Talk:Emergency contraception

message: This sentence: The annual failure rate of EC is estimated at 19-38%,[10] which means that over the course of a year, EC averages to less effective than it does for a single use implies both the 19% and 38% numbers are for levonorgestrel EC (perfect and typical use?), when actually the 38% number is for Yuzpe.  I will speculate that the 19% figure is the effectiveness of Postinor?  Not Postinor-2, marketed as EC, but the original Postinor, marketed as an ongoing postcoital contraceptive.  Which is somewhat problematic in estimating the annual effectiveness of EC, because Postinor is only approved for use four times a month. Although, the PubMed-listed studies of Postinor imply failure rates lower than 19% (, ).  
So, I'm not sure we should leave those annual numbers in (they are of suspect validity - though further research might be able to resolve that issue).  If they are left in, I think we should specify which number is levo and which is Yuzpe, and that they are for perfect use (not typical use).  Also, "less effective than for a single dose" doesn't appear to be true - levo 75% reduction in pregnancies single dose, annual (100-19=) 81% prevention of pregnancy - Yuzpe 57% reduction in pregnancy single dose, annual (100-38=) 62% prevention of pregnancy.  So technically more effective annually (though I think that's a result of inaccuracies in the estimates) - or can we even compare "reduction in pregnancy" numbers with "annual pregnancy rate" statistics?  I think the data does not support the "less effective..." statement and it should go. However, looking for other opinions before I go a-editing. Lyrl    Talk     Contribs   04:48, 2 December 2006 (UTC)
replies: text: I was just looking at the same sentence. The reference is a BMJ "rapid response" and doesn't actually cite the numbers in question, just says it's "no more effective" than withdrawal. Since the BMJ letter referenced Trussell, I found this on the Princeton/Trussell EC website, which cites a 20% annual failure rate for progestin-only and 40% for combined (close enough to 19-38%). But I think the main issue is that those estimates (19-38%) are for annual use of EC as the sole means of contraception. As Lyrl points out, this is problematic -  EC is clearly not intended for use as a sole means of contraception, so the numbers seem a little meaningless. I rewrote the sentence, leaving in the numbers, but emphasized that those numbers are estimated failure rates for EC as sole means of contraception, which absolutely no one is advocating. I also moved it below the numbers on single-use effectiveness in the emergency setting, since this is the more meaningful real-world context. MastCell 22:14, 2 December 2006 (UTC)
replies: text: Postinor (the original) is still sold, so obviously someone is advocating EC as sole means of contraception (however, only for women having intercourse four or fewer times per month).  Reviewing the article, there is actually a section on EC as an ongoing birth control method.  I'm going to move the discussion of annual failure rates to that section and make some related changes. Lyrl    Talk     Contribs   23:15, 2 December 2006 (UTC)
thread_title:  EC annual effectiveness 

message: The Aug 15, 2004  AFP Emergency Contraception review article  is a WP:RS, but its statement: "The FDA has cleared 13 brands of oral contraceptives for safety and efficacy when used for emergency contraception (Table 2)" listing 12 combined oral contraceptive pills and the progestin-only oral contraceptive Ovrette® is not correct.
On Feb 25, 1997, the FDA posted a notice in the Federal Register (Certain combined oral contraceptives for use as postcoital emergency contraception. Fed Regist 62(37):8610-2) which said the FDA Commissioner had concluded that certain COCPs (containing ethinylestradiol and norgestrel/levonorgestrel, i.e. the Yuzpe regimen) were safe and effective for off-label use as postcoital EC, was prepared to accept  NDAs for COCPs labeled as ECPs, and listed 6 then available COCPs that could be used as ECPs (Ovral®, Lo/Ovral®, Nordette®, Levlen®, Triphasil®, Tri-Levlen®).
On Sep 2, 1998, the FDA approved the prescription Yuzpe regimen Preven® Emergency Contraception Kit (which contained a urine pregnancy test and 4 COCPs equivalent to 4 Ovral® pills).
On Jul 28, 1999, the FDA approved the prescription progestin-only Plan B® (two 750 µg levonorgestrel pills) emergency contraceptive.
The FDA never approved the use of 40 regular progestin-only Ovrette® (75 µg norgestrel) POPs as safe and effective for use as EC.
Since the 1997 FDA notice almost 10 years ago that the COCP Yuzpe regimen for EC was safe and effective, 16 additional COCPs containing ethinylestradiol and norgestrel/levonorgestrel have been marketed in the U.S. that contain doses equivalent to the 6 COCPs listed in the 1997 FDA notice.
Forty Ovrette® pills containing 3 mg of norgestrel is equivalent to the 1.5 mg of levonorgestrel in two Plan B® pills and would work as EC, but is much less convenient and the likelihood of already having (or being able to purchase) over a month's supply of one brand of regular POPs is much lower than the likelihood of finding 4 to 10 pills of one of the 22 available brands of COCPs usable for the Yuzpe regimen.
References:
* Oct 20, 2006 - Planned Parenthood - Emergency Contraception 
* Nov 29, 2006 - Emergency contraception: Pill brands, doses, and instructions 
68.255.31.5 07:28, 5 December 2006 (UTC)
thread_title: FDA has not approved Ovrette® as EC

