine device (IUD) within 5 days (120 hours) of unprotected intercourse. It can be removed after the woman's next period, or left in place to provide ongoing contraception. The copper IUD reduces the risk of pregnancy by 99.9%.

Resources

www.nichd.nih.gov -- National Institute of Child Health and Human Development
www.plannedparenthood.org -- Planned Parenthood
http://ec.princeton.edu -- Emergency Contraception Website
www.acog.org -- American College of Obstetricians and Gynecologists
www.guttmacher.org -- The Alan Guttmacher Institute
www.arhp.org -- Association of Reproductive Health Professionals

References

Blythe MJ and Diaz A. Contraception and adolescents. Pediatrics. 2007; 120(5): 1135-48.

Cheng L, Gulmezoglu AM, Piaggio G, Ezcurra E and Van Look PF. Interventions for emergency contraception. Cochrane Database Syst Rev. 2008;(2): CD001324.

Cole JA, Norman H, Doherty M, Walker AM. Venous thromboembolism, myocardial infarction, and stroke among transdermal contraceptive system users. Obstet Gynecol. 2007 Feb;109(2 Pt 1): 339-46.

Collaborative Group on Epidemiological Studies of Ovarian Cancer, Beral V, DollR, Hermon C, Peto R, Reeves G. Ovarian cancer and oral contraceptives: collaborative reanalysis of data from 45 epidemiological studies including 23,257 women with ovarian cancer and 87,303 controls. Lancet. 2008 Jan 26;371(9609): 303-14.

Creinin MD, Meyn LA, Borgatta L, Barnhart K, Jensen J, Burke AE, et al. Multicenter comparison of the contraceptive ring and patch: a randomized controlled trial. Obstet Gynecol.2008;111(2 Pt 1): 267-77.

Erkkola R. Recent advances in hormonal contraception. Curr Opin Obstet Gynecol. 2007;19(6): 547-53.

Hannaford PC, Selvaraj S, Elliott AM, Angus V, Iversen L, Lee AJ. Cancer risk among users of oral contraceptives: cohort data from the Royal College of General Practitioner's oral contraception study. BMJ. 2007;335(7621): 651.

Hov GG, Skjeldestad FE and Hilstad T. Use of IUD and subsequent fertility--follow-up after participation in a randomized clinical trial. Contraception. 2007;75(2): 88-92.

Inki P. Long-term use of the levonorgestrel-releasing intrauterine system. Contraception. 2007;75(6 Suppl): S161-6.

Jick S, Kaye JA, Li L, Jick H. Further results on the risk of nonfatal venous thromboembolism in users of the contraceptive transdermal patch compared to users of oral contraceptives containing norgestimate and 35 microg of ethinyl estradiol. Contraception. 2007 Jul;76(1): 4-7.

Kaunitz AM. Clinical practice. Hormonal contraception in women of older reproductive age. N Engl J Med. 2008;358(12): 1262-70.

Kaunitz AM, Arias R and McClung M. Bone density recovery after depot medroxyprogesterone acetate injectable contraception use. Contraception. 2008;77(2): 67-76.

Kulier R, O'Brien PA, Helmerhorst FM, Usher-Patel M and D'Arcangues C. Copper containing, framed intra-uterine devices for contraception. Cochrane Database Syst Rev. 2007;(4): CD005347.

Lopez LM, Grimes DA, Gallo MF and Schulz KF. Skin patch and vaginal ring versus combined oral contraceptives for contraception. Cochrane Database Syst Rev. 2008;(1): CD003552.

Margolis KL, Adami HO, Luo J, Ye W, Weiderpass E. A prospective study of oral contraceptive use and risk of myocardial infarction among Swedish women. Fertil Steril. 2007 Aug;88(2):310-6.

Meirik O. Intrauterine devices - upper and lower genital tract infections. Contraception. 2007;75(6 Suppl): S41-7.

Nelson AL. Contraindications to IUD and IUS use. Contraception. 2007;75(6 Suppl): S76-81.

O'Brien PA, Kulier R, Helmerhorst FM, Usher-Patel M and d'Arcangues C. Copper-containing, framed intrauterine devices for contraception: a systematic review of randomized controlled trials. Contraception. 2008;77(5): 318-27.

Peterson HB. Sterilization. Obstet Gynecol, 2008;111(1): 189-203.

Polis CB, Schaffer K, Blanchard K, Glasier A, Harper CC and Grimes DA. Advance provision of emergency contraception for pregnancy prevention (full review). Cochrane Database Syst Rev. 2007;(2): CD005497.

Power J, French R and Cowan F. Subdermal implantable contraceptives versus other forms of reversible contraceptives or other implants as effective methods of preventing pregnancy. Cochrane Database Syst Rev. 2007;(3): CD001326.

Prager S and Darney PD. The levonorgestrel intrauterine system in nulliparous women. Contraception. 2007;75(6 Suppl): S12-5.

Roumen FJ. The contraceptive vaginal ring compared with the combined oral contraceptive pill: a comprehensive review of randomized controlled trials. Contraception. 2007;75(6): 420-9.

Rosenberg L, Zhang Y, Constant D, Cooper D, Kalla AA, Micklesfield L, et al. Bone status after cessation of use of injectable progestin contraceptives. Contraception. 2007;76(6): 425-31.

Tolaymat LL and Kaunitz AM. Long-acting contraceptives in adolescents. Curr Opin Obstet Gynecol. 2007;19(5): 453-60.

Reviewed last on: 11/11/2008
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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