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The Difference Between Emergency Contraception And Medication Abortion

There has been considerable public confusion about the difference between emergency contraception and medication abortion because of misinformation disseminated by anti-choice groups. Emergency contraception (EC) helps prevent pregnancy; medication abortion terminates pregnancy. According to the general medical definitions of pregnancy that have been endorsed by many organizations — including the American College of Obstetricians and Gynecologists and the United States Department of Health and Human Services — pregnancy begins when a pre-embryo completes implantation into the lining of the uterus (ACOG, 1998; DHHS, 1978; Hughes, 1972; “Make the Distinction …, “ 2001). Hormonal methods of contraception, including emergency contraception, prevent pregnancy by inhibiting ovulation and fertilization (ACOG, 1998). Medication abortion terminates a pregnancy without using instruments. By helping women terminate unwanted pregnancies up to 63 days after their last menstruation, medication abortion is a safe and effective option.

EMERGENCY CONTRACEPTION (EC) MEDICATION ABORTION
What is EC? What is medication abortion?
Also known as the "morning-after pill," EC contains hormones that reduce the risk of pregnancy if started within 120 hours of unprotected intercourse. The treatment is more effective the sooner it begins. Two brands — Next Choice® and Plan B® One Step — are currently available over the counter to individuals who are 17 or older. They are also available by prescription, as are certain brands of oral contraception taken in increased doses for use as EC ( RHTP, 2009; Rodrigues et al., 2001; Van Look & Stewart, 1998). Medication abortion is the medically supervised use of a medication called mifepristone — also known as the "abortion pll" — to induce abortion. Mifepristone (Mifeprex®) can be taken up to 63 days after the first day of the last menstrual period. It is used in conjunction with misoprostol, which is taken later to complete the abortion (Creinin & Aubény, 1999; Middleton et al., 2005; Schaff et al., 2000; Schaff et al., 2001).
How does EC work? How does medication abortion work?

 In its approval of EC, the U.S. Food and Drug Administration (FDA) delcared, "Emergency contraceptives act by delaying or inhibiting ovulation and/or altering tubal transport of sperm and/or ova (thereby inhibiting implantation)" (FDA, 1997). A few years later, a study found that most often, EC reduces the risk of pregnancy by inhibiting ovulation (Marions et al., 2002). More recent studies have suggested that progestin-only EC works only by preventing ovulation or fertilization, and has no effect on implantation (Croxatto et al., 2003; Novikova et al., 2007). In 2008, a consortium of authorties declared that progestin-only EC does not interfere with implantation (ICEC-FIGO, 2008).

