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The Best Emergency Contraception

Jill

via Slate, a quick and succinct run-down on the best emergency contraception. And, surprise surprise: It’s a drug that isn’t available for emergency contraception purposes in the U.S. And it won’t be anytime soon, because it’s a drug that gives anti-choicers fits: RU-486, or mifepristone, the “abortion pill.”

Mifepristone works by cutting off necessary pregnancy-sustaining hormones, which means that it can end an established pregnancy and prevent one from occurring. It’s legal in the U.S. for early-term abortions, but not for emergency contraception. The problem, of course, is that it walks the line between abortion drug and contraceptive — you can take it after sex, but unless you’re sure you’re pregnant — which, three days after sex, you won’t be — you probably aren’t going to know whether it terminated a pregnancy (abortion) or simply stopped one from beginning (contraception). That’s a big dilemma for people, and it feeds into a lot of the public confusion about contraception vs. abortion.

Here’s what Slate says:

Issue: When proper contraception isn’t available or for whatever reason isn’t used, there’s another alternative: emergency contraception. It isn’t intended to be a replacement for the real thing (for one thing, it’s not quite as effective), but for many women it’s a far better choice than nothing at all. An estimated 50 million pregnancies worldwide are terminated every year, a solution statistically safer than pregnancy, in terms of mortality rates, but less safe and more costly (in many ways) than preventing pregnancy in the first place.

Question: What is emergency contraception? What are the choices? Which method is best? How effective is it, and how safe? An extensive review of the literature, pulling together the results of 81 studies that included almost 46,000 women, compared most of the available regimens.

Methods: Emergency contraception usually involves the administration of one or two doses of a medication sometime in the three days following unprotected sex. (Calling it the “morning after pill” gives the wrong idea of the potential time frame.) The first available method was the Yuzpe regimen, introduced in the 1970s: two doses of a hormone combination similar to that contained in some birth control pills. It’s not available in American drugstores, but some doctors keep an office supply and give the pills to patients as needed. Plan B, which is available in the United States, uses levonorgestrel, a hormone similar to one produced by the body during pregnancy. And then there’s mifepristone (RU-486 or Mifeprex), a medication that blocks the activity of an important hormone needed to sustain pregnancy. Though this drug is licensed in the United States for medical abortions, it isn’t licensed for emergency contraception (a before- and after-pregnancy distinction). In addition to these medications are a few other measures that are rarely used, such as a copper IUD called ParaGuard, which can be inserted in the five days following sex and offers effective emergency contraception (as well as ongoing birth control, if it’s left in place).

Findings: The review clearly showed that the most effective medical option for emergency conception is mifepristone, which has a failure rate between 0.5 percent and 1 percent. Mifepristone also had the lowest incidence of side effects (some nausea and vomiting and sometimes a slight delay in the resumption of menses). The hormonal methods (Yuzpe and Plan B) carried an increased risk of nausea and vomiting and sometimes caused headaches. Yuzpe and Plan B were half as effective as mifepristone. The ParaGuard was also effective, with a failure of roughly 0.1 percent, though a smaller number of women were tested with this method. Also, IUD insertion requires special skills and is much more expensive. For all the methods, no serious side effects were reported among the 46,000 women in the study. A total of eight healthy babies were born after the emergency contraception failed.

Conclusion: The superior safety and efficacy of mifepristone means that the FDA, which regulates the drug, is denying women in the United States the best method of emergency contraception. My speculation, of course, is that the decision not to extend the drug’s license for this use was made more on political (and perhaps religious) grounds than on the basis of good science or good medicine. What’s to be done? As usual, beats me, but I wish a different decision had been made.

7 thoughts on The Best Emergency Contraception

  1. I really, really wish the FDA would approve the drug. Are any women’s groups or reproductive rights groups lobbying for it?

    That pill sounds a whole lot better than walking to a clinic and getting an abortion 2, 3 months later. I dont understand why so many Christian assholes are against a “morning-after” pill. And I am SO sick of them always trying to interfere with our own damn bodies.

  2. Wow, this post is hitting home for me right now.

    Long story short, a bladder infection early this month led to antibiotics. The doctor didn’t tell me (and I forgot to ask) if those antibiotics interfered with my birth control pills. Two weeks later, I discover they do.

    I immediately start using to condoms, but who knows?

