Important role in emergency contraception

I was happy to see the attention given to the importance of emergency contraception (EC) in the October 2006 Pediatric Pearls article, “Emergency contraceptive options available for adolescents” by Gupta and Goldman.1 One concern about the 2005 approval of nonprescription status for the emergency contraceptive Plan B^® is that family physicians might feel they have less of a role in providing it. As the primary care providers for most adolescents, family physicians are important to promotion of healthy sexuality in teens. This includes ensuring that they know about EC and how to get it. Although Plan B^® is available in pharmacies without a prescription, teens need to be aware that they have to request it at the pharmacist’s counter. This could pose a barrier for some, and family physicians can assist this group by reviewing alternative methods for obtaining EC (eg, sexual health clinics) or providing prescriptions for EC or doses to keep on hand “in case.” Although it is slightly less effective and more likely to cause nausea than Plan B, the Yuzpe regimen is another option, and doses can be made from office stocks of common oral contraceptive samples (eg, Alesse,^® 2 doses of 5 tablets each taken 12 hours apart). When EC has been provided in advance of need, it is used appropriately and has not resulted in lower use of regular contraception.2

Gupta and Goldman cite the higher risk of pregnancy after EC among women who have intercourse again within a few days of treatment. Family physicians should keep this in mind. For women who need ongoing contraception, EC alone is not enough. Those who want to use oral contraceptives can start them on the day following EC, but should be instructed to use a backup method until the pill has been taken for 7 consecutive days.3 This provides women with effective contraception for emergencies and long-term. The very small risk of failure of EC can be managed by performing a pregnancy test if women fail to have withdrawal bleeding when expected.

The authors mention the higher rates of sexually transmitted infections among teens. A request for EC should be an indication for sexually transmitted infection screening in teens. Unprotected intercourse, which necessitated EC, also puts them at risk for sexually transmitted infections.

Finally, the authors indicate that the regimen for Plan B is 1 pill taken as soon as possible and another taken 12 hours later. A simpler regimen of taking the 2 pills at the same time provides the same efficacy and avoids the problem of forgetting the second dose.3

Family doctors have an important role in prevention of negative health outcomes. In a world where 40% to 50% of teens are sexually active by grade 114 and 50% of pregnancies are unplanned, emergency contraception is a preventive therapy with the potential for huge effect.

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