|
            
| |
Planned Parenthood
|
Published by the Katharine Dexter
McCormick Library
|
|
Planned Parenthood Federation of
America
|
Federation of America, Inc.
|
434 West 33rd Street,
New York, NY 10001
|
|
212-261-4779
|
|
|
|
Fact Sheet
|
www.plannedparenthood.org
|
|
www.teenwire.com
|
|
Current as of
November 2004
|
The Difference
Between Emergency Contraception
and Medical Abortion
There is considerable public confusion about the
difference between emergency contraception and medical abortion because of misinformation
disseminated by anti-choice groups. Emergency
contraception helps prevents pregnancy; medical abortion terminates
pregnancy. According to general medical
definitions of pregnancy that have been endorsed by many organizations including the
American College of Obstetricians and Gynecologists and the United States Department of
Health and Human Services, pregnancy begins when a pre-embryo completes implantation into
the lining of the uterus (ACOG, 1998; DHHS, 1978; Hughes, 1972; “Make the Distinction…”
2001). Hormonal methods of contraception, including
emergency contraception pills, prevent pregnancy by inhibiting ovulation and fertilization
(ACOG, 1998). Medical abortion terminates a pregnancy without surgery. By helping women to prevent unplanned pregnancies
after unprotected intercourse, emergency contraception has the great potential to decrease
the rate of abortion. By helping women terminate unwanted pregnancies during the 63 days
after their last menstruation, medical abortion is a safe and effective option..
| EMERGENCY
CONTRACEPTION PILLS (ECPs) |
|
MEDICATION
ABORTION |
|
|
|
|
What are
ECPs? |
|
What is
medication abortion? |
| ECPs contain hormones that reduce the risk of pregnancy
if
started within 120 hours of unprotected intercourse. The treatment
is more effective the sooner it begins. Plan B is currently the only product marketed
specifically as emergency contraception. Certain oral contraceptives taken in
increased doses may also be used as ECPs (“FDA
Approves…,”1999; Rodrigues, et al., 2001; Van Look & Stewart,
1998). |
|
Medication
abortion is the use of medications that can induce abortion. There are currently
two drugs available in the U.S. for this purpose -- mifepristone and methotrexate.
Mifepristone can be taken up to 63 days after the first day of the last menstrual
period, and methotrexate can be taken up 49 days after the first day of the last
menstrual period. Both are used in conjunction with misoprostol, which is
taken after either mifepristone or methotrexate to complete the abortion. (Creinin
& aubeny, 1999; Schaff, 2000). Mifepristone is more commonly
used than methotrexate because it is more effective and more predictable
(Grimes and Creinin, 2004, Wiebe, et al., 2002)
|
|
|
|
| How
do the medications in ECPs work? |
|
How
do abortifacient medications work?
|
| According
to the Food and Drug Administration (FDA) "Emergency contraceptive
pills...act by delaying or inhibiting ovulation, and/or altering tubal
transport of sperm and/or ova (thereby inhibiting implantation)," and/or by altering the
endometrium (thereby inhibiting implantation" (FDA, 1997). A recent study
found
that most often, ECPs reduce the risk of pregnancy by inhibiting
ovulation (Marions, et al., 2002). A more recent study suggests
that progestin-only ECPs work only by preventing ovulation or
fertilization, and have no effect on implantation (Croxatto, et al.,
2003). |
|
Mifepristone
ends pregnancy by blocking the hormones necessary for maintaining a
pregnancy. Methotrexate stops the further development of the pregnancy in
the uterus. Misoprostol causes the
uterus to contract and empty (Creinin & Aubény, 1999). |
|
|
|
| How effective are
ECPs? |
|
How
effective is medication abortion?
|
| ECPs are
very effective at reducing the risk of pregnancy.
Studies have shown ECPs reduce the
risk of pregnancy when taken up to 120 hours after unprotected intercourse,
but
the sooner the dosing begins, the more effective the treatment. When taken
with 72 hours of unprotected intercourse, ECPs that contain both estrogen
and progestin, such as Preven, reduce the risk of pregnancy by 75 percent.
