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  • Title: Emergency contraception: a second chance at preventing adolescent unintended pregnancy.
    Author: Gold MA.
    Journal: Curr Opin Pediatr; 1997 Aug; 9(4):300-9. PubMed ID: 9300185.
    Abstract:
    Adolescent pregnancy challenges the United States and Europe. For most sexually active adolescents, pregnancy is unintended. Emergency contraception, also called the "morning-after treatment" or postcoital contraception is a way to prevent pregnancy after unprotected intercourse. In February 1997, the Food and Drug Administration (FDA) approved the use of certain oral contraceptive pills for emergency contraception. There are currently six brands of pills marketed in the United States that can be prescribed to, conform to the FDA-approved regimen. When emergency contraceptive pills are initiated within 72 hours of unprotected intercourse, they reduce the risk of pregnancy by 75%. Contraindications are the same as those used for ongoing contraceptive pills. The most common side effects are nausea, vomiting, menstrual disturbances, breast tenderness, abdominal cramping, dizziness, headache, and mood changes. Routinely counseling all adolescents about emergency contraceptive pills and increasing access to them can give adolescents a second chance at preventing pregnancy. When initiated within 72 hours of unprotected intercourse, emergency contraception can reduce the risk of unintended pregnancy by 75%. The most common approach to postcoital fertility control is the Yuzpe regimen, which can be used with six brands of oral contraceptives currently available in the US. Despite the US Food and Drug Administration's 1997 approval of use of oral contraceptives for this use, postcoital fertility control is neither promoted among US adolescents nor routinely included in contraceptive counseling. This paper reviews the efficacy, mechanism of action, regimens, cost, indications, contraindications, and side effects of emergency contraception. Also presented are guidelines for counseling adolescents, answering their questions, and the initial and follow-up visits. If the goal is to prevent adolescent pregnancy, all adolescents--regardless of sexual status--should be counseled about emergency contraception at every opportunity available. Counseling can be enhanced by placing posters in bathrooms and waiting rooms and providing written information. Access can be improved further by instructing secretarial and nursing staff to ask patients when they call for an appointment if emergency contraception is needed. Among the obstacles to more widespread use of this method are concerns on the part of some health care providers that the availability of emergency contraception will discourage compliance with ongoing methods and encourage sexual risk taking.
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