FHI - August 12, 1996

Using "The Pill" After Sex -- August 12, 1996

RESEARCH TRIANGLE PARK, NC -- Certain types of oral contraceptives can be used as "emergency contraception" after unprotected sex to prevent pregnancy, an option unfamiliar to most women.

When used for emergency contraception, the pill is about 75 percent effective in preventing pregnancy, while daily use of the pill is typically 97 percent effect. Unpleasant side effects may occur, including nausea, experts say in the current issue of Network, Family Health International's quarterly health bulletin. However, using oral contraceptives in this way is safe for any woman, including women with health conditions that might prevent them from using the pill on a regular basis.

Combined oral contraceptives must be taken in higher doses (multiple pills) within 72 hours after unprotected intercourse, and repeated 12 hours later. For "progestin-only" pills, which do not contain estrogen, the initial dose should be taken within 48 hours of exposure and repeated in 12 hours.

Women who have been sexually assaulted, who have forgotten to use their regular contraceptive, or whose contraceptive has failed are good candidates for emergency contraception. For example, emergency contraception can be a back-up method when diaphragms or condoms slip or break during use, or if a couple simply forgets to use them, says Dr. Roberto Rivera, FHI's corporate director for international medical affairs.

In June, an advisory panel of the U.S. Food and Drug Administration concluded that oral contraceptives are safe for emergency contraceptive use. The panel said the following dosages of six brands were known to work: two tablets per dose of Wyeth's Ovral or four tablets of Wyeth's Nordette, Lo/Ovral or Triphasil (yellow pills only) brands, or four tablets of Berlex Laboratories' Levlen or Tri-Levlen (yellow pills only) brands.

Emergency contraception can also be achieved by inserting a copper intrauterine device (IUD) within five days of unprotected intercourse or by using an antiprogestin, including mifepristone or RU 486, within 72 hours after intercourse.

The current issue of Network includes other articles on topics related to oral contraceptives:

A recent study found that monkeys given the hormone progesterone were more likely to develop simian immunodeficiency virus (SIV), a disease similar to HIV, raising questions about the safety of using contraceptive methods that contain synthetic progesterone (progestins). These methods include oral contraceptives, injectable contraceptives, and the subdermal implant, Norplant. A National Institutes of Health meeting of experts, chaired by FHI's medical director, Dr. Willard Cates Jr., strongly encouraged no change in the long-standing advice to couples that contraceptives containing progestins are safe and effective, but offer no protection against sexually transmitted diseases (STDs), including HIV. Couples at risk of STDs should use latex condoms for disease prevention.

More than 70 million women use the pill worldwide, but incorrect use is common, thus lowering its effectiveness. Also, many women in some cultures discontinue using them due to such side effects as changes in menstrual patterns. Better counseling about side effects and the need for correct, consistent use can improve pill use and effectiveness, experts say.
Since the pill was introduced more than 30 years ago, there have been hundreds of major studies on risks and benefits, including the relationship of the pill to diseases. According to recent World Health Organization criteria, most women can use the pill without safety concerns. Women who should not use the pill include those with a greatly increased risk of cardiovascular disease, who are both over 35 years old and smoke heavily (more than 20 cigarettes daily), or who have certain preexisting conditions that could be worsened by the pill.

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Using "The Pill" After Sex -- August 12, 1996