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Emergency Contraception Debates and Alternatives
Medication
History
Emergency contraception was in early 1960s used by physicians as a treatment method for victims of sexual assault. It was used to prevent unintended pregnancy after the incidence and to help the affected individuals to forget the memories of the inhumane experience by preventing unwanted pregnancies. Medical practitioners used to prescribe emergency contraception that contained a high dose of estrogen to the victims of rape. The medication was found to be effective, but it had severe side effects. Plan B One-Step over the counter birth control was introduced to the public in the year 1999 as an emergency contraceptive drug, and it became available in retail pharmacies countrywide in September 2009. It is used to prevent unintended pregnancies that may occur after individuals have unprotected intercourse with their partners or as an alternative for the contraceptives failure. Plan B One-Step tablet is also used by rape victims to prevent accidental conceptions (Munro, Dulin, & Kuzma, 2015).
Indication for the medication
Indication for the medication can be through analyzing populations that commonly use the emergency contraceptives. According to Mittal (2014), teenagers aged 15 to 18 years should receive prescriptions to prevent early and unintended pregnancies. According to studies, a high number of Chinese women become pregnant even after using Plan B One-Step (Munro et al., 2015). Female Black Americans and minority groups in America also represent a significant proportion of individuals who suffer from sex assaults. As a result, they are likely to seek for the prescription to avoid unintended rape pregnancies.
Pharmacokinetics
The pharmacokinetics for the Plan B One-Step includes absorption, distribution, metabolism and excretion. The medication contains Levonorgestrel hormone that is used in many birth control pills and it is completely absorbed into a human body at a high rate after oral administration. It has a bioavailability of about 100% and does not have a first pass metabolism. It is indicated that approximately 50% is bound to albumin and 47.5% is bound to sex hormone binding globulin (SHBG) (Munro et al. 2015, p. 143). According to Lewis and Sullivan (2012), levonorgestrel is not completely metabolized by the liver. The primary metabolites are 3±, 5²- and 3±, 5±-tetrahydrolevonorgestrel and have a 16²-hydroxynorgestrel. It also has urinary metabolites hydroxylated at the 2± and 16² (Mittal, 2014, p 14047). During phase 1 of metabolic processes, low quantities of metabolites are identified in plasma as a pair of sulfate and glucuronide. Levonorgestrel is mainly excreted in the urine, but small amounts can be found in the feces.
Pharmacodynamics for the Medication and Dosage
Levonorgestrel is used as a contraceptive, and it is one pill that contains 1.5 mg of a progesterone-type drug. It causes cervical mucus to become thick, inhibits survival of sperm and alters endometrium. According to Mittal (2014), the medication is used to change tubal transport of ova and sperm. It slows down the implantation process by preventing the formation of mucous membrane that lines the uterus during pregnancy. The full dose should be administered the soonest possible after having unprotected intercourse. The Plan B One-Step dosage is a single (1.5 mg) tablet that is taken once before the end of 72 hours after having unprotected sex or in a case of a contraceptive failure (Woo & Wynne, 2011).
Monitoring, Side Effects and Cost of Medication
Patients should be reexamined if they start vomiting within one hour after taking the Plan B One-Step tablet (Munro et al., 2015). Individuals should avoid taking another dose before seeking advice from medical practitioners. Patients should also be examined within three weeks after medication. The physician should confirm the possibility of being pregnant and validate the absence of any harmful effect. The most common side effects of Plan B One-Step tablet include nausea and vomiting. Doctors advise patients to take pills with food and use anti-nausea medications. Other side effects include a change in menstrual period, dizziness, headache, breast tenderness and abdominal pain (Lewis, & Sullivan, 2012, p. 117). The average cost of medication is about $ 45 U.S dollar. One of the guidelines that recommend the use of Plan B One-Step is the Clinical Effectiveness Unit Guidance. It is written by Royal College of Obstetricians and Gynecologists. It is based on the consensus scoring and the comments made by the peer reviewers.
Controversy Surrounding the Use of Plan B One-Step
It stems from people failure to understand whether the medication can be used to discontinue a pregnancy. Emergency contraception has over the past years raised concerns among the supporters and their opponents. Groups that advocates use of Plan B One-Step to control birth believes it can reduce the number of unintended abortions and pregnancies. The controversy arises since the opponents believe that using medication is equivalent to terminating pregnancies.
They argue that to allow the use of Plan B One-Step tablet will amount to support of abortion in the society. Munro et al. (2015) explain that the contraceptive does not have any impact on implantation. However, people opposing to it fail to understand how the medication works. They believe that it prevents implantation of a fertilized egg. According to Lewis and Sullivan (2012), the drug cannot prevent pregnancy of an already fertilized ovum. Great numbers of people that oppose the emergency contraceptive often confuse it and interpret its functions to be the same as those of abortion pill, RU486. It is hence viewed to be an immoral practice since they argue that the medication does not value the life a fetus.
