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Re: Emergency ContraceptivesFrom: ainsron (ainsron@sbcglobal.net)Tue Mar 7 19:02:00 2006
Progestin-only pills are less effective than combined oral contraceptives. Failure rate during first year of typical use ranges from 1.1% to 13.2%. Effectiveness is highest if ovulation is consistently inhibited. Effectiveness is greatest, then, when the "normal" bleeding pattern is most disturbed. If mini-pills are used correctly and consistently, 5 in 1,000 women would become pregnant in the first year. In lactating women, the progestin-only pill is nearly 100% effective. Effectiveness is definitely reduced if the progestin-only pill is taken even a few hours late Ronald E. Ainsworth, MD, FACOG -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Larry Glazerman Sent: Tuesday, March 07, 2006 3:19 PM To: Multiple recipients of list OB-GYN-L Subject: Re: Emergency Contraceptives I'm wondering where the "higher failure rate when not breastfeeding" cpmes from. I've always believed that progestin only pills were equally effective as combinationM but with poorer cycle control. Larry R. Glazerman MD This message was sent from my Treo 650. -----Original Message----- From: dahmd@cfl.rr.com (D. Ashley Hill) Subj: Re: Emergency Contraceptives Date: Tue Mar 7, 2006 3:20 pm Size: 1K To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> At Tue, 7 Mar 2006, LCLEMOS@aol.com wrote: Laurie- First of all, as you can tell, this list is not for discussing actual medical issues :) I'll try to be coherent (I had a busy night with 9 deliveries). When prescribing combination birth control pills or the (rare) depo-Provera injection, I hand the patient a "prescription" for calcium twice a day. I also discuss breakthrough bleeding and when to discontinue the pill or call for questions or an appointment. When prescribing the progestin-only pill I discuss the need for same time administration and the higher failure rate when not breastfeeding. I discuss infection risks for non-monogamous behavior and the potential for both amenorrhea and abnormal bleeding with the Mirena LUS. Some prescribe estrogen to take if bleeding from a denuded endometrium occurs, but I prefer for patients to call first. I do discuss emergency contraception with barrier methods. We are on call in-house 24/7 so unless someone calls at 2am, it's not a big deal. We educate to call the next morning, which helps, but we don't get many calls because we spend a lot of time educating that patients should not depend on EC since it's failure rate is higher than most other forms of contraception. Ashley (Sorry to tell you, Laurie, it's 75 degrees and I'm heading to the pool).
-- D. Ashley Hill, MD Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency and Loch Haven Ob/Gyn Group Orlando, Florida
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