message: :Adverse effects
:Plan B and Yuzpe should not be used by women who are already pregnant, because they are not effective after implantation. 
:Because they contain estrogen, combined estrogen-progestin emergency contraception (Yuzpe regimen) pills should not be used by women with a history of heart attack, stroke, blood clots, or patients with severe liver disease or the very rare condition of porphyria.
:If pregnancy occurs despite use of ECPs, the women is at slightly increased risk of ectopic pregnancy. A history of ectopic pregnancy is not a contraindication to use of ECPs, but consumers and health providers should be alert to the possibility of an ectopic pregnancy in women who become pregnant or complain of lower abdominal pain after taking levonorgestrel EC.{{cite web}title=Morning after pill to carry new warning on ectopic pregnancy|publisher=bmj.com|date=January 30, 2003|accessdate=2006-11-09|url=http://www.bmj.com/uknews/news20030130.shtml#2}} Ectopic pregnancy is a medical emergency which can be fatal.
:The herbal preparation of St John's wort and some enzyme-inducing drugs (e.g. anticonvulsants or rifampicin) may reduce the effectiveness of ECP, and a larger dose may be required. (Levonorgestrel 1500mcg initial dose and an extra 750 mcg after 12 hours).For women who are using liver enzyme inducing drugs, what dose of progestogen-only emergency contraception is advised?  PDF members response 916 Faculty of Family Planning and Reproductive Health Care -  Clinical Effectiveness Unit
:Three cases of convulsions have been reported following use of levonorgestrel ECPs. Two cases occured in women with epilepsy, and are surmised to be caused by interaction of contraceptive hormones with antiepileptic drugs.
:Ten cases of hypersensitivity (allergic) reaction, seven of which were considered life-threatening, have been reported following use of levonorgestrel ECPs.
:Breast cancer cells are often hormone-sensitive, therefore hormonal birth control methods (including ECPs) are not recommended for women who have, have had, or suspect they have breast cancer. Laboratory studies have suggested levonorgestrel might have an effect on breast cancer. Human studies to date have been too small to draw definite conclusions about breast cancer risk of ongoing progesterone-only contraception, though it is known that ongoing use of combined hormonal contraceptives slightly increases breast cancer risk.
:Side effects
:The most common side effect of emergency contraception pills is nausea (50% of users of combined pills, 23% of progestin-only users), and a significant number of users vomit. Estrogen in combined ECPs is responsible for the increased incidence of nausea and vomiting. Antiemetics may be prescribed for both methods. Consider antiemetics 1 hour before each ECP dose. If vomiting occurs within an hour after taking ECPs, it may be necessary to repeat the dose.
:Other common side effects are abdominal pain, fatigue, headache, dizziness, breast tenderness.  These side effects normally resolve within 24 hours.
:Temporary disruption of the menstrual cycle is also common and may manifest as early or late periods, spotting or breakthrough bleeding, and (less commonly) missed periods.  The primary mechanism of EC is delaying ovulation.  Menstruation occurs, on average, 14 days after ovulation, so delayed ovulation results in delayed menstruation.  Suppression of ovulation may cause anovulatory bleeding, which could manifest as an early period.
This would combine seven sections of heavily related topics into one section (though I'm not sure 'adverse effects' is the best title for the new section).  I believe combining them improves readibility in general (many short sections in a row are difficult to read), makes the related nature of the effects more understandable (for example, by putting the discussion of women taking antiepileptics needing a higher dose next to reports of epileptics having seizures associated with ECPs), and helps the table of contents look less unbalanced with so many negative headings.
This edit would also put discussion of the menstrual disruption side effect directly above the section discussion when pregnancy testing is appropriate, which I think would be a helpful tie-in. Comments and suggestions? Lyrl    Talk     Contribs   02:47, 8 December 2006 (UTC)
replies: text: I like this a lot. Good work. I agree that combining sections, and making things more concise is better (and do we really need a new section header for one sentence paragraphs?)--Andrew c 04:02, 8 December 2006 (UTC)
replies: text: I think it's a good idea, and the proposed wording is a good start. MastCell 05:27, 8 December 2006 (UTC)
thread_title:  Proposed rewrite of "Contraindications" et. al. sections 

