Contraception – the morning after

A former postcoital contraceptive was diethylstilbestrol (DES) which has been linked to cancer in the daughters of women who had taken the drug to prevent miscarriage

Abstract

Although no postcoital method has been developed for safe and effective regular use, postcoital contraception is being offered in Canada and Western Europe on an emergency basis to people who experience such problems as a burst condom. It is little known in the US, however. The 1st commercial version of a postcoital method recently became available to women in England.

The first reference in the medical literature to the use of postcoital contraceptives appeared in a 1966 article by John Morris and Gertrude van Wagenen of the Yale University School of Medicine. The drug referred to was diethylstilbestrol (DES), given in doses of 50 mg daily for five days following unprotected intercourse. Although this treatment produced several immediate side effects, including nausea or vomiting in most patients, trials showed that only about one percent of women who took it became pregnant.

DES was used for more than a decade as a postcoital contraceptive, and it was even endorsed by the U. S. Food and Drug Administration (FDA) in 1975 for use by rape victims. Many people questioned the FDA’s action because DES had been linked to cancer in the daughters of women who had taken the drug to prevent miscarriage.

A new postcoital contraceptive regime was developed by Albert Yuzpe and consists of 4 ordinary contraceptive pills combining estrogen and progestin to be taken over a 12-hour period. In the US, this is the formulaion of birth control pill marketed under the trade name Ovral by Wyeth Laboratories. England and Germany are the only countries in which the Yuzpe method is officially approved for use as an emergency postocital contraceptive, but the method is used to some degree in most European countries, being well-known in France and Denmark. The most frequent side-effect reported by Yuzpe is vomiting experienced by 29% of women; another 22% felt nauseated. Other side effects, e.g. headache, were infrequent. The findings of the Pregnancy Advisory Service and the Brook Advisory Centre in Britain are reported. Overall very few side effects were found. Postcoital contraceptive treatment may cause the length of the cycle in which it occurs to be irregular. Treatment before day 15 has been found to shorten the cycle, whereas treatment after day 15 lengthens it. The majority of women who become pregnant due to treatment failure tend to seek an abortion. Ectopic pregnancy incidence may also be a result of treatment failure. In 1981, the International Planned Parenthood Federation (IPPF) issued a statement endorsing the use of postcoital contraceptives. Reasons for using them include rape, problems with barrier methods, ineffective use of the pill and IUD expulsion. No drug company in the US has expressed interest in getting FDA approval to market a postcoital contraceptive, partly because its usage might not be widespread. Opposition to approval from groups who believe life begins at conception and consequently that postcoital contraceptives are an abortifacient is expected.

Sources

  • Contraception–the morning after, Family planning perspectives, NCBI PubMed PMID: 6519238, 1984 Nov-Dec.
  • Image credit someecards.
DES DIETHYLSTILBESTROL RESOURCES

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