contraceptives--postcoital and Migraine-Disorders

An overview is presented of the major methods of contraception available to the sexually active adolescent. Emphasis is given to the combined birth control pill, while the literature describing absolute and relative contraindications to oral contraception is reviewed. It is noted that adolescents with chronic illness must also be evaluated for contraceptive needs. Other methods covered include the intrauterine device, barrier methods (diaphragm, condom, and vaginal contraceptives), injectable contraceptives, postcoital contraception, and methods under current investigation. The approach to each patient must be individualized, based on her coital activity, understanding of alternatives, medical status, and what method is chosen.

Topics: Adolescent; Adult; Chemical and Drug Induced Liver Injury; Collagen Diseases; Contraception; Contraceptive Agents, Female; Contraceptive Devices, Female; Contraceptive Devices, Male; Contraceptives, Oral, Synthetic; Contraceptives, Postcoital; Diabetes Mellitus, Type 1; Epilepsy; Female; Humans; Intrauterine Devices; Male; Migraine Disorders; Oligomenorrhea; Progesterone; Risk; Vaginal Creams, Foams, and Jellies

Topics: Adult; Brain Ischemia; Contraceptives, Postcoital; Estrogens; Female; Humans; Infarction, Middle Cerebral Artery; Magnetic Resonance Imaging; Migraine Disorders; Paresis; Risk Factors; Temporal Lobe; Tomography, Emission-Computed, Single-Photon

This article answers some questions about use of emergency contraceptive pills (ECP) in the US. It is acceptable to prescribe ECPs over the telephone. ECPs should not be given to women with severe migraine headaches with neurologic impairment. ECPs are acceptable for women who are smokers and over 35 years old, diabetics with vascular disease, women with a history of severe migraine, and women with a benign or malignant liver tumor. Women who seek ECPs over 72 hours after unprotected sexual intercourse could have ECPs, insertion of a Copper T380 IUD, or Ru-486, when available in the US. Lo-Ovral4+4 is the preferred ECP. Ovral2+2 is less often available and tends to cost more. An ECP prescription might indicate Phenergan (25 mg), 4 tablets, taken between 6 and 7 PM, and repeated in 12 hours. Another ECP prescription might indicate Lo-Ovral (21-pill pack), 4 tablets taken one half hour after anti-nausea medication, and repeated in 12 hours. If nausea is severe from the first or second dose of Lo-Ovral, an extra tablet of Phenergan may be taken. For continued contraception, the patient should be prescribed a low-dose pill and not a 50 mcg pill. The most common transition from ECP combined pills to regular oral contraception is to prescribe 4 tablets followed by 4 tablets 12 hours later, and to start a new package of pills the Sunday after menstruation begins. Nonlapsed pill taking involves taking the 4 tablets, followed by 4 tablets in 12 hours, and 1 tablet taken daily for the next 13 days (with backup contraception the first 7 days), and a lapse for 7 days. Nothing needs to be done for vomiting. Women are not likely to abuse this option. It should be widely known and appreciated that mistakes do happen, emergency contraception does work, and women should be aware of ECPs. 98% of women bleed by 21 days after ECP use. There appears to be no increased risk of birth defects among pill users who become pregnant.

Topics: Americas; Contraception; Contraceptive Agents; Contraceptive Agents, Female; Contraceptives, Oral; Contraceptives, Postcoital; Delivery of Health Care; Developed Countries; Disease; Drug Prescriptions; Family Planning Services; Health Planning; Health Planning Guidelines; Migraine Disorders; North America; Organization and Administration; United States; Vascular Diseases