    I looked up EC and saw that mifepristone was the best, but it isn’t available. So, I can’t take it now, when I’m NOT pregnant and ensure that no pregnancy occurs, but can take it two weeks from now if there is implantation, thus having a medical abortion? That seems just idiotic to me.

    (BTW, I’m 98% sure no fertilization is going on based on timing of antibiotics and infrequency of sex this month. But still, I’ll be glad to see my period next week when it comes.)

  3. I dont understand why so many Christian assholes are against a “morning-after” pill.

    Really loaded question with no single answer.

    There is indeed a portion of the population that wants to control women’s rights, and it uses Biblical laws to justify its stance (also conveniently ignoring plenty of other laws that would be annoying to uphold). The answer for this is the classical feminist response: these people want to control your body because they like to be in control of anything they can get their grubby little hands on.

    The consistently pro-life Christians (anti-death penalty, pro-social programs, anti-abortion) really believe that life begins at conception, so losing a fertilized egg is losing a life. These people tend to be well-educated, upper-middle class types who haven’t been exposed to the ramifications of their stance. To them, there’s no difference between throwing a 1 week-old infant in the trash and undergoing an abortion.

    I will admit, being both a Christian and thoroughly pro-choice, that the concept of a fertilized egg being expelled makes me feel qweezy the way that opening a door of an AIDS patient made me feel during college fifteen years ago: logically, I know that the fertilized egg is not even close to a person (just like I knew there was a 0% chance I could contract AIDS from delivering some food), but at a purely emotional level, I’m still disturbed by the idea (just like I was still terrified, despite knowing I was absolutely safe).

    Of course, the real issue here is not that they’re disturbed by the pill. The issue is that they’re trying to use their personal beliefs to inform public policy, which is simply unacceptable.

  4. I am surprised that Slate did not mention the drug misoprostol, also known as Cytotec. Misoprostol is given in conjunction with Mifepristone, to induce uterine contractions to expel “products of conception.” Although Cytotec/Misoprostol is not actually licensed for use on gynecology/obstetrics, it is used quite often by doctors all over the world – especially in developing countries.

    Misoprostol alone can be used as emergency contraception, and it is much less expensive than Mifepristone. Women on Waves has a little bit of info about how to self-induce a medication abortion on their website.

    Misoprostol has been used extensively in Latin America for self-induced medication abortion – especially in Brazil. Also, there have been reports of women self-inducing medication abortion in the US using misoprostol – though some women have been prosecuted for their actions.

    Misoprostol is really an amazing drug for gynecology/obstetrics. It can also be used for making a surgical abortion easier – if you give it to a woman 3-4 hours prior to the surgical procedure, women don’t have to go through the process of dilating the cervix with laminaria. It is more comfortable and less painful. It has also been used in developing countries for control of postparum hemorrhage, which is a major cause of maternal mortality.

    Anyhow – I’ll stop extolling the virtues of Misoprostol now. 🙂 I’m a reproductive health geek, currently doing a summer internship with a safe abortion program in India, so wanted to throw in my $0.02.

    Also – to respond to another commenter, according to the scientific research, antibiotics actually should not interfere with your birth control. That’s what it says in the bible of contraception, anyhow – Robert Hatcher’s “Contraceptive Technology,” now in it’s 17th edition. So, your doctor was not necessarily off-base in not telling you about the possible interaction, because the research suggests that indeed, antibiotics and birth control pills used together should not pose a problem.

    I know there are many anecdotal stories, however, so I think using a back-up method like condoms or investigating EC probably isn’t a bad idea.

  5. I think this might be more complicated than a straight anti choicer thing. The problem is, mifepristone can be used later to cause abortions, unlike levnorgesterel which is completely ineffective after that third day window. If mifepristone were available over the counter, lots and lots of women would almost certainly be using it at home for abortions. Which is fine on a basic level- I think women *should* have the right to abort at home if they want- but would be very dangerous in reality. Medical abortions use mifepristone to stop the foetus developing and then another drug to encourage expulsion from the uterus. If not, you can retain the products of conception which can lead to infection or haemmorhage.

    So I reckon levnorgesterel is actually quite a good thing, in that if mifepristone was the only thing used you can bet it would only be available on prescription. Levnorgesterel is less effective, sure, but benign enough that the restrictions on sale could be slackened.

  7. Mifepristone is not illegal, its just not approved for in-home usage and has to be administered in a healthcare facility (doctor’s office, hospital).

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