Emergency Contraception, What Teen Girls Should Know
Now that the American Academy of Pediatrics (AAP) has announced that teen girls younger than 17 should be prescribed emergency contraception before they may need it, many people are asking questions, such as whether this recommendation will help reduce teenage pregnancy and if such a move is safe. Here are some things teen girls--and their parents--should know about emergency contraception.
Why the AAP made the recommendation
Teenage pregnancy rates in the United States are significantly higher than those of other industrialized nations, according to the AAP, even though the rates have declined somewhat over the past few decades. In fact, the AAP stated in August 2010 that the United States had the highest pregnancy rate among teenagers in the Western Hemisphere, and that one-quarter of teens in the US had a sexually transmitted disease.
Therefore, the AAP Committee on Adolescence noted that if teen girls younger than 17 had a prescription for emergency contraception before they needed it, they would be more likely to use it and avoid unintended pregnancy. The AAP also warned, however, that teen girls should be fully educated about the fact that emergency contraception offers no protection against sexually transmitted diseases.
Currently, teenage girls age 17 and older and boys 18 and older in all 50 states do not need a prescription for most emergency contraception. Reasons teenagers may need emergency contraception include sexual assault (10% of teen girls are victims of sexual assault), unprotected sex, broken or misused condoms, and forgetting to take hormonal contraceptives.
Types of emergency contraception
Five types of emergency contraception are available in the United States: ella, levonorgestrel tablets, Next Choice, Next Choice One Dose, and Plan B One Step. All can help prevent unintended, unwanted pregnancy if they are used within 120 hours of having sex, depending on how close a woman is to ovulating. It's important to note, however, that because teen girls may not know exactly how close they are to ovulating, they should take emergency contraceptives as soon as possible after having unprotected or unplanned sex.
Emergency contraception pills are also known as morning after pills or day after pills, even though they are still effective if taken up to five days after sex. These emergency contraceptives should not be used as a regular form of birth control, nor are they effective in stopping an existing pregnancy.
Of the five emergency contraceptives, four (all except ella) contain the female hormone levonorgestrel, a synthetic progestogen. This hormone causes changes in the cervical mucus and uterine lining that make it difficult for sperm to complete its journey and fertilize an egg. These four pills are currently available over the counter for teen girls 17 years and older and boys 18 years and older, but by prescription only for girls 16 and younger.
Unlike the other four pills, ella contains ulipristal acetate, which is known as a selective progesterone receptor modulator. It is available by prescription only, regardless of age. Basically, ulipristal acetate helps prevent or delay the release of an egg from the ovary and may also prevent an egg from attaching to the uterus.
This product is more effective than the emergency contraceptives that contain levonorgestrel only. According to the Office of Population Research at Princeton University, clinical studies have shown that ella remains equally effective over five days after unprotected sex while products that contain levonorgestrel only may be ineffective by day 5.
In addition to the five emergency contraceptives just described, other options for preventing pregnancy in an emergency is to take a different dose of daily birth control pills (typically called combined pills when they contain both estrogen and progestin) or having a physician insert an IUD within five days of the unprotected or unplanned sexual encounter. However, all five of the emergency contraceptives are more effective and can cause fewer side effects than using an emergency dose of birth control pills (which should be done with a doctor's guidance).
The most common side effects associated with ulipristal acetate include abdominal pain, headache, nausea, and unusual weakness or fatigue. Teen girls who experience cramping, pain, or heavy bleeding should contact their doctor immediately.
Clinical trials of levonorgestrel show the most common side effects are heavier menstrual bleeding, nausea, lower abdominal pain, fatigue, headache, and dizziness. Any unusual or severe symptoms should be reported to a physician immediately.
When taking any of the emergency contraceptives, teen girls who vomit within two hours of dosing should contact their doctor, because they may need to take another dose. Teens who had been using birth control before using an emergency contraceptive, including the Pill, should continue with their regular birth control methods, because you can still become pregnant after using emergency pills.
The bottom line
To prevent pregnancy after unwanted or unprotected sex, teen girls (and women) can take emergency contraception within 120 hours of the sexual act. However, it can take time to find a pharmacy, get a prescription, and have it filled. By offering teen girls prescriptions for emergency contraceptive before the fact, it may reduce the number of unwanted teenage pregnancies.
Office of Population Research, Princeton University
Upadhya KK et al. Emergency contraception. Pediatrics 2012; doi:10.1542/peds.2012-2962