Pediatrics Group Calls for Easier Access to Emergency Contraception

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Pediatricians should counsel all adolescents on use of emergency contraception, such as Plan B, as part of routine practice, according to an American Academy of Pediatrics (AAP) policy statement.

Healthcare professionals should provide teens with an education on the use, availability, and advance prescription of emergency contraception, as well as contraindications and adverse events related to different forms of emergency contraception, according to the statement drafted by Drs. Krishna Upadhya and Cora Breuner and colleagues of the AAP Committee on Adolescence.

"The discussion of emergency contraceptions methods with patients must also include the fact that none of these methods will protect from sexually-transmitted infections," they wrote online in the journal Pediatrics.

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The authors noted that despite significant declines in teen birth rates over the past two decades, birth rates remain "significantly higher than other industrialized nations." The use of emergency contraception can reduce risk of pregnancy up to 120 hours after unprotected sex or in the event of contraceptive failure, though forms of emergency contraception are most effective if used within 24 hours after intercourse.

They also noted that teens are "more likely to use emergency contraception if it has been prescribed in advance of need."

The policy statement recommended three methods of emergency contraception, including levonorgestrel (Plan B), ulipristal acetate, and the Yuzpe method, which involves use of combining oral hormonal contraceptives.

Plan B requires patients to take two 0.75 mg levonorgestrel tablets 12 hours apart or a single 1.5 mg dose, which may be "equally effective and without increase in adverse effects." The drug is contraindicated in patients who are known to be pregnant and may cause adverse events of nausea, vomiting, and heavier menstrual bleeding. Patients should take a pregnancy test if they do not have a normal period within 3 weeks of using Plan B.

Ulipristal is a single pill (30 mg) that prevents binding of progesterone and should be taken within 120 hours after unprotected sex. Adverse events include headache, nausea, and abdominal pain. Patients with existing pregnancy should not take ulipristal due to risk of fetal loss, and use may require a pregnancy test. Patients with severe abdominal pain 3 to 5 weeks after treatment should be evaluated for ectopic pregnancy.

The Yuzpe method requires patients to take two doses of at least 100 µg of ethinyl estradiol and at least 500 µg of levonorgestrel and can be useful for patients with "no or limited access to an emergency contraception product." Though the use is considered off-label, the statement noted that the combination oral contraceptive use has been declared safe and effective.

Adverse events with the Yuzpe method include nausea and vomiting, fatigue, breast tenderness, headache, abdominal pain, and dizziness. Antienimics may offset the effects of nausea and vomiting with this method if taken an hour before administration. This method should not be used by patients with a contraindication to estrogen use.

In addition to informing patients about emergency contraception use, pediatricians should encourage both male and female patients to get tested or treated for sexually transmitted infections and discuss ongoing contraception methods following use of emergency contraception.

The authors also noted that, at the policy level, "pediatricians should advocate for increased nonprescription access to emergency contraception for teenagers regardless of age and for insurance coverage of emergency contraception to reduce cost barriers."

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