HealthDay News — Pediatric clinicians should educate all adolescents on the use of emergency contraceptives, such as Plan B, as part of routine practice, the American Academy of Pediatrics recommended in a policy statement.
Discussions should include information about use, availability and advance prescription of emergency contraception, as well as contraindications and adverse events related to different forms of emergency contraception, Krishna K. Upadhya, MD, MPH, and colleagues reported in Pediatrics.
“The discussion of emergency contraception methods with patients must also include the fact that none of these methods will protect from sexually-transmitted infections,” Upadhya and members of the AAP’s Committee on Adolescence wrote.
Pediatricians should be aware of the prevalence of sexual behavior among teenagers and that teenagers are at high risk of contraceptive failure. 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.
Because teens are “more likely to use emergency contraception if it has been prescribed in advance of need,” the committee recommended clinicians consider prescribing three forms of emergency contraceptive in advance: levonorgestrel (Plan B), ulipristal acetate, and the Yuzpe method, which involves use of combining oral hormonal contraceptives.
This policy “increases the likelihood of use when needed, reduces time to use, and does not decrease condom or other contraceptive use,” the researchers noted.
Compared with combined hormonal emergency contraception methods, levonorgestrel has an improved adverse effect profile and increased effectiveness. Females aged 17 or older can obtain levonorgestrel without a prescription. Levonorgestrel requires patients to take two 0.75 mg tablets 12 hours apart or a single 1.5 mg dose. It is contraindicated in patients who are known to be pregnant and may cause adverse events of nausea, vomiting and heavier menstrual bleeding.
Ulipristal is a single 30 mg pill that prevents binding of progesterone and should be taken within 120 hours after unprotected sex. Adverse events include headache, nausea and abdominal pain. Because ulipristal increases the risk of fetal loss in existing pregnancies, use may require a pregnancy test. Patients who experience severe abdominal pain three to five weeks after treatment should be evaluated for ectopic pregnancy.
The Yuzpe method consists of two doses of at least 100 μg of ethinyl estradiol and at least 500 μg of levonorgestrel and may be useful for patients with “no or limited access to an emergency contraception product.” Adverse events include nausea and vomiting, fatigue, breast tenderness, headache, abdominal pain and dizziness. This method should not be used by patients with a contraindication to estrogen use.
As part of routine anticipatory guidance, counseling should be provided to all adolescents and families of disabled adolescents regarding emergency contraception.
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,” the committee concluded.