(ABC News)–Pediatricians should counsel all adolescents on use of emergency contraception, such as Plan B, as part of routine practice, according to an American Academy of Pediatrics (AAP) policy statement.
Healthcare professionals should provide teens with an education on the use, availability, and advance prescription of emergency contraception,
as well as contraindications and adverse events related to different
forms of emergency contraception, according to the statement drafted by
Drs. Krishna Upadhya and Cora Breuner and colleagues of the AAP
Committee on Adolescence.
“The discussion of emergency contraceptions methods with patients must
also include the fact that none of these methods will protect from
sexually-transmitted infections,” they wrote online in the journal
The authors noted that despite significant declines in teen birth rates
over the past two decades, birth rates remain “significantly higher than
other industrialized nations.” 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.
They also noted that teens are “more likely to use emergency contraception if it has been prescribed in advance of need.”
The policy statement recommended three methods of emergency
contraception, including levonorgestrel (Plan B), ulipristal acetate,
and the Yuzpe method, which involves use of combining oral hormonal
Plan B requires patients to take two 0.75 mg levonorgestrel tablets 12
hours apart or a single 1.5 mg dose, which may be “equally effective and
without increase in adverse effects.” The drug is contraindicated in
patients who are known to be pregnant and may cause adverse events of
nausea, vomiting, and heavier menstrual bleeding. Patients should take a
pregnancy test if they do not have a normal period within 3 weeks of
using Plan B.
Ulipristal is a single pill (30 mg) that prevents binding of
progesterone and should be taken within 120 hours after unprotected sex.
Adverse events include headache, nausea, and abdominal pain. Patients
with existing pregnancy should not take ulipristal due to risk of fetal
loss, and use may require a pregnancy test. Patients with severe
abdominal pain 3 to 5 weeks after treatment should be evaluated for
The Yuzpe method requires patients to take two doses of at least 100 µg
of ethinyl estradiol and at least 500 µg of levonorgestrel and can be
useful for patients with “no or limited access to an emergency
contraception product.” Though the use is considered off-label, the
statement noted that the combination oral contraceptive use has been
declared safe and effective.
Adverse events with the Yuzpe method include nausea and vomiting,
fatigue, breast tenderness, headache, abdominal pain, and dizziness.
Antienimics may offset the effects of nausea and vomiting with this
method if taken an hour before administration. This method should not be
used by patients with a contraindication to estrogen use.
In addition to informing patients about emergency contraception use,
pediatricians should encourage both male and female patients to get
tested or treated for sexually transmitted infections and discuss
ongoing contraception methods following use of emergency contraception.
The authors also noted that, at the policy level, “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.”
Copyright 2012 ABC News