message: I'm confused as to what is meant by the sentence "...parochial high school nurses were allowed to dispense Norlevo in schools." I checked the link, but it seems to say the same exact thing with no explanation. Is it saying that nurses at french parochial schools can dispense ECs whether the school allows it or not if they so choose, or are they forced to do it? I think that this section needs a little clarification even though it is just a minor detail. Is there any way we can actually find a copy of whatever law approved this? Chooserr 04:52, 10 December 2006 (UTC)
replies: text: I don't think France (or any European country) has had the conscience refusals so publicized in the U.S.  So I would assume French school nurses would have no objection to dispensing ECPs.  The law would seem to say that schools were required to allow nurses to dispense ECPs upon request.  Does that help any? Lyrl    Talk     Contribs   14:03, 10 December 2006 (UTC)
replies: text: Yes, but I'm talking about catholic schools. In which case you wonder is the law forcing the nurses to dispense ECs, or saying that they can dispense ECs, if they want, regardless of the opinions of those who own and run the school. Allow seems to me to be the wrong word here, and it'd be better if we can link to and quote from the actual law. Chooserr 01:43, 11 December 2006 (UTC)
replies: text: I also found this. Not sure if you will have access or not, but it says similar things that the AGI article, but in different words. Same with this and "Without Fanfare, Morning-After Pill Gets a Closer Look", GINA KOLATA October 8, 2000, NYT. It seems like they were 'granted the right' to dispense, not necessarily required to. Maybe a French speaker with access to French sources could help out, but I agree with Lyrl that refusal probably isn't as big of an issue in France as it may be in other places. Regardless our sources support our wording. Just because we don't have all the answers to your questions doesn't mean we need a fact tag.--Andrew c 03:12, 15 December 2006 (UTC)
replies: text: Andrew C, I don't think that it is good enough just because our source claims it, especially since they probably don't follow the NPOV rules that wikipedians should hold in mind while writing articles. I don't think that quoting some external source just makes it POV. These cases should be looked into, for I am certain that this isn't the only one. And if it can't be verified it should be removed or reworded or something. Chooserr 03:34, 15 December 2006 (UTC)
replies: text: I don't understand what isn't verifiable. We have the New York Times, the Guttmacher Institute, and two employees of HRA Pharma Laboratoire in Paris writing to a peer-reviewed, scholarly journal. Can you please explain to me what your objection is? A law was passed in France on a national level in late 2000 that gave permission (authorization, allowed, etc) to school nurses to give out EC in schools. This is verifiable by all of these sources, right? And this is basically what our text says, right? So what is the problem? I apologize for my confusion.-Andrew c 04:58, 15 December 2006 (UTC)
replies: text: Maybe I wasn't saying what I meant properly, or maybe you just misunderstood, but while this may be verifiable it is still in my opinion vague. I don't know the implications. Would this force a school nurse, even those at catholic schools, to dispense ECs inspite of their opinions, or allow them to distribute them regardless of the opinions of those who own and run the schools if they so choose? Those are my two questions. Chooserr 05:18, 15 December 2006 (UTC)

text: I agree that we do not have every fine detail included in the article (and maybe that section could use expansion). But I feel that this issue is independent of verification and citation claims. I'll look further into this. If that section needs a tag, I feel an Template:Expand-section tag would work better. And yes, I was a little confused and I'll take the blame for the misunderstanding. Hopefully we can get more detail, but I personally think the current state of that section isn't terrible or anything. You wouldn't happen to know French, would you?-Andrew c 06:03, 15 December 2006 (UTC)
replies: text: Ok, I found this. It is "Bulletin Officiel du ministère de l'Education Nationale et du ministère de la Recherche" or Official Bulletin for the Ministry of National Education and for the Ministry of Research. Scroll down to "Application de la loi n° 2000-1209 du 13 décembre 2000 relative à la contraception d'urgence" or Application of the law # 2000-1209, Dec. 12,  2000 regarding emergency contraception. And in the "Annexe" for that section is PROTOCOLE NATIONAL SUR LA CONTRACEPTION D'URGENCE EN MILIEU SCOLAIRE or National Protocol on Emergency Contraception in Scholastic Environments. And there list what I believe to be the text of the law. And from what I can gather, your concerns are not addressed in the text of the law. Therefore, you are asking sticky legal questions that can only be answered by French courts. Have these questions been asked? Maybe we should look into that, but further speculation seems like OR without sourcing. Feel free to use google or babblefish to translate the text and see if I missed anything (or if you know French, ignore that last part). Hope this helps.-Andrew c 06:38, 15 December 2006 (UTC)
replies: text: I know a little bit of french so I may check this out, especially your link. Thanks, by the way. Chooserr 07:31, 15 December 2006 (UTC)

text: Scratch that my french is no where near standing up to this document, but it seems like there is a lot of information if we can just get someone to read it. It talks about the situations and the "right" so it's gotta be there. Chooserr 07:34, 15 December 2006 (UTC)
replies: text: From what I can gather from babelfish, wiktionary, and my year and a half living in Montréal, it describes the following: The law deals with the methods of administering EC without a perscription in secondary schools. Each school is responsible for making sure the following provisions are respected and enacted. 1. To be able to administer EC, the nurses associated with the school should have a private room for confidentiality. 2. Regardless of the student's age (minor or not) before EC is dispensed, there must be a discussion. This gives the nurse time to assess if the situation meets both the criteria of article L. 5134-1 of the code of the public health and the drug infosheet. The nurse then must tell the student that EC is not a regular method of BC, that it is not always effective. If the student doesn't meet the criteria for the drug, they shall be directed to a family planning center, hospital, OBGYN, or other doctor. 3. Describes the situations for minors and those 18 and over. For minors, the nurse describes the usual routes for obtaining EC, and recommends going to a doctor. Parental/guardian involvment is encouraged, but not required. If the student is distressed and cannot obtain EC in the normal means, then the nurse can dispense the drugs in exceptional circumstances. For those 18 and over, it is basically the same. 4. The nurse must keep a record of dispensing EC in a "cahier de l'infirmière" or similar log book. Statistics must be compiled at the end of the year. 5. The nurse should set up a follow-up appointment for the student with a medical professional, where pregnancy tests, STD preventions, and regular method of contraception can be discussed. That's all I could get from there. Nothing seems to suggest anything about refusal clauses or anything. I'm fine with how the article is, and I think I'm going to give up on researching more. If you find anything else, or have more concerns, please voice them (and if you are so inclined, you could contact Wikipedia:Reference desk/Language or Wikipedia:Translation or Wikipedia:Translation into English. Good luck.--Andrew c 19:23, 15 December 2006 (UTC)
thread_title:  France & ECs 