Mifepristone ends pregnancy by blocking the hormones necessary for maintaining a pregnancy. Misoprostol causes the uterus to contract and empty (Creinin & Aubény, 1999).
How effective is EC? How effective is medication abortion?
EC is very effective at reducing the risk of pregnancy. Studies have shown that EC reduces the risk of pregnancy when taken up to 120 hours after unprotected intercourse, but the sooner the dosing begins, the more effective the treatment. When taken within 72 hours of unprotected intercourse, EC that contains both estrogen and progestin reduces the risk of pregnancy by 75 percent. Within the same time frame, progestin-only regimens, such as Plan B One Step and Next Choice, reduce the risk of pregnancy by 89 percent. When initiated within 24 hours of unprotected intercourse, progestin-only EC reduced the risk of pregnancy by 95 percent (Ellertson et al., 2003; Rodrigues et al., 2001; TFPMFR, 1998; Van Look & Stewart, 1998). Medication abortion is highly effective at ending very early pregnancies. Complete abortion will occur in 96–97 percent of women who choose mifepristone. In the small percentage of cases that medication abortion fails, other abortion procedures are required to end the pregnancies (ACOG, 2001; Schaff et al., 2000).
How safe is EC? How safe is medication abortion?
EC is safe for almost all women — millions of women around the world have used EC safely (Guillebaud, 1998; Van Look & Stewart, 1998). Medication abortion is safe for most women — millions of women around the world have used it safely. There are risks associated with all medical procedures, including abortion. And, in extremely rare cases, death is possible from serious complications of medication abortion, but it remains safer than carrying a pregnancy to term (ARHP, 2008).
Does EC cause an abortion? Can the medicines used for medication abortion also be used for emergency contraception?
EC will not induce an abortion in a woman who is already pregnant, nor will it affect the developing pre-embryo or embryo (Van Look & Stewart, 1998). Emergency contraception prevents pregnancy and helps a woman prevent the need for abortion. Although some studies show that mifepristone could be used in very low doses to reduce the risk of pregnancy as a method of emergency contraception within five days of unprotected intercourse, it is not approved for use as EC in the United States at this time (Ho et al., 2002; TFPMFR, 1999).
Why might a woman choose EC? Why might a woman choose medication abortion?
Women may use EC as a means of preventing pregnancy after unprotected intercourse — in cases of unanticipated sexual activity, contraceptive failure, or sexual assault. Nearly half of America's 6.4 million annual pregnancies are unintended (Finer & Henshaw, 2006). Women might choose medication abortion as a way to end pregnancy because it is a noninvasive procedure and does not require anesthesia. It is free from the risk of injury to the cervix or uterus and the complications caused by the use of  anesthesia for other abortion procedures (Aguillaume & Tyrer, 1995). Women who chose medication abortion also reported that they felt it was a more "natural" way to end a pregnancy (Winikoff, 1995).
Does EC have side effects? Does medication abortion have side effects?
Side effects are far less common using progestin-only EC than using combined hormone EC. The most common side effects  include nausea and vomiting. Abdominal pain, breast tenderness, dizziness, fatigue, headaches, and irregular bleeding may also occur (Van Look & Stewart, 1998). The most common side effects following medication abortion are similar to those of a miscarriage — abdominal pain, bleeding, changes in body temperature, dizziness, fatigue, and gastrointestinal distress (ACOG, 2005; Creinin & Aubény, 1999; Stewart et al., 2005).
How long does the process of using EC take? How long does the process of medication abortion take?
Combine hormone EC is taken in two doses, 12 hours apart. Progestin-only EC can be taken in one dose. Side effects associated with EC generally subside within 48 hours. EC affects the timing of the menstrual cycle in 1015 percent of women. Changes in the menstrual cycle are seen with both combination and progestin-only EC. If the next menstrual cycle is more than one week late, a woman should visit her clinician for a pregnancy test (Van Look & Stewart, 1998; von Hertzen et al., 2002). It begins immediately after taking the mifepristone. Some women may begin spotting before taking the misoprostol, the second medication. For most, the bleeding and cramping associated with medication abortion begin after taking it. More than 50 percent of women who use mifepristone abort within four or five hours after taking the misoprostol. Heavy bleeding may continue for about 13 days. Spotting can last for a few weeks. About 92 percent of mifepristone abortions are completed within a week(ACOG, 2001; el-Refaey et al., 1995; Newhall & Winikoff, 2000; Peyron et al., 1993; Wiebe et al., 2002).
Are women who have used EC satisfied with it? Are women who have had medication abortions satisfied with the method?
An overwhelming majority of EC users are satisfied with it. One study found that 97 percent of EC users would recommend it to friends and family (Harvey et al., 1999). Another study found that 92 percent of women who had used EC would use it again in the case of a contraceptive emergency (Breitbart et al., 1998). An overwhelming majority of women who choose medication abortion were satisfied with it. A recent study found that 97 percent of women who had medication abortions would recommend it to a friend. Additionally, 91 percent of the women reported that they would choose medication abortion again if they had to have another abortion (Hollander, 2000).
Where can I get EC? Where can I get a medication abortion?
Plan B One Step and Next Choice are currently available over-the-counter (OTC) to women and men who are 17 and older. They and other forms of EC are also available by prescription for all women. If you need a prescription for EC, you can contact your nearest Planned Parenthood® health center at 1-800-230-PLAN or www.plannedparenthood.org. Contact your nearest Planned Parenthood health center at 1-800-230-PLAN or www.plannedparenthood.org, another women's health care center, or your private clinician. Planned Parenthood health centers that do not provide medication abortion can refer you to a provider who does.
How much does EC cost? How much does medication abortion cost?
Nationwide, the price of EC ranges from $10$70 (PPFA, 2009a). Costs vary from community to community, based on regional and local expenses. Contact your nearest Planned Parenthood® health center at 1-800-230-PLAN or www.plannedparentnood.org for information about costs in your area. Nationwide, the price of medical abortion ranges between $350 and $650. This includes two or three office visits, testing, and exams (PPFA, 2009). Costs vary from community to community, based on regional and local expenses. Contact your nearest Planned Parenthood health center at 1-800-230-PLAN or www.plannedparenthood.org for information about costs in your area.

