Hormonal Emergency Contraception

Melissa Sanders Wanner, Pharm.D., Rachel L. Couchenour, Pharm.D.

Disclosures

Pharmacotherapy. 2002;22(1) 

In This Article

Adverse Effects

Adverse effects were reported less frequently in women taking danazol than in those taking the Yuzpe regimen.[8] The occurrence rates of nausea (10-30% vs 55-70%) and vomiting (1-4% vs 17-22%) were lower with danazol than the Yuzpe regimen. Breast tenderness occurred at a similar rate (21% vs 18%) in both groups.[8,9] Menstrual irregularities are less common with danazol than with other methods of emergency contraception. Most women will have their next menses either within 3 days of its expected date (56%) or 4-7 days early (30%).[8]

Many oral contraceptive pills contain the hormones used in the Yuzpe regimen and may be taken in varying doses for emergency contra-ception, although none is FDA approved for this use. In 1997, the FDA concluded that certain oral contraceptives containing combinations of ethinyl estradiol and norgestrel or levonorgestrel were safe and effective for emergency contraception.[3] During the next 2 years, Preven and Plan B became available. To expedite the use of these pills soon after unprotected intercourse, having women keep a pack of oral contraceptive pills or a prescription for emergency contraceptives at home has been proposed.[39] In addition, the incoming president of the American College of Obstetricians and Gynecologists has asked obstetricians and gynecologists to offer an advanced prescription for emergency contraceptives to women during routine office visits.[40] The organization also supports making over-the-counter emergency contraceptives available to women.[40] Others suggest that all obstetrics-gynecology, family practice, adolescent health, and internal medicine clinicians routinely discuss emergency contraception with patients so that they know it is available should the need arise. However, a small survey of physicians with expertise in adolescent health indicated that only 28% provided emergency contraceptive counseling during family planning office visits.[41]

Awareness about emergency contraception is low among the general public. A 1999 poll of New Jersey and Oregon voters revealed that one-third of those polled knew that emergency contraceptive pills were available in the U.S., and fewer than 10% of women had ever discussed emergency contraception with their physician or other health care professional.[42] To increase awareness among women and improve access, the Reproductive Health Technologies Project and the Office of Population Research at Princeton University have established the emergency contraceptive hotline (1-888-NOT-2-LATE).[39] This is an automated toll-free hotline available 24 hours/day in English and Spanish. The confidential hotline provides information about emergency contraception and the names and phone numbers of five clinicians in the caller's geographic area who prescribe emergency contraceptives. Identical information may be obtained at their Web site (www.not-2-late.com). The directory contains over 2900 providers located in all 50 states, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands. A recent study examined the accessibility of emergency contraceptives using this hotline and Web site.[39] Only 76% of attempts to obtain emergency contraceptives resulted in an appointment with or a telephone prescription from a hotline provider.

Involving pharmacists as providers of emergency contraceptives has created another opportunity for women to access emergency contraception. Pharmacists in Washington State may enter into collaborative drug therapy agreements with state prescribers, usually a physician or a nurse practitioner, to prescribe emergency contraceptives for patients.[43] These agreements permit pharmacists to prescribe emergency contraceptives according to specific prescribing protocols developed by the prescriber and the pharmacist. These agreements have several advantages for patients. Pharmacies have convenient business hours and locations. For young women who may not have a regular health care provider, access through a pharmacy avoids the long wait often experienced by new patients who attempt to schedule an appointment with a physician. The Washington State Medical Association has publicly endorsed this project.[43] In the United Kingdom, the Committee on Safety of Medicines has granted nonprescription status to levonorgestrel-only emergency contraceptives, which can be sold directly by pharmacies.[44] Some believe that this move will help reduce the number of unintended pregnancies, whereas others express concern that the policy reduces the opportunity for concurrent detection and treatment of sexually transmitted diseases.[45]

Mifepristone recently was approved by the FDA for the termination of early pregnancy, defined as 49 days or fewer.[46] Access for use as an emergency contraceptive is severely restricted in the U.S. and unavailable to women, although it is the emergency contraceptive of first choice in other parts of the world.[1] Danazol is not FDA approved for emergency contraception but is approved for the treatment of endometriosis, fibrocystic breast disease, and hereditary angioedema and therefore available by prescription in the U.S.[2]

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