message: I removed the International Availability entry for the United States Virgin Islands (population 112,000 in 2005) that stated:
: The Yuzpe regimen and diethylstilbestrol are used on the island of St. Croix.
citing, on the Women's Coalition of St. Croix website (last updated May 24, 2005), a webpage of information on what to do:
* If You've Been Sexually Assaulted, listing under: 
** Choices You Need To Make
*** In order to prevent pregnancy from the assailant, there is the option of taking the "Morning After Pill."  Up to 72 hours following your assault, and preferably less than 24, you may choose to take the Morning After Pill. The Morning After Pill treatment actually consists of four pills, two taken initially and two more taken twelve hours after the initial dosage. This is not a form of contraception. Each of the pills contains a high dosage of the synthetic hormones estrogen and/or progesterone. The pills prevent implantation of a fertilized egg in the uterus. Some women may experience side effects including headache, nausea and vomiting. More serious side effects may occur, and those women who are advised against using birth control pills are advised not to use the morning after pill.
*** Some physicians recommend a drug called Diethylstilbestrol (DES), or another pregnancy preventing drug. This drug prevents pregnancy if you begin taking it within 48 hours after the rape and continue the medication for the next 5 days. DES has potential side effects, the most common being cramps and vomiting. Ask the doctor what you can expect when taking the drug, so you can decide if it makes sense to you.
Although I'm sure the Women's Coalition of St. Croix is a wonderful organization, they are not a WP:RS on the medication currently prescribed by U.S. physicians on St. Croix for emergency contraception.
Why would U.S. physicians on St. Croix (population 52,324 in 2000) still use  DES, a medication that the FDA ordered labeled "THIS DRUG PRODUCT SHOULD NOT BE USED AS A POSTCOITAL CONTRACEPTIVE" over three decades ago, was superseded by the Yuzpe regimen two decades ago, and has not been commercially available in the U.S. for a decade, OR the Yuzpe regimen, still be used an emergency contraceptive INSTEAD OF Plan B, which is more effective, has fewer side effects, and has been FDA-approved over six years ago for emergency contraception?? 
As stated in WP:RS: Exceptional claims require exceptional evidence. Not a webpage containing some information that appears to have not been updated for two decades or more.
FP101 23:31, 10 December 2006 (UTC)
thread_title:  St. Croix  

message: I've shortened the U.S approval controversy section a little further, as an opinion had been expressed that it was too long, recentist, America-centric, etc. I'm including an excised portion below, so as not to be accused of "removing sourced content" without a trace (once bitten...)
In 2005, a study was published demonstrating that direct access to ECPs without a prescription doesn't result in fewer unintended pregnancies than controlled access via prescription.   
Cheers. MastCell 23:25, 18 December 2006 (UTC)
thread_title:  Approval controversy (U.S.) 

message: The "International availability" section seems designed to list EC availability status in every one of the world's nearly two hundred countries.  This documentation goal seems worthy, but the list is already quite long and taking up a disproportionate share of the article.  I propose spinning it off into List of emergency contraceptive availability by country.
Availability is currently dealt with in summary form in the "Types of ECPs" section: Progestin-only EC is available as a dedicated emergency contraceptive product under many names worldwide, including: in the U.S., Canada and Honduras as Plan B; in the U.K., Ireland, Australia, New Zealand, Portugal and Italy as Levonelle; in 44 nations including France, most of Western Europe, India, and several countries in Africa, Asia and Latin America as NorLevo; and in 44 nations including most of Eastern Europe, Mexico and many other Latin American countries, Portugal, Australia and New Zealand, Israel, China, Hong Kong, Taiwan and Singapore as Postinor-2.  I'm not sure anything else is needed in this article, other than adding a "See also" hatnote linking to the new article in the "ECPs" section. 
There is currently some historical information in the availability list.  That could be moved to the "History" section before spinning of the list. Lyrl    Talk     Contribs   02:04, 29 December 2006 (UTC)
replies: text: I think that's a good idea. The lengthy list of countries under "Availability" was wreaking havoc on the table of contents, too. A sub-article in list format sounds like a good idea. MastCell 03:21, 29 December 2006 (UTC)
thread_title:  International availability - spin off into own article 

