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The story of the morning after pill

The controversy that has surrounded emergency contraception

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The history of the morning after pill or more appropriately, emergency contraception, has been filled with controversy. The concerns about the availability of hormonal emergency contraception have stemmed from the belief held by some people that the morning after pill is an abortion pill; this is untrue and the real abortion pill which is available today acts in a completely different way.

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There are two types of morning after pill, the first containing levonorgestrel (Levonelle) acts by delaying or preventing the production of an egg by the ovary (ovulation), thinning the lining of the uterus so that an egg cannot implant and in addition it causes the mucous around the cervix to thicken so that sperm cannot penetrate and enter the uterus. The second type of pill which contains ulipristal acetate (ellaOne) also delays ovulation; this pill can be taken up to five days after unprotected sex whereas Levonelle can be taken up to three days after.

Both of these pills prevent pregnancy occurring whilst the abortion pill which is used for cases of up to ten weeks gestation, causes the pregnancy to end. This pill, mifepristone, works by blocking the action of progesterone which causes the lining of the uterus to break down and so the pregnancy cannot continue.

1920’s

Whatever your personal beliefs with regards to this, the roots of emergency contraception lie in animal studies carried out as far back as the 1920’s. Researchers during that period demonstrated oestrogen, when given to pregnant mammals, could interfere with the pregnancy. The process was first taken up by the veterinary profession when they administered oestrogen as a way to prevent dogs or horses becoming pregnant when they had mated but their owner did not want any progeny. 

1960’s

Despite there being some anecdotal reports of the administration of oestrogen post coitally to humans in the 1940’s, the first fully documented cases were not published until the 1960’s. The first case occurred in the Netherlands when a thirteen year old girl had been raped and oestrogen was given to her to prevent any subsequent pregnancy materialising.

In the US further study was being done into high dose oestrogens being given to prevent pregnancy in cases of sexual assault.

1970’s

Following the investigations into high dose oestrogens, in the 1970’s Canadian doctor Albert Yuzpe along with colleagues began to investigate combinations of oestrogen and progesterone which replaced the high dose oestrogen method. This combination formula became known as the Yuzpe regimen.

It is during the late 1970’s that we first see the use of post coital insertion of the copper intrauterine device (IUD) as emergency contraception.

1980’s

The Yuzpe method continued to be the emergency method of contraception to be used postcoitally in many countries.

In the UK the first hormonal emergency contraception became available on the NHS in 1984; the product was a combination of oestrogen and progesterone and was known as Schering PC4.

2000’s

In 2000, the product Levonelle 2 was licenced for use in the UK. It was the first progesterone only based product to become available. This was followed by the licencing and availability of Levonelle in the UK in 2001; this was now also available free and without prescription. In 2005 the progesterone only emergency contraception regimen change from 2 tablets to one and became available in the UK as Levonelle 1500 and Levonelle one step which was the pharmacy product.

In 2009 the first ulipristal acetate product, ellaOne, became licenced and available in the UK. The benefits of this product were that it is effective for use up to 120 hours (5 days) after having unprotected sex.

In 2015 the decision was made to make the morning after pill available to under sixteens which of course sparked a debate!

Conclusion

Research continues into emergency contraception but to this day, the copper intrauterine device inserted up to five days after unprotected sex remains the most reliable form of EC.

There is still a degree of reticence being shown by women when it comes to accessing the morning after pill; when this was researched, the main reason proffered was a reluctance to discuss sexual behaviour and habits with a stranger in what may be a public place such as a pharmacy.

Whilst we are far from utopia, developments in legislation and products which allow women to have greater control over their bodies and their reproductive rights are moving in the right direction.

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