Within the same time frame, progestin-only
regimens, such as Plan B, reduce the risk of pregnancy by 89 percent. When initiated within 24 hours of
unprotected intercourse, progestin-only ECPs were found to reduce the risk of
pregnancy by 95 percent (Ellertson,
et al, 2001; Rodrigues, et al, 2001; TFPMFR,
1998; Van Look & Stewart, 1998)
. |
|
Medication
abortion regimens are highly effective at ending very early pregnancies. Complete abortion will occur in 92–96
percent of women receiving the methotrexate regimen. Complete abortion will occur in
96-97percent of women receiving the mifepristone regimen. In the small percentage of cases in which
medication abortions fail, other abortion procedures are required to end the
pregnancies (ACOG, 2001, Schaff, et al., 2000). |
|
|
|
| How safe are
ECPs? |
|
How
safe is medication abortion?
|
| ECPs are
safe for almost all women — millions of women around the world have used ECPs
safely (Guillebaud, 1998; Van Look & Stewart, 1998). |
|
Medication
abortion is safe for most women — millions of women around the world have had them
safely (Creinin & Aubény, 1999).
|
|
|
|
| Do ECPs cause an abortion? |
|
Can the medicines used for
medication abortion also be used for emergency contraception?
|
| ECPs will not induce an abortion
in a woman who is already pregnant, nor will they affect the developing pre-embryo or embryo
(Van Look & Stewart, 1998). Emergency
contraception prevents pregnancy and helps prevent the need for abortion.
In fact, an estimated 43 percent of the decrease in U.S. abortions
between 1994-2000 can be attributed to the availability of emergency
contraception (AGI, 2003). |
|
Although some studies show that mifepristone could be used in very low doses to reduce the risk
of pregnancy as a method of
emergency contraception within five days of unprotected
intercourse, mifepristone is not an approved ECP in the U.S. at this time
(Ho, et al., 2000; TFPMFR,
1999). |
|
|
|
| Why might
a woman choose ECPs? |
|
Why might
a woman choose medication abortion? |
| Women may
use ECPs as a means of preventing pregnancy after unprotected intercourse — in
cases of unanticipated sexual activity, contraceptive failure, or sexual assault. Nearly half of America’s 6.3 million
annual pregnancies are accidental (AGI, 2004).
Widespread use of emergency contraception could prevent an estimated 1.7
million unintended pregnancies and 800,000 abortions each year (Glasier &
Baird, 1998; Van Look & Stewart, 1998). |
|
Women may
choose medication abortion as a means of ending pregnancy because it is a noninvasive
procedure and does not require anesthesia. It
is free from the risk of injury to the cervix or uterus and the complications
caused by anesthesia used in abortion procedures (Aguillaume & Tyrer,
1995). Women who chose medical abortion also reported that they felt it was
more “natural” way to abort (Winikoff, 1995).
|
|
|
|
| Do ECPs
have side effects? |
|
Does
medication abortion have side effects? |
| The most common side effects
reported by women following use of ECPs include nausea and vomiting. Breast tenderness, fatigue, irregular bleeding,
abdominal pain, headaches, and dizziness may also occur. Side effects are
far less common using progestin-only ECPs than combination hormone ECPs
(Van Look & Stewart, 1998).
|
|
The most
common side effects reported by women following medication abortions are similar to
those of a spontaneous miscarriage — abdominal pain, bleeding, and
gastrointestinal distress (Creinin & Aubény, 1999). |
|
|
|
| How long does the process of
using ECPs take? |
|
How long
does the process of medication abortion take? |
| ECPs are taken in two doses, 12 hours apart.
Progestin-only ECPs can also be taken in one dose. Side effects
associated with ECPs generally subside within 48 hours. ECPs
aggect the timing of the menstrual cycle in 10 - 15 percent of
women. Changes in the menstual cycle are seen with both
combihation and progestin-only ECPs. If the next menstrual cycle
is more than one week late, a woman should visit her clinician for a
pregnancy test (von Hertzen, et al., 2002; Van Look & Stewart,
1998). |
|
It
begins immediately after taking mifepristone or methotrexate. Some
women may begin spotting before taking the misoprostol, the
second medication. For most, the bleeding and cramping associated
with medication abortion begin after taking it. More than
50 percent of women who use mifepristone abort within four-five hours
after taking the misoprostol. Heavy bleeding may continue for
about 13 days. Spotting can last for a few weeks. About 92
percent of mifepristone abortions are completed within a week.