message: Note discussion at Talk:Birth control#"pregnancy rate" rather than "failure rate" re replacing occurrences of "failure rate" with "pregnancy rate".  I would also like to see the same change on this page.  Please make any comments there.  --Coppertwig 03:59, 8 January 2007 (UTC)
replies: text: On the one hand, "failure rate" is most descriptive and intuitive, since pregnancy does represent a failure of birth control methods in such a setting. On the other hand, I can understand the desire not to refer to a pregnancy as a "failure". I guess I'm on the fence and don't feel particularly strongly one way or the other. MastCell 17:31, 8 January 2007 (UTC)
thread_title:  "Pregnancy rate" rather than "failure rate" 

message: I'm proposing that the sections about Mifepristone be removed, as it is generally not known as emergency contraception, aka the "Morning After Pill".  There should probably be a link to the Mifepristone article, but as it is now, the article risks confusing readers.  MaskedEditor 01:56, 9 January 2007 (UTC)
replies: text: Generally known to who? It's licensed for use as emergency contraception in China, home of one-fifth of the world's population. Besides, isn't part of reading an encyclopedia learning things you didn't know before?  I'm not sure "not generally known" is a criteria for excluding things from an encyclopedia. Lyrl    Talk     C   02:03, 9 January 2007 (UTC)
replies: text: I meant "not generally known" in the sense that Pluto is not generally known as a planet, not in the sense that an obscure fact is not generally known.  That said, I can appreciate the argument that the Chinese government considers it emergency contraception, even though the rest of the world does not.  The article is still misleading, given that the intro paragraph says that emergency contraception is also known as the morning after pill, giving the impression that these two terms are synonymous.  I'll clean this up if nobody does it first.  MaskedEditor 16:10, 9 January 2007 (UTC)
replies: text: We have citations of mifepristone being used as EC instead of an abortifacient, and I do not believe we are giving undue weight. I believe the current state of the article is fine and clearly explains the two uses of mifepristone. But maybe you could explain your proposed changes here so I understand your complaint more.-Andrew c 16:26, 9 January 2007 (UTC)
replies: text:  I added a citation for Mifepristone being used in China and Russia, hope it's clear.Nimravid (talk) 09:55, 16 March 2011 (UTC)
thread_title:  Mifepristone 

message: While the "risky sex" section currently only deals with STDs, the same behavior leads to unplanned pregnancy and abortion - currently dealt with in a separate section "Abortion rates and EC".  I feel these topics are sufficiently inter-related they should be combined.  What do others think? Lyrl    Talk     C   22:55, 18 February 2007 (UTC)
replies: text: I think that makes sense. MastCell 18:07, 19 February 2007 (UTC)
thread_title:  Abortion rates and risky sex 

message: This page doesn't say anything about how the pill works! Would anyone care to explicate?--Heyitspeter 22:14, 19 February 2007 (UTC)
replies: text: From the introduction to the article: "ECPs," or "ECs", or "morning-after pills"—are drugs that act both to prevent ovulation or fertilisation and possibly post-fertilisation implantation of a blastocyst (embryo). ECPs are distinct from medical abortion methods that act after implantation. More detailed information is presented in the "Controversy" section, though I can see why someone looking for "mechanism of action" would not go looking under "controversy".  Maybe that section should be renamed. Lyrl    Talk     C   23:47, 19 February 2007 (UTC)
thread_title:  Mechanism of Action 

message: From the article: Studies in humans have shown that the rate of ovulation suppression is approximately equal to the effectiveness of emergency contraceptive pills, suggesting that might be the only mechanism by which they prevent pregnancy.
But that doesn't mathematically make sense, and wouldn't suggest that.  In order to suggest that the only mechanism by which ECPs prevent pregnancy is ovulation suppression, the rate of ovulation suppression among women who have not yet ovulated needs to be higher than the effectiveness.  After all, some of the women who take ECPs to prevent pregnancy have already ovulated by the time that they take the pills; if ECPs work only by preventing ovulation, then they aren't effective in that situation at all.
There's a mathematical upper bound on the effectiveness of ECPs if they work only by ovulation suppression.  The exact upper bound depends on:
* The length of time after ovulation that the egg can be fertilized (less than 24 hours, AIUI), which puts a bound on how long the woman may have ovulated before sex and fertilization occur
* The length of time after sex that the ECPs are taken, which provides a further window for ovulation and hence fertilization (and decreases the window for ovulation suppression)
* The length of time that sperm remains in the uterus after sex (3-5 days, AIUI) and the rate of decreasing concentration (and presumably chance of fertilization), which puts a bound on the rate of pregnancies preventable by ovulation suppression
27 Feburary 2007 —The preceding unsigned comment was added by 71.163.137.186 (talk • contribs).
:some of the women who take ECPs to prevent pregnancy have already ovulated by the time that they take the pills; if ECPs work only by preventing ovulation, then they aren't effective in that situation at all. - From the article, Recent studies in rats and monkeys have shown that post-ovulatory use of progestin-only and combined ECPs have no effect on pregnancy rates.
:Also, effectiveness for ECs is calculated very differently than any other method of contraception.  Please carefully read the effectiveness section of the article.  Hopefully that will help explain why, if ovulation suppression is the only mechanism, ovulation suppression rates would be equal to (not higher than) the reduction in pregnancy rates. If not, ask here and maybe we'll get ideas for rewriting the effectiveness section to make it more understandable. Lyrl    Talk     C   00:31, 28 February 2007 (UTC)
thread_title:  Mechanism of Action and Mathematics 

