THE EDITOR, Sir:I WOULD like to use this medium to correct some inaccuracies published over the last two weeks about postinor 2, "the morning after pill". I was amazed to see in your western edition that an accountant at a Montego Bay pharmacy stated that postinor caused internal bleeding. I am not quite sure where this accountant got his medical information, but to see your editorial repeat this on 9/12/03 was even more appalling.
In 1981, I was the recipient of PAHO family planning fellowship to Hungary. I took back 250 packs of postinor, each pack containing 10 tablets. Those were the first postinor to come to Jamaica (each pack now contains 2 tablets). Of the 2500 tablets, many women used it without any problems.
Postinor is a progestogen called laevonorgestrel. It is the synthetic form of progesterone, a hormone produced by the ovaries. Initially, it was recommended to be taken not more than once weekly or four times per month but this recommendation was changed because too frequent use caused the lining of the womb to shed prematurely and this was frustrating but posed no risk to health. This is the bleeding that occurred and NOT internal bleeding.
Sometimes this even helped to prevent pregnancy, since most women in our culture do not have sexual intercourse while there is bleeding. In addition, the shedding of the lining of the uterus is a sign that pregnancy did not occur. If four oral contraceptive pills (e.g. Perle) are taken within 72 hours after unplanned sex and four taken 12 hours later, it will have the same effect as postinor and, if used too frequently, will cause the same breakthrough bleeding. It may also cause nausea since the dosage is high.
It is unfortunate that a fall in condom sale is linked with increased use of emergency contraceptive. There is no evidence to confirm this and the statement that this will also lead to HIV/AIDS seems to be unwarranted since there are so many other factors. Many persons in stable unions, who are not using condoms, use emergency contraceptive.
Over the past weeks I have noted a lot of judgmental statements without any evidence to link one thing to another. It is about 25 years since postinor is being used as an emergency contraceptive and it has proven to be safe, fairly effective and if taken too frequently, it will only cause frequent spotting and NOT internal bleeding.
I am, etc.,
WENDEL GUTHRIE
wengut@cwjamaica.com
Ggynaecologist