Cited References

ACOG — American College of Obstetricians and Gynecologists. (1998, July). Statement on Contraceptive Methods.

_____. (2001, April). “Medical Management of Abortion.” ACOG Practice Bulletin, 26, 1–13.

_____. (2005, October). “Medical Management of Abortion.” ACOG Practice Bulletin, 67, 1–12.

Aguillaume, Claude & Louise Tyrer. (1995). “Current Status and Future Projections on Use of RU-486.” Contemporary Ob/Gyn, 40(6), 23–40.

ARHP — Association of Reproductive Health professionals. (2008, April). What You Need to Know — Mifepristone Safety Overview. [Online]. http://www.arhp.org/upload/Docs/mifepristonefactsheet.pdf, accessed September 29, 2009.

Breitbart, Vicki, et al. (1998). “The Impact of Patient Experience on Practice: The Acceptability of Emergency Contraceptive Pills in Inner City Clinics.” Journal of the American Medical Women’s Association, 53(5 Supplement 2), 255–58.

Creinin, Mitchell & Elizabeth Aubény. (1999). “Medical Abortion in Early Pregnancy.” In Maureen Paul, et al., Eds. A Clinician’s Guide to Medical and Surgical Abortion. New York: Churchill Livingstone.

Croxatto, Horatio B., et al. (2003). “Mechanisms of Action of Emergency Contraception.” Steroids, 68, 1095–98.

DHHS — U.S. Department of Health and Human Services. (1978). Code of Federal Regulations. 45CFR46.203.

Ellertson, Charlotte, et al. (2003). “Extending the Time Limit for Starting the Yuzpe Regimen of Emergency Contraception to 120 hours.” Obstetrics and Gynecology, 101, 1168–71.

El-Refaey, H., et al. (1995). “Induction of Abortion with Mifepristone (RU 486) and Oral or Vaginal Misoprostol.” New England Journal of Medicine. 332(15), 983–7.

FDA — U.S. Food and Drug Administration. (1997). “Prescription Drug Products; Certain Combined Oral Contraceptives for Use as Postcoital Emergency Contraception.” Federal Register, 62(37), 8609–12.

Finer, Lawrence B. & Stanley K. Henshaw. (2006). “Disparities in Rates of Unintended Pregnancy in the United States, 1994 and 2001.” Perspectives on Sexual & Reproductive Health, 38(2), 90–6.

Guillebaud, John. (1998). “Commentary: Time for Emergency Contraception with Levonorgestrel Alone.” The Lancet, 352(9126), 416.

Harvey, S. Marie, et al. (1999). “Women’s Experience and Satisfaction with Emergency Contraception.” Family Planning Perspectives, 31(5), 237–40 & 260.

Ho, Park Chung, et al. (2002). “Mifepristone: Contraceptive and Non-Contraceptive Uses.” Current Opinions in Obstetrics and Gynecology, 14(3), 325–30.

Hollander, Dore. (2000). “Most Abortion Patients View Their Experience Favorably, But Medical Abortion Gets a Higher Rating Than Surgical.” Family Planning Perspectives, 32(5), 264.

Hughes, Edward, Ed. (1972). Obstetric-Gynecologic Terminology. Philadelphia, PA: F. A. Davis Company.

ICEC-FIGO — International Consortium for Emergency Contraception – International Federation of Gynecology & Obstetrics. (2008-October). “How do levonorgestrel-only emergency contraceptive pills (LNG ECPs) prevent pregnancy?” [Online]. http://www.cecinfo.org/PDF/ICEC_MOA_10_14.pdf, accessed September 25, 2009.