message: I've removed the scare quotes and so-called's from the section on ethical questions about EC.  Scare quotes are inherently POV and thus not appropriate for an encyclopedia article. Miraculouschaos 22:27, 11 March 2007 (UTC)
replies: text: I removed the sentence altogether because it has been fact tagged for a while (the bot mislabeled it because it isn't smart enough to search the archives). Also, why did you insert "federal law"? Do you have more information about this? If you do, please feel free to restore the sentence with your source. Thanks!-Andrew c 22:43, 12 March 2007 (UTC)
replies: text: I was just trying to re-word the sentence after deleting the scare quotes...I believe there was a federal law under consideration a couple of years ago that would have required pharmacists to stock and dispense contraceptives, but included a conscience clause for those who had documented religious objections to doing so.Miraculouschaos 16:50, 13 March 2007 (UTC)
replies: text: If that is the case, mentioning that would be helpful here. But sourcing I guess is the issue. If anyone is reading this and knows more, or wants to do the research, please help this article out! Thanks.-Andrew c 21:38, 13 March 2007 (UTC)
replies: text: Not aware of any federal law (although federal law does allow providers to decline to participate in abortion). Conscience/refusal clauses vary on a state-by-state basis, although some nationals (Target, WalMart) have uniform policies. Useful references are here and here. As far as Walmart specifically, I'll look into it. MastCell 22:20, 13 March 2007 (UTC)
thread_title:  so-called "Conscience Clause" 

message: "Although EC is in wide use as an option for victims of sexual assault, some researchers believe it is underutilized as a public health measure.[87] Abortions because of rape account for less than one percent of all annual abortions.[88]"
The last sentence, though true, seems out of place in this article.  It seems likely that it was placed there to advance a belief rather than to improve the article. 
Feel free to correct me if I'm wrong. 
Mike 71.248.152.37 23:10, 15 March 2007 (UTC)
thread_title:  Possible bias 

message: I've moved this out of the article and brought it here for discussion.
:Little is known about long-term side effects, but these may include fibroids, in terms of physical health, and serious long lasting depression in terms of psychological health (as is the case with abortion and miscarriage). The systemic therapeutic method known as "Family Constellations" (now "Hellinger Sciencia") developped by Bert Hellinger reveals 'side effects' of a further reach in relation to any type of abortion (as well as miscarriage), including the discarding of fertilised eggs in artificial insemination procedures. Such deeper consequences may be, i.e., the break up of the couple, as both members tend to blame each other for the loss either consciously or unconsciously[ref][/ref]
It isn't clear to me that this has anything at all to do with EC, and the author seems to confuse EC with abortion and miscarriage (things that can happen to pregnant women, where EC is not effective on pregnant women). Furthermore, I seriously question the reliability of the cited source. I'd like to discuss this further if anyone want to propose including it. Thanks. -Andrew c [talk] 23:49, 21 April 2010 (UTC)
replies: text: It's absurd to say the only place there is medical information regarding these side effects is some Spirit Walk, new age DVD. If these are known, commons side effects, cite the patient data sheet, or medical journals, or something along those lines. And it still doesn't change the fact that it's written in a manner which seems entirely ignorant of what EC is, so it isn't apparent how it relates to this article, as it is written. Please defend your edit and your source, or consider major revisions. Thanks. See also WP:BRD and WP:EW. You shouldn't try to edit war to force new controversial, disputed content into an article, but try to work out a compromise or consensus for your proposal here first. Thanks.-Andrew c [talk] 13:57, 24 April 2010 (UTC)
thread_title:  "Hellinger Sciencia" 

message: I don't do enough on Wikipedia to have confidence in fixing this correctly. Hopefully someone else active here can take care of this.  Link 100 is to a Forbes article that is no longer accessible on their website.  It appears, though, that this same article is now available here: http://sexualhealth.e-healthsource.com/?p=news1&id=534950  Perhaps this cite could be updated?
Also, someone ought to add the new information about "ella" and "ellaOne" which the FDA is in the process of considering approving as an emergency contraceptive. Cngcng (talk) 19:57, 18 June 2010 (UTC)
replies: text: I added some information about ella, a new citation and how it works.Nimravid (talk) 09:56, 16 March 2011 (UTC)
thread_title:  Citation 100 Broken 

message: Since the mechanism of action was unknown for some of these in the few years old papers, there have been studies for some of these EC methods that clarify the mechanism of action.  I added a lot of citations, and added information on how some of them work, moved some sentences around if needed from the addition, etc.  There were some places waiting for citation that I updated.Nimravid (talk) 10:04, 16 March 2011 (UTC)
thread_title:  Many more citations added, updates to include new research 

