Saturday, September 29, 2007

Plan B And The Selective Right To Bodily Integrity

When you voluntarily ask a government clinic to give you, and the clinic does give you, a pill to prevent pregnancy, you get to sue the government (.pdf) for violating your constitutionally protected right to bodily integrity, family privacy and religious freedom.

Which makes me wonder. When the government forces you to carry a pregnancy to term, what do you get to sue the government for? An extra, super duper, violation of your right to bodily integrity, family privacy and religious freedom?

And while we wait for our irony meters to return from the repair shop, let's use this case as a teaching moment.

You have a 16 yo sexually active female, not currently using any birth control (and, we can infer, no prior use) requesting the emergency contraception pill (ECP). You decide to go with a combination regimen, and give her 8 tabs of Nordette, to be taken in two separate doses of 4 pills (0.6 mg of levonorgestrel and 120 µg of ethinyl estradiol), 12 hrs apart. When the patient asks if the pills will make her sick you tell her to drink ginger ale to minimize side effects.

What could you have done differently, and why?

Well, two things.

1) Use Plan B

First, you could've given her Plan B, a progestin-only regimen, instead of Nordette, a combination estrogen/progestin regimen. By using Plan B you maximize compliance and minimize side effects. Plan B consists of only two pills; both can be taken at the same time (1.5 mg levonorgestrel). Plan B also doesn't contain estrogen and is less likely to cause side effects.

As you know, ECPs have no serious or long term side effects. [The only contraindication is known pregnancy because ECPs won't have any effect.] However, some women do experience minor side effects when using ECPs, mainly nausea and vomiting. [Other problems: headache, dizziness, lower abdominal pain, breast tenderness, vaginal bleeding.]

Studies have shown that a progestin-only ECP like Plan B is less likely to cause nausea and vomiting:

Plan B (progestin-only ECP)

  • 23% (~one in four) of users experience nausea

  • 6% (~one in 17) of users throw up

Nordette (combination ECP)

  • ~51% of users experience nausea

  • 23% (~one in four) of users throw up

2) Use meclizine

Second, in order to minimize side effects, in addition to ginger ale, you could've advised the patient to use an OTC anti-nausea drug:

To prevent nausea and vomiting, you can take the non-prescription anti-nausea medicine meclizine (also sold under the brand names Dramamine II or Bonine). Research shows that taking two 25 mg tablets 1 hour before using combined emergency contraceptive pills reduces the risk of nausea by 27% and vomiting by 64%, but this drug doubles your chances of feeling drowsy (to about 30%).

[Keep in mind that if you vomit within 1 hr of taking an ECP dose it's best to repeat the dose.]

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