Only 75 percent of methotrexate abortions are completed as soon -- it
may take up to four weeks (ACOG, 2001; el-Refaey, et al., 1995; Newhall
& Winikoff, 2000; Peyron, et al., 1993; Wiebe, et al.,
2002). |
|
|
|
| Are women
who have used ECPs satisfied with them? |
|
Are women
who have had medication abortions satisfied with the method?
|
| An overwhelming majority of ECP
users are satisfied with the method.
One study found that 97 percent of ECP users would recommend the
method to friends and family (Harvey, et al., 1999). Another study found that 92 percent of
women who had used ECPs would use them again in the case of a contraceptive
emergency (Breitbart, et al., 1998). |
|
An overwhelming majority of women who choose medication abortions are satisfied
with the method. A recent study found
that 97 percent of women who had medication abortions would recommend the method to a
friend. Additionally, 91 percent of
the women reported that they would choose medication abortion again if they had to
have another abortion (Hollander, 2000). |
|
|
|
| How much
do ECPs cost? |
|
How
much does medication abortion cost?
|
| The price
of ECPs varies, but is usually between $20–$25 (OPR, n.d.). |
|
The price
of medication abortion varies between $350 and $575.
This includes two or three office visits, testing, and exams (PPFA,
2002). |
Cited References
ACOG — American College of Obstetricians and Gynecologists. (1998, July). Statement on Contraceptive Methods.
_____. (2001, April). “Medical Management of Abortion.” ACOG Practice Bulletin, 26, 1–13.
AGI---Alan
Guttmacher Institute. (2003, accessed
2004). Emergency
Contraception: Improving Access. [Online].
http://www.agi-usa.org/pubs/ib_3-03.html
------.
(2004) Facts in Brief: Contraception Use. New York: AGI.
Aguillaume, Claude & Louise Tyrer. (1995). “Current
Status and Future Projections on Use of RU-486.” Contemporary Ob/Gyn,
40(6), 23–40.
Breibart,
Vickie, et al. (1998) "The Impact of Patient Experience on Practice:
The Acceptability of Emergency Contraceptive Pills in Inner-City Clinics.” Journal
of the American Medical Women’s
Association, 53(5 Supplement 2), 255–258.
Creinin,
Mitchell & Elizabeth Aubény. (1999). “Medical
Abortion in Early Pregnancy.” In Maureen
Paul, et al., Eds. A Clinician’s Guide to Medical and Surgical
Abortion. New York: Churchill Livingstone.
Croxatto,
Horatio B., et al. (2003). "Mechanisms of Action of Emergency
Contraception." Steroids, 68, 1095-98.
DHHS — Department of Health and Human Services. (1978). Code of Federal Regulations. 45CFR46.203.
Ellertson, Charlotte, et al. (2003). “Extending the Time Limit for
Starting
the Yuzpe Regimen of Emergency Contraception to 120 Hours.” Obstetrics & Gynecology, 101,
1168–1171.
el-Rafaey, H., et al. (1995).
"Induction of Abortion with Mifepristone (RU 486) and Oral or
Vaginal Misoprostol." New England Journal of Medicine, 332(15),
983-87.
FDA — Food and Drug Administration. (1997).
“Prescription Drug Products;
Certain Combined Oral Contraceptives for Use as Postcoital Emergency
Contraception.” Federal Register,
62(37), 8609–8612.
“FDA Approves Progestin-Only Emergency Contraception.” (1999). The Contraception Report,
10(5), 8–10 & 16.
Glasier, Anna & David Baird. (1998). “The Effects of
Self-Administering
Emergency Contraception.” The
New England Journal of Medicine, 339(1), 1–4.
