EMERGENCY CONTRACEPTION (EC)

MEDICATION ABORTION

What is EC?

What is medication abortion?

EC contains hormones that reduce the risk of pregnancy if started within 120 hours of unprotected intercourse. The treatment is more effective the sooner it begins. Plan B^® is currently the only product marketed specifically as emergency contraception. Certain oral contraceptives taken in increased doses may also be used as EC ("FDA Approves...," 1999; Rodrigues et al., 2001; Van Look & Stewart, 1998).

Medication abortion is the use of medications that can induce abortion. There are currently two drugs available in the U.S. for this purpose — mifepristone and methotrexate. Mifepristone can be taken up to 56 days after the first day of the last menstrual period, and methotrexate can be taken up to 49 days after the first day of the last menstrual period. Both are used in conjunction with misoprostol, which is taken after either mifepristone or methotrexate to complete the abortion (Creinin & Aubény, 1999; Middleton et al., 2005; Schaff, 2000; Schaff et al., 2001). Mifepristone is more commonly used than methotrexate because it is more effective and more predictable (Grimes & Creinin, 2004; Wiebe et al., 2002).

How do the medications in EC work?

How do abortifacient medications work?

According to the Food and Drug Administration (FDA), "Emergency contracep[tion]...act[s] by delaying or inhibiting ovulation, and/or altering tubal transport of sperm and/or ova (thereby inhibiting fertilization), and/or altering the endometrium (thereby inhibiting implantation)" (FDA, 1997). A recent study found that most often, EC reduces the risk of pregnancy by inhibiting ovulation (Marions et al., 2002). A more recent study suggests that progestin-only EC works only by preventing ovulation or fertilization, and has no effect on implantation (Croxatto et al., 2003).

Mifepristone ends pregnancy by blocking the hormones necessary for maintaining a pregnancy. Methotrexate stops the further development of the pregnancy in the uterus. Misoprostol causes the uterus to contract and empty (Creinin & Aubény, 1999).

How effective is EC?

How effective is medication abortion?

EC is very effective at reducing the risk of pregnancy. Studies have shown EC reduces the risk of pregnancy when taken up to 120 hours after unprotected intercourse, but the sooner the dosing begins, the more effective the treatment. When taken within 72 hours of unprotected intercourse, EC that contains both estrogen and progestin reduces the risk of pregnancy by 75 percent. Within the same time frame, progestin-only regimens, such as Plan B, reduce the risk of pregnancy by 89 percent. When initiated within 24 hours of unprotected intercourse, progestin-only EC was found to reduce the risk of pregnancy by 95 percent (Ellertson et al., 2003; Rodrigues et al., 2001; TFPMFR, 1998; Van Look & Stewart, 1998).

Medication abortion regimens are highly effective at ending very early pregnancies. Complete abortion will occur in 92–96 percent of women receiving the methotrexate regimen. Complete abortion will occur in 96–97 percent of women receiving the mifepristone regimen. In the small percentage of cases in which medication abortions fail, other abortion procedures are required to end the pregnancies (ACOG, 2001; Schaff et al., 2000).

How safe is EC?

How safe is medication abortion?

EC is safe for almost all women — millions of women around the world have used EC safely (Guillebaud, 1998; Van Look & Stewart, 1998).

Medication abortion is safe for most women — millions of women around the world have had them safely (Creinin & Aubény, 1999). There are risks associated with all medical procedures, including abortion. In extremely rare cases, death is possible from serious complications.

Does EC cause an abortion?

Can the medicines used for medication abortion also be used for emergency contraception?

EC will not induce an abortion in a woman who is already pregnant, nor will it affect the developing pre-embryo or embryo (Van Look & Stewart, 1998). Emergency contraception prevents pregnancy and helps a woman prevent the need for abortion.

Although some studies show that mifepristone could be used in very low doses to reduce the risk of pregnancy as a method of emergency contraception within five days of unprotected intercourse, mifepristone is not approved for emegency contraceptive use in the United States at this time (Ho et al., 2002; TFPMFR, 1999).

Why might a woman choose EC?