message: This page got a spike of 6,000 hits on Thursday, and it was almost certainly because people are interested in Plan B because of the FDA's rejection of its OTC application. 
I realize that Wikipedia is an international encyclopedia and has to cover a lot of ground, but I think we should cover the regulatory issues around Plan B in some detail and make it clearer to people who are looking for information about Plan B that this is the right place. --Nbauman (talk) 17:04, 11 December 2011 (UTC)
thread_title:  Plan B 

message: This caught my attention so I googled around and found this:
:"Can I Use Regular Birth Control Pills as Emergency Contraception?  Yes, certain brands of birth control pills can be used in increased doses as emergency contraception. The Emergency Contraception Website has information about what brands of pills can be used and how to use them."  - http://www.plannedparenthood.org/health-topics/emergency-contraception-morning-after-pill-4363.asp
Following the link to http://ec.princeton.edu/questions/dose.html#dose seems to say that a wide variety of ordinary birth control pills can be used in two doses of 4, 5, or 6 pills each, 12 hours apart. That approach seems much less expensive than two generic levonorgestrel 0.75 mg tablets over the counter.
Is the Princeton site a reliable source? What are the disadvantages of this approach? The very recent reviews  and  both mention this approach in their abstracts, but I can't read their full text. This seems very significant to me. Liang Xie (talk) 22:08, 21 October 2012 (UTC)
thread_title:  Regular birth control pills as EC 

message: I reverted the following 5th repeated inappropriate addition of WP:SYNTHESIS about cancer to the "Safety" section of this article by Changerchangerchanger (contribs | talk):The most prevalent type of emergency contraception in the United States (ie, Plan B) contains more than 75% of amount of levonorgestrel (ie. 1.5 mg) found in a entire month worth of some oral contraceptives (eg, Triphasil which contains 1.92 mg)). This may have carcinogenic implications in that the World Health Organization (IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, 2007) has labelled oral contraceptives as a Group I carcinogen and a recent meta-analysis in the Mayo Clinic Proceedings (Mayo Clin Proc. 2006) have noted that ingestion of oral contraceptives at a young age increases the risk of premenopausal breast cancer by 44% (OR, 1.44; 95% CI, 1.28-1.62; 99% CI, 1.24-1.68)1. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Combined estrogen-progestogen contraceptives and combined estrogen-progestogen menopausal therapy. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans 2007; 91:74–84.2. Mayo Clin Proc. 2006;81(10):1290-1302The cited sources (contradicted by many other authoritative reliable sources) are about ongoing daily use of combined oral contraceptive pills—not about one-time or occasional usage of progestin-only emergency contraceptives. BC07 (talk) 19:53, 18 November 2012 (UTC)
thread_title: Repeated addition of [[WP:SYNTHESIS]] about cancer

message: This source: 
Durrance, Christine Piette (July 2013). "The effects of increased access to emergency contraception on sexually transmitted disease and abortion rates". Economic Inquiry 51 (3): 1682–1695. doi:10.1111/j.1465-7295.2012.00498.x 
has been added to the article today, but I don't think it is compliant with WP:MEDRS - not only is it a primary source, it's also published in an economics journal. It's not listed in PubMed either. Is there a good (policy based) reason to have it in the article anyway? --Six words (talk) 11:57, 23 December 2013 (UTC)
replies: text: No, it was not compliant with WP:MEDRS and there was not a good reason to have it in the article, so I removed it. BC07 (talk) 15:06, 24 December 2013 (UTC)
thread_title:  Is this really compliant with [[WP:MEDRS]]? 

