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Emergency contraception

Contraception is usually thought of as a measure to be taken in advance of or during sex. But even though many women don't realize it, something still can be done after the fact —after unprotected sex; after a condom breaks; after a diaphragm, cap, or sponge becomes dislodged; or after a rape. Called by several names—such as the morning­after pill, postcoital contraception, emergency contraception, or interception—the regimen involves ingesting higher­than­normal doses of contraceptive hormones within 72 hours of intercourse, and then ingesting even more of the same hormones 12 hours later.

The drug companies that sell OCs don't have approval from the Food and Drug Administration to market their pills for emergency contraception, mainly because they haven't applied for it. However, physicians are allowed to prescribe an approved drug for any purpose they deem reasonable; so normal birth control pills—maybe ones similar to those in your drawer or purse—have been used after the fact since the early 1980s to prevent possible pregnancies.

There are several different postcoital treatment options available in the United States. The regimen of choice involves the use of an OC called Ovral, a high­dose pill containing the progestin norgestrel.

Here's how the regimen works: Two Ovral tablets are taken within 72 hours of unprotected sex; then 2 more Ovral tablets are taken 12 hours after the first dose. Because this much hormone can upset your system, always talk with your doctor before attempting emergency contraception of this type.

Depending on where you are in your menstrual cycle, postcoital pills work by either stopping release of an egg from the ovary, disrupting fertilization by the sperm, or preventing a fertilized egg from implanting in the lining of the uterus.

The Norplant system requires just one trip to the doctor every 5 years—and nothing else! There's no daily pill to remember and nothing to fuss with before sex. The only major drawback to the system is the insertion procedure. Because the 6 levonorgestrel-filled capsules that make up the system must be placed under the skin, you can expect tenderness and swelling of your upper inner arm for a couple of days while the insertion site heals.
The most significant side effect is severe nausea, which affects about one­third of women using this regimen. However, this should stop a day or so after treatment. If the nausea is so severe that you have to vomit within an hour of taking the dose, you may need to take extra pills. You can also get anti­nausea medication from your doctor. Other side effects you might experience include headache, breast tenderness, dizziness, and fluid retention.

You should have your period in 2 or 3 weeks. If it hasn't started in 3 weeks, consider taking a pregnancy test. And don't forget to watch out for the Pill warning signs (turn to the “See Your Doctor...” box, page 267).

There are several other brands of pills containing norgestrel, including Lo/Ovral, Nordette, Levlen, Triphasil, and Tri­Levlen. If you are currently taking any of these pills, you can use them in an emergency, but you'll have to take twice the amount because they aren't as strong as Ovral. This means you will need to take four tablets within 72 hours, and then another four tablets 12 hours later. If you use the triphasic pills (Triphasil or Tri­Levlen), make sure you take only the pills designated for the last week. These are the ones with the right dose. Again, be sure to consult your physician before using OCs in this way.

Other progestin­based brands would probably work the same way, but they haven't been studied, so experts can't reliably make any recommendations.

Reported effectiveness rates for this treatment option vary, but a recent study found that emergency contraception of this type can be up to 75 percent effective, depending on where a woman was in her cycle when she had unprotected sex.

Dr Mohans Diabets
American Diabetes Association
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