The controversy also stems among the political fields. Some leaders claim that Plan B One-Step should be available in pharmacies and young girls from the age of 17 years and below should be allowed to access it without doctors prescription. Female aged 16 and below cannot obtain the medication without permission from medical practitioners. The controversy arises because some political leaders argue that the average age of onset of menstruation for girls is about 12 years. Despite the fact that they are productive just like other elderly females, it is unethical to allow it as an OTC drug. Young adults could be unaware of the correct dosage and side effects of the medication. The controversy hence arises as a result of different political opinions concerning the medication being allowed as an over the counter drug or whether pharmacies should request for doctors prescription from patients (Lewis, & Sullivan, 2012).
Alternatives to the Controversial Medication
An intrauterine device and birth control implants can be used as an alternative to Plan B One-Step tablet. According to Pickle, Wu and Burbank-Schmitt (2014), the birth control implant is put under the skin of the upper side of a womans arm to protect against pregnancy. It is a thin and flexible plastic that is about size of a cardboard. The birth control implant is used once within a period of four years. The most common negative effect of the medication is bleeding irregularly, and it occurs during the first six to twelve months of use.
They include fewer, lighter or completely lack of periods. The adverse effects can cause increased spotting and light bleeding between menstruations. Less common side effects include discoloring or scarring of the skin over the implant, changes in sex drive, nausea, gaining weight, frequent headache, sore breasts and pain at the insertion site (Lewis, & Sullivan, 2012, p. 119). Severe negative impacts after using birth control implants include yellowing of the skin especially eyes, abnormally heavy and prolonged bleeding, increased redness and pain at the arm where the device is inserted (Lewis, & Sullivan, 2012).
The cost of insertion includes inserting costs and removing charges. The total cost of inserting the implant depends on insurance of a patient and can be approximate $800 and removal costs of up to $300. Monitoring commences after insertion. It is advisable for the patients to inform any healthcare provider that they are using the birth control implant. The monitoring is continuous when the patients have concerns about its location and if the experience severe side effects. According to Pickle et al. (2014), the removal should be conducted when implant becomes ineffective or when an individual wants to conceive. After the end of four years, it should be removed since it interferes with periods and increase irregularities.
An intrauterine device is a tiny device that is put in the uterus to avoid an unintended pregnancy. It is a long-term and reversible contraceptive. A single insertion works efficiently for durations of up to 12 years. Pickle et al. (2014) support that IUD is efficient and can prevent unintended pregnancies if inserted within seven days of unprotected intercourse. Side effects include mild to moderate pain after an intrauterine device is inserted. An individual may experience cramping or ache in the back that last for few days after it is inserted. A person may have heavy periods and worse menstrual cramps. The cost of IUD varies and can be up to $ 1,000. The monitoring is by individuals, and they should seek medical advice if they notice any change in the position of the device. They should check it regularly since it can come out during their periods. IUD can also slip at some stage in the first three months of insertion.
Personal Opinion
I will use the Plan B One-Step during my medical practice. The medication has been surrounded by controversy that cannot be supported by scientific evidence. For instance, Plan B One-Step tablet has been misinterpreted to work in a similar way as abortion pills. The interpretation is different to how the medication works. According to Lewis and Sullivan (2012), Plan B One-Step tablet cannot alter a fertilized egg. I can prescribe the use of drug since it efficiently protects unintended pregnancies. I can use caveats when prescribing the medication since it is estimated to be 70% to 90% efficient. The medication can only prevent pregnancy if used within 72 hours of unprotected intercourse. I will advise patients to use alternatives like implants birth control and IUD since they have high levels of efficiency. Alternatives are also cheaper when compared with Plan B One-Step medication.
References
Lewis, J. D., & Sullivan, D. M. (2012). Abortifacient potential of emergency contraceptives. Ethics & Medicine: An International Journal of Bioethics, 28(3), 113-120.
Mittal, S. (2014). Emergency contraception: Potential for womens health. Indian Journal of Medical Research, 140(1), 14045-14052.
Munro, M. L., Dulin, A. C., & Kuzma, E. (2015). Features: History, policy and nursing practice implications of the Plan B® emergency contraceptive. Nursing for WomenS Health, 19(2), 142-153.
Pickle, S., Wu, J., & Burbank-Schmitt, E. (2014). Prevention of unintended pregnancy. A focus on long-acting reversible contraception. Primary Care: Clinics in Office Practice, 41(2), 239-260.
Woo, T. M., & Wynne, A. L. (2011). Pharmacotherapeutics for nurse practitioner prescribers. Philadelphia, PA: F.A. Davis Company.
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