message: Moved the following stale, hodgepodge, play-by-play, U.S.-centric section started on 24 February 2006 by Chooserr (talk | contribs) to talk page:United States legal and ethical controversiesA great deal of controversy accompanied the FDA approval of over-the-counter (OTC) access to Plan B. Supporters of over-the-counter access believe that easier access will reduce unintended pregnancy and abortion rates; some abortion opponents believe that EC itself is a form of abortion. The American Medical Association, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and other leading U.S. medical organizations all supported OTC access. An advisory committee to the FDA recommended that Plan B be made available over the counter in 2003. In 2004, the FDA refused the advisory board's recommendation and prohibited over-the-counter sale, citing insufficient evidence that ECPs could be used safely by adolescents without medical supervision. In 2005, Susan F. Wood, assistant FDA commissioner for women's health and director of the Office of Women's Health, resigned to protest the FDA's delay. Reproductive rights supporters accused the FDA of basing the decision on political pressure from the pro-life lobby. The Center for Reproductive Rights filed a lawsuit regarding the approval process, which had not been resolved . In the legal proceedings, two senior FDA officials alleged in depositions that the decision to reject the OTC application was made on political, rather than scientific, grounds to "appease the administration's constituents". In 2006, the FDA approved over-the-counter access to Plan B for women 18 years of age and older. In April 2009, the FDA followed the ruling of a New York Federal District Court and loosened the restrictions to allow Duramed Pharmaceuticals to provide Plan B without a prescription to 17-year-olds. However, as of June 2009, Duramed had not yet put a non-prescription Plan B product for 17-year-olds through FDA approval, a process that could take some time.On April 5, 2013, Judge Edward R. Korman of the U.S. District Court for the Eastern District of New York ruled that "the government must make the most common morning-after pill available over the counter for all ages, instead of requiring a prescription for girls 16 and younger." Korman ordered the U.S. Food and Drug Administration to lift all age and prescription restrictions on Plan B One-Step and its generic counterparts within thirty days. In his opinion Korman wrote that "More than twelve years have passed since the citizen petition was filed and eight years since this lawsuit commenced. The F.D.A. has engaged in intolerable delays in processing the petition. Indeed, it could accurately be described as an administrative agency filibuster."On April 30, 2013, the Obama administration U.S. Food and Drug Administration approved (with three-year marketing exclusivity) Teva Pharmaceutical Industries Plan B One-Step for sale without a prescription to anyone age 15 or over who can show proof of age such as a driver's license, birth certificate, or passport to a drug store retail clerk. Generic one-pill levonorgestrel emergency contraceptives and all two-pill levonorgestrel emergency contraceptives will remain restricted to sale from a pharmacist—without a prescription to anyone age 17 or over who can show proof of age.On May 1, 2013, the Obama administration U.S. Department of Justice said it would appeal Judge Korman's decision and pending the appeal asked him to stay his order for the FDA to approve levonorgestrel emergency contraceptives for OTC sale without prescription or age restriction by May 6, 2013.A Massachusetts law that went into effect on 14 December 2005 requires all hospitals in the state to provide emergency contraception to any "female rape victim of childbearing age"  including Catholic Hospitals who oppose the provision of emergency contraception. In a letter criticizing the joint UN/WHO Inter-agency Field Manual on Reproductive Health in Refugee Situations, the Catholic Church explains its belief that emergency contraception, along with IUDs and hormonal contraception, cannot be considered "solely contraceptive because in the case of effective fertilization a chemical abortion would be carried out during the first days of pregnancy." The Catholic position on family planning is explained further in Ethical and Religious Directives for Catholic Health Care Services. Because of this expressed moral stance against emergency contraception, the Massachusetts Catholic Conference opposed this law, stating interference with religious freedom.In isolated instances across the United States, pharmacists have refused to dispense emergency contraception even when presented with a legal prescription. In 2010, the Washington State Pharmacy Board decided that pharmacists do have a right to refuse to dispense emergency contraception. In addition, Wal-Mart, the nation's fifth-largest distributor of pharmaceuticals, refused to stock EC, beginning with Preven in 1999. However, Wal-Mart reversed this position when it was announced that stores would sell Plan B in March 2006.The Congregation for the Doctrine of the Faith in the 2008 Instruction Dignitas Personae (Paragraph 23) stated that: "Alongside methods of preventing pregnancy which are, properly speaking, contraceptive, that is, which prevent conception following from a sexual act, there are other technical means which act after fertilization, when the embryo is already constituted, either before or after implantation in the uterine wall. Such methods are interceptive if they interfere with the embryo before implantation and contragestative if they cause the elimination of the embryo once implanted...Therefore, the use of means of interception and contragestation fall within the sin of abortion and are gravely immoral. Furthermore, when there is certainty that an abortion has resulted, there are serious penalties in canon law."
BC07 (talk) 12:54, 22 March 2014 (UTC)
thread_title:  United States legal and ethical controversies 

message: Does not appear to be a have good impact factor. Thus I am not sure it supports
"Some scholars still insist that the abty-implantation effect is possible and aptients should be infomed about it. Chris Kahlenborn, Rebecca Peck, Walter B. Severs, Mechanism of action of levonorgestrel emergency contraception, „The Linacre Quarterly”, Volume 82, Issue 1 (February, 2015), s. 18-33, DOI: 10.1179/2050854914Y.0000000026, PMID: 25698840 "
[Per http://www.maneyonline.com/bibliometrics/lnq] Doc James (talk · contribs · email) 17:38, 3 February 2016 (UTC)
replies: text: Per here it looks like it just started  Doc James (talk · contribs · email) 17:39, 3 February 2016 (UTC)
replies: text: Trimmed it again. The fact that The_Linacre_Quarterly is associated with the Catholic church raises concerns IMO. Doc James (talk · contribs · email) 12:09, 14 February 2016 (UTC)
thread_title: Linacre Quarterly

message: Hi  and , I noticed that the phrasing of the article for sexual assault section was changed from "rape victims" to "women who have been raped". The article also uses "women" for "women who had been sexually assaulted" and "women of child-bearing age". This seems to omit girls, however, who also can experience sexual assault and need emergency contraception. Should instances of "women" here (and perhaps other places in the article) be replaced by "women and girls"? Elysia (Wiki Ed) (talk) 19:59, 19 July 2019 (UTC)
replies: text: Agree with User:UCDEBS "individuals or people who have been raped" is better. Doc James (talk · contribs · email) 00:16, 20 July 2019 (UTC)
thread_title:  Terminology  

message: Rather than just stating that it's a type of birth control, the article should state the difference between emergency contraception and abortion. A lot of people who read this probably want to know that. —Lights and freedom (talk ~ contribs) 20:39, 25 April 2023 (UTC)
thread_title:  Difference between emergency contraception and abortion