Make the Distinction: EC Prevents Pregnancy. (2001). Contraceptive Technology Update, 4.

Marions, Lena, et al. (2002). “Emergency Contraception with Mifepristone and Levonorgestrel: Mechanism of Action.” Obstetrics and Gynecology, 65–71.

Middleton, Tamer, et al., (2005). “Randomized Trial of Mifepristone and Buccal or Vaginal Misoprostol for Abortion Through 56 Days of Last Menstrual Period.” Contraception, 72, 328–32.

Newhall, Elizabeth Pirruccello & Beverly Winikoff, (2000). “Abortion with Mifepristone and Misoprostol: Regimens, Efficacy, Acceptability and Future Directions.” American Journal of Obstetrics  and Gynecology, 183(2), S44–53.

Novikova, Natalia, et al. (2007). “Effectiveness of levonorgestrel emergency contraception given before or after ovulation — a pilot study.” Contraception, 75, 112–118.

Peyron, R., et al. (1993). “Early Termination of Pregnancy with Mifepristone (RU 486) and Orally Active Prostaglandin Misoprostol.” New England Journal of Medicine, 328(21), 1509–13.

PPFA — Planned Parenthood Federation of America. (2009). “The Abortion Pill (Medication Abortion).” [Online].
http://www.plannedparenthood.org/healthtopics/abortion/abortion-pill-medication-abortion-4354.htm, accessed September 25, 2009.

_____. (2009a). “Emergency Contraception (Morning After Pill).” [Online]. http://plannedparenthood.org/healthtopics/ emergency-contraception-morning-after-pill-4363.htm, accessed  September 30, 2009.

RHTP — Reproductive Health Technologies Project. (2009). “FDA Approved Emergency Contraceptive Products Currently on the Market. [Online].
http://www.rhtp.org/documents/PlanB-NextChoice-OneStepChart.pdf, accessed September 25, 2009.

Roderigues, Isabel, et al. (2001). “Effectiveness of emergency contraceptive pills between 72 and 120 hours after unprotected sexual intercourse.” American Journal of Obstetrics and Gynecology, 531–537.

Schaff, Eric, et al. (2000). “Low-Dose Mifepristone Followed by Vaginal Misoprostol at 48 Hours for Abortion up to 63 Days.” Contraception, 61(1), 41–6.

Schaff, Eric, et al. (2001). “Randomized Trial of Oral Versus Vaginal Misoprostol at One Day after Mifepristone for Early Medical Abortion.” Contraception, 64, 81–5.

Stewart, Felicia H., et al. (2005). “Abortion.” Pp. 673–700 in Robert A. Hatcher, et al., Eds., Contraceptive Technology — 18th Revised Edition. New York: Ardent Media, Inc.

TFPMFR — Task Force on Postovulatory Methods of Fertility Regulation. (1998). “Randomised Controlled Trial of Levonorgestrel Versus the Yuzpe Regimen of Combined Oral Contraceptives for Emergency Contraception.” The Lancet, 352(9126), 428–33.

_____. (1999). “Comparison of Three Single Doses of Mifepristone as Emergency Contraception: A Randomised Trial.” The Lancet, 353(9154), 697–702.

Van Look, Paul & Felicia Stewart. (1998). “Emergency Contraception.” In Robert A. Hatcher et al., Eds, Contraceptive Technology — 17th Revised Edition. New York: Ardent Media.

von Hertzen, Helena, et al. (2002). “Low Dose Mifepristone and Two Regimens of Levonorgestrel for Emergency Contraception: A WHO Multicentre Randomised Trial.” The Lancet, 260,  1803–10.

Wiebe, Ellen, et al. (2002). “Comparison of Abortions Induced by Methotrexate or Mifepristone Followed by Misoprostol.” Obstetrics and Gynecology, 99(5), 813–9.

Winikoff, Beverly. (1995). “Acceptability of Medical Abortion in Early Pregnancy.” Family Planning Perspectives, 27(4), 142–8, 185, & 199.

Lead Author — Jennifer Johnsen, MPH
Revised by — Jon Knowles

Published: 12.13.06 | Updated: 11.12.09

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