If she chooses oral contraceptives, pills condoms can be given to her with instructions. The adolescent can be praised for coming in for emergency contraception, and a suggestion can be made that she consider another method of preventing pregnancy. This appointment is an opportune time for counselling around the teen’s choices about her sexual activity, contraception, sexually transmitted infections and safer sex. An appointment can be scheduled for one week after the next expected menstrual period. They should also return if they have heavy bleeding or pain. Teens should be advised to return for a pregnancy test if their next period is more than one week late or if the next period is unusual in any way. She should be told that ECPs do not prevent or treat sexually transmitted infections.īecause emergency contraception is not 100% effective, follow-up is important. If the patient is taking emergency contraception because she has missed birth control pills, she can start a new pack of pills the day after she takes emergency contraception. Explain that if she is going to have intercourse before her next period, she should use a barrier method with a spermicide. Discuss her options should she become pregnant (see statement on Adolescent pregnancy ). Explain that the next period might be early, on time or late. There are incomplete data regarding interactions of these medications with levonorgestrel (Plan B), but available information suggests that there is increased clearance of the drug, and a reasonable course would be to double the dose of levonorgestrel in the presence of liver enzyme-inducing drugs.Īfter determining whether emergency contraception is indicated, explain the method to the adolescent and the possibility of failure of the method. Pregnancies that occur do not need to be terminated just because emergency contraception was used.įor adolescent girls taking medications that induce liver enzymes ( Table 3), the dose of estrogen-containing ECPs should be increased to three high dose norgestrel-ethinyl estradiol pills, taken twice. Given that no teratogenic risk has been found with pregnancies that occur while women are taking high dose birth control pills, it is unlikely that there is an increased risk of birth defects in babies born to adolescent girls who have taken emergency contraception during pregnancy. Most teens will get their period within 21 days of treatment. Breast tenderness, headaches and dizziness are less common side effects of ECPs. Adolescent girls who vomit more than 1 h after taking a dose do not need to retake those pills because absorption has occurred, and the nausea and/or vomiting are likely to be a result of treatment. Giving the antiemetic after nausea occurs is not helpful. To increase the efficacy of the antiemetic, it can be given 1 h before the hormones. Nausea and vomiting are frequent side effects when estrogen-containing ECPs are given without antiemetics. Although there may be some spotting in the days after treatment, 58% of women have their period within a few days of the expected date. Levonorgestrel ECPs are associated with nausea in 23% of cases, abdominal pain in 18%, fatigue or headache in 17% and vomiting in 6% of women. However, these have not been evaluated in clinical trials. But if using cycled pills, use only four pills of the highest dose and repeat 12 h later. It has been suggested that if norgestrel-ethinyl estradiol is not available, use four lower dose oral contraceptive pills. If Plan B is not yet available in your province, two high dose norgestrel-ethinyl estradiol (Ovral, Wyeth-Ayerst, St Laurent) tablets can be given with 50 mg dimenhydrinate initially the entire dose is repeated 12 h later. If the second set is missed, the entire course must be repeated. For practical reasons, the first pill(s) can be delayed so that both doses are given during the teen’s normal waking hours. The drug company does not make a recommendation regarding concurrent administration of 50 mg dimenhydrinate, but there is no reason to believe that it will interfere with the efficacy of ECPs and can be given with either or both doses (see short and long term effects, below).įor either regimen, the timing of the second dose is important. A prescription can be written for ‘Plan B, as directed’ or ‘levonorgestrel 0.75 mg PO now and again in twelve hours’.Īlthough nausea is much less common with levonorgestrel only, almost one quarter of women taking it report some nausea. Some teens will have difficulty getting a prescription filled, and may not be able to manage a visit to both the physician’s office and the drugstore. ![]() Paediatricians, family physicians and others who care for teens should consider having ECPs available in the office.
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