Grimes,
David A. & Mitchell D. Crenin. (2004). "Induced Abortion: An
Overview for Internists." Annals of Internal Medicine, 140(8),
620-26.
Guillebaud, John.
(1998). “Commentary: Time
for Emergency Contraception
with Levonorgestrel Alone.” The
Lancet, 352(9126), 416.
Harvey, S. Marie, et al. (1999).
“Women’s Experience and Satisfaction with Emergency Contraception.” Family Planning Perspectives, 31(5),
237–240 & 260.
Ho, Pak Chung, et al. (2002). “Mifepristone:
Contraceptive and Non-Contraceptive
Uses.” Current Opinions in
Obstetrics & Gynecology, 14(3), 325–330.
Hollander,
Dore. (2000). “Most Abortion
Patients View Their Experience Favorably, But
Medical Abortion Gets a Higher Rating
than Surgical.” Family Planning Perspectives, 32(5),264.
Hughes,
Edward, Ed. (1972). Obstetric-GynecologicTerminology. Philadelphia: F. A. Davis Company.
“Make
the Distinction: EC Prevents Pregnancy.”
(2001). Contraceptive Technology Update, 22(1), 4.
Marions,
Lena, et al. (2002). Emergency Contraception with Mifepristone and
LevonorgestrelL Mechanism of Action." Obstetrics and Gynecology,
100(1), 65-71.
Newhall,
Elizabeth Pirruccello & Beverly Winikoff. (2000). "Abortion with
Mifepristone and Misoprostol: Regimens, Efficacy, Acceptability and Future
Directions." American Journal of Obstetrics and Gynecology, 183(2),
S44-53.
OPR —
Office of Population Research, Princeton University. (n.d., accessed
(2001, August 22). Questions about Emergency Contraception [Online]. http://ec.princeton.edu/questions/eccost.html
Peyron,
R., et al. (1993). "Early Termination of Pregnancy with Mifepristone (RU
486) and Orally Active Prostaglandin Misoprostol." New England Journal
of Medicine, 328(21),1509-13.
PPFA — Planned Parenthood Federation of
America. (2002, accessed May 20,
2004). Medical
Abortion — Questions and Answers [Online]. http://www.plannedparenthood.org/ABORTION/medicalabortion.html
Rodrigues,
Isabel, et al. (2001). "Effectiveness of Emergency Contraception Pills
Between 72 and 120 Hours After Unprotected Sexual Intercourse." American
Journal of Obstetrics and Gynecology, 184(4), 531-37.
Schaff,
Eric et al. (2000). "Low-Dose Mifepristone Followed by Vaginal
Misoprostol at 48 Hours for Abortion up to 63 Days." Contraception, 61(1),
41-6.
TFPMFR —
Task Force on Postovulatory Methods of Fertility
Regulation. (1998). “Randomised Controlled Trial of
Levonorgestrel Versus the Yuzpe Regimen of Combined Oral Contraceptives for
Emergency Contraception.” The
Lancet, 352(9126). 428–433.
_____. (1999). “Comparison
of Three Single Doses of Mifepristone as Emergency Contraception: A
Randomised Trial.” The Lancet, 353(9154), 697–702.
Van Look, Paul & Felicia Stewart.
(1998).
“Emergency
Contraception.”
In Robert A. Hatcher et al., Eds.
Contraception Technology, 17th edition.
New York: Ardent Media.
von
Hertzen, Helena, et al. (2002). "Low Dose Mefepristone and Two
Regimens of Levonorgestrel for Emergency Contraception: A WHO
Multicentre Randomised Trial." The Lancet, 360, 1803-10.
Wiebe,
Ellen, et al. (2002). "Comparison of Abortions Induced by
Methotrexate or Mifepristone Followed by Misoprostol." Obstetrics
& Gynecology, 99(5), 813-19.
Winikoff,
Beverly. (1995). “Acceptability of Medical Abortion in
Early Pregnancy.” Family
Planning Perspectives, 27(4), 142–148 & 185, 199.
Lead
Author -- Jennifer Johnsen
|
Planned
Parenthood of Amarillo & the Texas Panhandle