Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Emergency hormonal contraception (the "morning
after pill")
Emergency hormonal contraception is sometimes called "the morning after pill." It is actually a short course of the hormones found in oral contraceptives taken at a high dose. The exact regimen (the number of pills and the number of days) depends on the type of oral contraceptive used.
Depending upon the time during the
menstrual cycle that the emergency contraceptives are taken, these may prevent pregnancy by blocking the implantation of the fertilized egg in the uterus, by inhibiting ovulation, or by interfering with fertilization of the egg. To be considered a possible candidate for emergency contraceptive pills a woman should receive medical attention within 72 hours of unprotected intercourse. The pills are most effective when taken as soon as possible after unprotected intercourse. (In contrast, emergency contraception with an IUD may be possible 5 days after intercourse, see below.) The only known contraindication to emergency contraception is pregnancy. So a woman must not be pregnant when these methods are used. Emergency hormonal contraception may be taken on any day of the menstrual cycle.
Emergency hormonal contraception is available in the US for people aged 17 or
older (proof of ID is required for purchase). It is also available for younger
teens with parental permission.
Neither a physical examination, nor any laboratory tests are required prior to
use of the emergency hormonal contraception. It can be taken at any time during
the menstrual cycle, and the next menstrual period typically occurs within one
week of the expected time. The timing of the subsequent menses is to some extent
dependant upon the time in the cycle at which the emergency contraceptive was
taken.
There are no serious side effects, but the pills may cause nausea in 30% to 50% and
vomiting in 15% to 20% of women. These side effects may be controlled by taking an anti-nausea drug such as dimenhydrinate (Dramamine). Frequently a doctor will give a prescription nausea medication, such as
prochlorperazine (Compazine), at the same time as the emergency contraceptive pill. A woman may also experience breast tenderness and a temporary disruption of her menstrual cycle.
The most common type of emergency hormonal contraception involves the administration of the progesterone hormone levonorgestrel in two doses (marketed as Plan B in the U.S.). Another formulation for emergency hormonal contraception uses estrogen along with levonorgestrel, but levonorgestrel-only medication may be more effective and causes less nausea compared to estrogen-containing products.
Clinical trials using low doses of mifepristone (known earlier as RU-486, sometimes called
"the abortion pill") have shown that this agent is extremely effective as an emergency contraceptive when taken prior to ovulation, but it has not been approved for this use.
Mifepristone (Mifeprex) has been approved, in much higher doses, for terminating a pregnancy of less than 49 days' duration and must be taken under a physician's supervision.
Another type of anti-progestin medication that is similar to mifepristone in its
structure and actions is known as ulipristal acetate. Ulipristal acetate (Ella)
is marketed for emergency contraception in Europe and was approved by the US FDA
in August 2010 for use in the US for emergency contraception up to 120 hours
after intercourse.
Although effectiveness of the oral contraceptives are dependent to some extent upon how soon after unprotected intercourse they are taken,
efficacy studies have generally reported pregnancy rates of 0.2% to 3% with use
of oral emergency contraception.
This strategy is not meant to be a primary birth control method. Once the emergency is over, a woman should receive proper counseling so that she can select an effective and appropriate contraceptive method to use on a regular basis if she continues to be sexually active.
Sexually transmitted diseases, or STDs,
are infections that are transmitted during any type of sexual exposure,
including intercourse (vaginal or anal), oral sex, and the sharing of sexual
devices, such as vibrators. Women can contract all of the STDs, but may have no symptoms, or have different symptoms than men do.
Sexually transmitted diseases, or STDs, are infections that are transmitted during any
type of sexual exposure, including intercourse (vaginal or anal), oral sex, and
the sharing of sexual devices, such as vibrators. Although treatment exists for many STDs, others currently are
usually incurable, such as those caused by HIV, HPV, hepatitis B and C, and HHV-8.
Menstruation (menstrual cycle) is also referred to as a "period." When a woman menstruates, the lining of the uterus is shed. This shedding of the uterine linking is the menstrual blood flow. The average menstrual cycle is 28 days. There can be problems with a woman's period, including heavy bleeding, pain, or skipped periods. Causes of these problems may be amenorrhea (lack fo a period), menstrual cramps (dysmenorrhea), or abnormal vaginal or uterine bleeding. There are a variety of situations in which a girl or woman should see a doctor about her menstrual cycle.
Sexual health information including birth control, impotence, herpes, sexually transmitted diseases, staying healthy, women's sexual health concerns, and men's sexual health concerns. Learn about the most common sexual conditions affecting men and women.
There are a number of different methods of birth control to include: barrier methods, IUDs, hormonal methods, natural methods, and surgical sterilization. Birth control methods can be reversible or permanent. In simple terms, all methods of birth control are based on either preventing a man's sperm from reaching and entering a woman's egg (fertilization) or preventing the fertilized egg from implanting in the woman's uterus (her womb) and starting to grow.
When you are pregnant, many sexually transmitted diseases (STDs) can be especially harmful to you and your baby. These STDs include herpes, HIV/AIDS, genital warts (HPV), hepatitis B, chlamydia, syphilis, gonorrhea, and trichomoniasis. Symptoms include bumps, sores, warts, swelling, itching, or redness in the genital region. Treatment of STDs while pregnant depends on how far along you are in the pregnancy and the progression of the infection.
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