Ovral

Emergency contraception pills, high-dose hormone drugs that must be used within 72 hours of unprotected intercourse, are available without a prescription in some countries. Though highly successful (75%) in preventing pregnancy, ECP is a little known option in the U.S. Three years ago the American College of Obstetricians and Gynecologists launched an educational campaign aimed at physicians and women, featuring free booklets, a nationwide ad campaign, and a toll-free hotline. Still, surveys have shown that only about 1% of American women surveyed have ever used ECP.

The need for new ideas about getting the word out is critical. When ECP came up at the most recent meeting of the American College of Obstetricians and Gynecologists, the topic was framed with this alarming statistic: Half of all pregnancies in the U.S. are unintended, resulting in 1.4 million abortions and 1.1 million births that women either did not want until later in life or did not want at all.

Now one small step has been taken to make ECP available over the counter in the U.S. The Food and Drug Administration held hearings in June at which an advisory committee floated the idea of selling ECP without a doctors prescription (see page one for related article). The subject might receive more attention this fall, according to an FDA spokesman.

The safety and high degree of efficacy of ECP, which prevents pregnancy by keeping a fertilized egg from implanting into the uterus, was well established years ago. Six commonly prescribed brands of birth control pills can double as emergency contraception when used according to instructions on timing and dosage. They are Ovral, Lo/Ovral, Levlen, Nordette, Tri-Levlen, and Triphasil. In 1998, the FDA approved Preven, the first product solely for the purpose of emergency contraception. The next year Plan B became the first progestin-only ECP; it is 10% more effective and has a lower risk of nausea and vomiting than the standard estrogen/progestin combination. (Taking Dramamine II or Benadryl one hour before the first dose of a combination ECP will reduce the chances of nausea.) Another option is the copper intrauterine device, which has a failure rate of less than 1% even if inserted by a health professional as late as seven days after unprotected intercourse.

No serious side effects have been reported for ECP, not even the small risk of blood clots long associated with oral contraceptives, because the high doses are taken for a short duration. Moreover, the drugs will not cause harm to the fetus of a woman who takes ECP without realizing that she has an already established pregnancy, according to studies cited at the American College of Obstetricians and Gynecologists meeting.

ECPs efficacy is clearly dependent upon easy access, but many women do not have a physician and not all pharmacies stock the products. A pilot study conducted in Washington State showed that when ECP was made available to women directly from pharmacists, an estimated 700 pregnancies were prevented in a 16-month period. Crucial to the success of this pilot project was the education of the participating pharmacists who in turn instructed the women. One-half of the women surveyed said that if the pharmacists hadnt provided ECP, they would have waited to see if they became pregnant. Many women in this study said that they did not have a health care provider. There were no reports of injury or misuse during this project, which was sponsored by Program for Appropriate Technology in Health.

Resource

Call 1-888- NOT-2-LATE for the name and number of providers in your area who prescribe ECP. This toll-free hotline is sponsored by the Reproductive Health Technologies Project which bills itself as "not tied to any companies that make or sell emergency contraception." Visit this Web site (ec.princeton.edu/) to learn more about emergency contraception options.

COPYRIGHT 2000 Center for Medical Consumers, Inc.
COPYRIGHT 2000 Gale Group