Thinking Ahead About Emergency Contraception

During travel medicine consultations with her patients, Dr. Terri Rock brings up the question ever so delicately. There’s no easy way, she has learned, to ask people planning a trip whether they’ve thought about their need to take along emergency contraception.

But Rock, a Santa Monica family practice physician with expertise in travel medicine, mentions it if they don’t, because she has seen too many travelers come home worried about pregnancy or sexually transmitted diseases.

“When I bring up the possibility of sex with a stranger, they all say, ‘Oh, no,’ ” she says. “They are almost offended.” In fact, “the people you least suspect get into trouble. And there’s so little awareness about emergency contraception.”

Although emergency contraception--preventing pregnancy after sexual intercourse, usually with a specific combination of hormone pills--is widely available, the concept is not widely known. In a 1997 survey by the Kaiser Family Foundation, 41% of respondents were not familiar with the term.

Dr. Anna Glasier, director of Family Planning and Well Woman Services in Edinburgh, Scotland, addressed the issue in an editorial recently in the Journal of Travel Medicine. Emergency contraception may be needed during a trip in a variety of situations besides unprotected sex with a stranger, she writes. A condom may break. Or a woman who’s on the pill may be unsure of her level of protection if she has been vomiting as a result of motion sickness.

In many countries, Glasier notes, no licensed method of emergency contraception is available. Although there are widely used alternatives to a licensed method, such as taking two timed doses of several pills from a monthly pack of oral contraceptives, many doctors are ignorant of them or refuse to prescribe them.

For information, travelers can turn to the Internet. The Office of Population Research at Princeton University operates the Emergency Contraception Web site, https://opr.princeton.edu/ec/. In the section titled “ECPs Around the World,” the Princeton site lists which options are available by country.

Emergency contraception pills include two types: a combination of estrogen and progestin or a progestin-only pill. A physician can prescribe these in advance.

Emergency contraceptive kits are newer options, also available by prescription. One is Preven, which includes estrogen-progestin pills and was approved by the Food and Drug Administration in 1998. Another is Plan B, progestin-only pills, approved by the FDA in July. Each is for one-time-only use and sells for about $30.

Emergency contraceptives are generally referred to as “morning after” pills because the regimen must be taken within 72 hours of sex (and preferably earlier). They work mainly by preventing ovulation or fertilization and do not cause abortion, experts agree. The pills won’t work if a woman is already pregnant and won’t affect an existing pregnancy, experts add.

The progestin-only pills reduce the risk of pregnancy by about 88%; the combined pills reduce the risk by about 75%. (This doesn’t mean that 12% to 25% of women will become pregnant. Statistically, if 100 women have unprotected sex once during the second or third week of their cycle, eight will conceive. If combined pills are used for emergency contraception, 75% fewer, or two women, will get pregnant; with progestin-only pills, only one would get pregnant.)

Rock warns women to expect nausea after taking emergency contraceptives. And, she adds, anyone who has had unprotected sex while traveling should see a physician to screen for sexually transmitted disease.

Healthy Traveler appears on the second and fourth Sundays of the month. Kathleen Doheny can be reached at kdoheny@compuserve .com.