The “Morning After Pill” Ashley Blevins-Griffith Master’s Project Spring 2007

Definition The Morning After Pill (a.k.a. “Emergency Contraception): A form of medication taken within 72 hours of sexual intercourse to prevent pregnancy.

Controversy of Abortion According to the National Institute of Health’s definition of when life officially begins, determines that emergency contraception is NOT considered an abortifacient. However, at the beginning of the decade, 20% of women practitioners in California’s health maintenance organization considered EC an abortifacient. By the end of the 1990’s approximately 39% of primary care providers also considered it as such.

Regimens of “The Morning After Pill” Yuzpe –The most accepted mechanism is that the hormones prevent proliferation of the endometrium; therefore preventing the fertilized egg from attaching. Mifepristone (RU-486) –2 possible mechanisms of action: Some believe that it works as a progesterone antagonist. Progesterone is essential for the proliferation of the endometrium, so this would allow the pill to work in the same way as the Yuzpe regimen. Others believe that Mifepristone causes a decrease in leptins, which in turn causes a reduction in FSH secretion. This will prevent ovulation and decrease the chance of an unintended pregnancy.

Yuzpe vs. Mifepristone Which is better? –When comparing a single dose of Mifepristone with the Yuzpe regimen, 402 women received Mifepristone and 398 received the Yuzpe regimen. Of the 402, zero became pregnant. On the other hand, 4 of the 398 women on the Yuzpe regimen became pregnant. –Women who took Mifepristone experience less side effects such as breast tenderness, nausea and vomitting than those who took Yuzpe.

Benefits of “The Morning After Pill” Decreases the number of unintended pregnancies. Has been shown to not cause miscarriages. If the method is not effective, there is no increased chance of birth defects. Effective up to 72 hours after sexual intercourse. Does not increase clotting factors or clot formation. Patients can be evaluated over the telephone or in non-office settings

Pitfalls of “The Morning After Pill” Contraindicated in pregnancy because it will not work. Not successful as the primary method of preventing pregnancy. Adverse side effects. Not 100% effective. Efficacy of the medication drastically decreases with the time a woman waits between sexual intercourse and the initial dose. Main cause of ectopic pregnancy. Possible tubal pregnancies. Inadvisable for women who experience crescendo migraines or frequent migraines with severe neurological deficits. Does not protect against STD’s. Unavailability. Most Physician’s will only prescribe this medication to victims of rape or incest.

OTC Availability Practitioners are concerned about making EC available OTC because of 4 reasons: –Lack of consultation –EC is not the most safe or effective type of long term contraceptive. –Pharmacy is not appropriate for selling this medication. –Women would abuse its availability.

Results of EC being made available OTC in England No significant increase in the number of women who used the morning after pill or who participated in unprotected sexual intercourse. The only significant finding was where the women obtained the medication. (More OTC and less from Practitioner).

Either way…. An increase in the number of sales of “The Morning After Pill” or any other emergency contraception will only lead to a decrease in the number of unintended pregnancies.

In the Future Trials are being conducted to see if emergency contraception will be effective after as much time as 120 hours after unprotected sexual intercourse. Also, trials are being conducted to see if lower doses of Mifepristone will be as effective as the higher doses.

For Help… For women who want to understand the benefits and risks of EC, the Reproductive Health Technologies Project in Washington, DC, along with the Office of Population Research at Princeton University sponsored a toll free emergency number (1-888-NOT-2-LATE) in There is also a website available that was constructed in The website and number are confidential and available 24/7 in Spanish or English. These resources also offer the names and numbers of practitioners in the caller’s area who can schedule a consult and prescribe the medication.

Conclusion The benefits and pitfalls of emergency contraception are outlined and will need to be considered by every female patient that wishes to prevent an unintended pregnancy. The topic of emergency contraception encompasses far more than just the scientific studies of effectiveness, and mechanism of action, its use depends on morals, customs, and social beliefs.