The Morning After the Holiday Party

It’s that time of year: the office holiday party. And even with the best of intentions, the lure of mistletoe and a little too much vodka can lead to the horror of waking up next to the hot guy from accounting who is now naked, and, by the way, not so hot. Particularly since you are fairly sure there was no condom involved and you haven’t been on the pill for months. Now what?

Posted on | Lauren Streicher, MD | Comments ()

It’s that time of year: the office holiday party. And even with the best of intentions, the lure of mistletoe and a little too much vodka can lead to the horror of waking up next to the hot guy from accounting who is now naked, and, by the way, not so hot. Particularly since you are fairly sure there was no condom involved and you haven’t been on the pill for months. Now what?


A few years ago you would have had to sweat it out and wait for your next period hoping that the fertility gods decided to give you a pass. Fortunately, there is now reliable, safe Emergency Contraception (EC) available, and you won’t have to face anyone other than a pharmacist to get it. So, stop beating yourself up and head down to your local drugstore.


While many women are aware that there is such a thing as EC (also known as the morning after pill), what many don’t realize is that it is readily available, safe to use, highly effective … and does not need to be taken the morning after!


EC was first described in 1974 when it was found that multiple birth control pills taken immediately after unprotected intercourse prevented pregnancy. While many gynecologists were aware of this “off label” use, emergency pills were not known or prescribed by the majority of physicians in this country. In 1998, emergency oral contraception became FDA approved, and Preven, followed by Plan B, hit the market.


Emergency contraception (EC) involves taking 1 or 2 pills within 5 days of unprotected intercourse. The hormones in two types of EC are the same hormones commonly found in birth control pills. (The newest EC pill, ulipristal, is nonhormonal.) The difference between emergency contraception and standard oral contraceptives is in the dosage and timing. The sooner the pills are taken, the more effective. (Hence, “the morning after” pill), but it is still highly effective as long as it is taken within 5 days of unprotected intercourse.  Side effects are minimal and can include nausea, vomiting and light bleeding.  If pregnancy does occur, or if you are already pregnant, there is no risk to the developing fetus.


Since emergency contraception has been available, the thousands of prescriptions that have been filled only represent a fraction of the women who could have benefited. According to the Guttmacher Institute, 50% of the pregnancies that occur in the United States each year are unplanned. By age 45, half of all American women will experience an unintended pregnancy. Every year, failed contraception, or no contraception, contributes to 3.2 million unintended pregnancies.


So, why aren’t these pills leaping off the pharmacy shelves? Lots of reasons. First, relatively few people seem to know about it. Direct marketing to consumers for emergency contraception is rarely seen, unlike ads for conventional birth control, hair loss products and of course, the ever-lucrative Viagra. Also, since it used to be that a prescription was required, a lot of women are not aware that emergency contraception is now available without a prescription if you are 17 or older. Another obstacle to public acceptance of emergency contraception is the confusion that still exists with another product; RU486 is an abortofacient that became FDA approved around the same time as EC, and received far more publicity. Emergency Contraception and RU486 are completely unrelated, and used in completely separate circumstances, yet confusion is still rampant about the two. Few people are aware that while emergency contraception is taken within 5 days of unprotected intercourse to PREVENT pregnancy, RU486 is taken AFTER established pregnancy to induce abortion.  A surprising number of people think that RU486 is the morning after pill, and are therefore are reluctant to take it.
 
Whether the condom slipped or if for any reason you had unprotected sex, your first visit should be to the pharmacy. You then need to get to your gynecologist for an STI screen. If you have picked up a Christmas gift that wasn’t on your wish list, like chlamydia, it's best to find out and get it taken care of. No need to go into the whole story for your gyne, simply say, “I had sex without a condom and would like an STI screen.” What I can’t help you with is facing your co-workers (including naked guy from accounting) on Monday. But don’t worry … chances are they had just as much to drink, and remember even less than you do. For more information, click here.

Blog written by Lauren Streicher, MD
Dr. Lauren Streicher is an Assistant Clinical Professor of Obstetrics and Gynecology at Northwestern University’s medical...