Postcoital Methods of Birth Control

POSTCOITAL PILLS

Postcoital pills are hormones administered after unprotected sex; they are intended to prevent implantation from taking place if an egg has been fertilized. Of course at this stage it is too early to tell easily whether conception has occurred, so in some cases the pills will not be terminating a pregnancy at all; nevertheless, they are given with that intention.

The most common hormone used is a brand of the ordinary combined contraceptive pill; this has the fewest side-effects. Two tablets are taken within 72 hours of sex, and two more 12 hours later. This treatment may produce nausea, and even vomiting. The woman is warned to watch out for all the pill warning signs, although these are very unlikely to occur with this one-off dose. This treatment has a 0-1.6% failure rate; as yet there is no evidence of any harm to any baby which survives the treatment. High-dose progestogens are also used sometimes in the same way, but these are less common.

POSTCOITAL IUD

This treatment consists of inserting a copper-bearing IUD into the woman’s uterus within five days of unprotected sex; it works by preventing implantation if an egg has been fertilized. As with the postcoital pill, the woman may not have conceived at all, but if she has the IUD will interrupt the progress of the pregnancy. This method has the ‘advantage’ that the IUD can be left in place and will prevent further pregnancies from continuing in the same way.

MENSTRUAL EXTRACTION

This process is also known as menstrual regulation, and involves sucking out the contents of the uterus at the normal time for a period. Menstrual extraction first became popular among women’s self help groups in the USA; it was evolved as a way of minimizing the discomfort and inconvenience of normal periods. A simple vacuum instrument is inserted into the uterus through the cervix, and the thickened lining of the uterus, which has begun to break down as a normal period, is extracted. In this way the menstrual bleeding that normally takes four to six days can be over in about half an hour; the process can be done by another woman, who does not need to be medically trained (at least in theory) — this is what has made it so popular with women’s groups. Of course, if the woman is pregnant, the process also removes the young embryo at the same time and stops the pregnancy.

Although menstrual extraction was not developed as a form of birth control it can obviously act as one, and in fact the main interest in it these days is as a way of interrupting pregnancy. Medical opinion has advised that it is not a good idea to use it regularly simply as a means of making menstruation easier; it involves inserting a foreign body into the sterile environment of the uterus every month, which can lead to complications or infection. Many women feel that menstrual extraction every month would avoid the moral dilemma of choosing an abortion specifically, as each month they would not know whether they were pregnant or not. In fact, of course, the intention is still to abort any embryo that might be present in the uterus; Hatcher et al. In Contraceptive Technology actually advise that it is ‘usually better to wait until a positive diagnosis of pregnancy can be made’ rather than to use menstrual extraction every month regardless. In this case there would be no doubt that there was a pregnancy, and the woman would be making a definite choice to abort it by having a menstrual extraction.