Why might a woman choose medication abortion?

Women may use EC as a means of preventing pregnancy after unprotected intercourse — in cases of unanticipated sexual activity, contraceptive failure, or sexual assault. Nearly half of America's 6.4 million annual pregnancies are unintended (Finer & Henshaw, 2006).

Women may choose medication abortion as a means of ending pregnancy because it is a noninvasive procedure and does not require anesthesia. It is free from the risk of injury to the cervix or uterus and the complications caused by anesthesia used in other abortion procedures (Aguillaume & Tyrer, 1995). Women who chose medication abortion also reported that they felt it was a more "natural" way to abort (Winikoff, 1995).

Does EC have side effects?

Does medication abortion have side effects?

The most common side effects reported by women following use of EC include nausea and vomiting. Breast tenderness, fatigue, irregular bleeding, abdominal pain, headaches, and dizziness may also occur. Side effects are far less common using progestin-only EC than combination hormone EC (Van Look & Stewart, 1998).

The most common side effects reported by women following medication abortions are similar to those of a spontaneous miscarriage — abdominal pain, bleeding, changes in body temperature, dizziness, fatigue, and gastrointestinal distress (ACOG, 2005; Creinin & Aubény, 1999; Stewart et al., 2005).

How long does the process of using EC take?

How long does the process of medication abortion take?

EC is taken in two doses, 12 hours apart. Progestin-only EC can also be taken in one dose. Side effects associated with EC generally subside within 48 hours. EC affects the timing of the menstrual cycle in 10-15 percent of women. Changes in the menstrual cycle are seen with both combination and progestin-only EC. If the next menstrual cycle is more than one week late, a woman should visit her clinician for a pregnancy test (Van Look & Stewart, 1998; von Hertzen et al., 2002).

It begins immediately after taking mifepristone or methotrexate. Some women may begin spotting before taking the misoprostol, the second medication. For most, the bleeding and cramping associated with medication abortion begin after taking it. More than 50 percent of women who use mifepristone abort within four – five hours after taking the misoprostol. Heavy bleeding may continue for about 13 days. Spotting can last for a few weeks. About 92 percent of mifepristone abortions are completed within a week. Only 75 percent of methotrexate abortions are completed as soon — it may take up to four weeks (ACOG, 2001; el-Refaey et al., 1995; Newhall & Winikoff, 2000; Peyron et al., 1993; Wiebe et al., 2002).

Are women who have used EC satisfied with it?

Are women who have had medication abortions satisfied with the method?

An overwhelming majority of EC users are satisfied with the method. One study found that 97 percent of EC users would recommend the method to friends and family (Harvey et al., 1999). Another study found that 92 percent of women who had used EC would use it again in the case of a contraceptive emergency (Breitbart et al., 1998).

An overwhelming majority of women who choose medication abortion are satisfied with the method. A recent study found that 97 percent of women who had medication abortions would recommend the method to a friend. Additionally, 91 percent of the women reported that they would choose medication abortion again if they had to have another abortion (Hollander, 2000).

Where can I get EC?

Where can I get a medication abortion?

Plan B is currently available over-the-counter (OTC) to women and men 18 and older. Plan B and other forms of EC are also available by prescription for all women. If you need a prescription for EC, contact your nearest Planned Parenthood^® health center at 1-800-230-PLAN for information.

Contact Planned Parenthood at 1-800-230-PLAN, other women's health care centers, or your private clinician. Planned Parenthood centers that do not provide medication abortion can refer you to someone who does.

How much does EC cost?

How much does medication abortion cost?

Nationwide, the price of EC ranges from $10-$35 (Hatcher et al., 2005). Costs vary from community to community, based on regional and local expenses. Contact your nearest Planned Parenthood^® health center at 1-800-230-PLAN for information about costs in your area.

Nationwide, the price of medical abortion ranges between $350 and $575. This includes two or three office visits, testing, and exams (PPFA, 2002). Costs vary from community to community, based on regional and local expenses. Contact your nearest Planned Parenthood health center at 1-800-230-PLAN for information about costs in your area.