Monique Rainford

I sincerely appreciate the questions generated from my article on infertility and I will address them. I apologise that I am unable to give personal replies.

"My question relates to the side effects of using the 'morning after pill'. I read that women who have used this pill will have ectopic pregnancy, if they conceive after the use of this form of 'contracep-tion'. Is this true in all cases? Does the use of this pill prevent safe conception when you choose?"

Dear Reader,

The 'morning after pill' or emergency contraception is medication used to prevent pregnancy after unprotected intercourse or if a woman is concerned that her protection is inadequate. For example, a woman may select this method if she has missed her oral contraceptive pills or if the condom breaks. Methods of emergency contraception include high doses of certain combinations of oral contraceptive pills, a progestin-only pill, other hormonal combinations and the copper intrauterine device.

The method currently available in Jamaica without a prescription is the levonorgestrel, a progestin-only method, sold as postinor 2 or postinor 2 SD. Both are equally effective and the latter is recommended by the World Health Organisation. This medication has been shown to delay or inhibit ovulation and although it may have other mechanisms of action, it is not an abortion pill. Emergency contraception is most effective if used as soon as possible after the specific act of intercourse causing concern. However, it can be used up to 72 hours later and it may even be effective if started up to 120 hours later.

Abortion pill

The side effects of the levonorgestrel-only method include nausea occurring in about 18 per cent of cases, vomiting which occurs in about four per cent of cases, irregular bleeding, breast tenderness, abdominal pain, dizziness, headache and fatigue. No deaths or serious complications have been associated with emergency contraception.

Women are often concerned because of bleeding problems. These may occur in the week or month after use and usually improves without medical intervention. However, if the irregular bleeding persists or if she has pain in her lower abdomen, she should see her doctor.

There is currently no available evidence that emergency contraception increases the risk of ectopic pregnancy and because it prevents pregnancy, the overall risk of ectopic pregnancy is decreased. There is also no evidence to suggest that emergency contraception causes any risk to the woman who uses the medication or to the developing baby if she does in fact conceive.

Based on several studies, the efficacy of emergency contraception is approximately 75 per cent if the combined oral contraceptive pills are used. Additional studies show that the levonorgestrel-only method is even more effective. It may be used more than once (even within the same menstrual cycle) but it is not recommended as a method of long-term contraception.

Married and infertile

" I'm married 15 years, 48, wife 40, contraception used first year of marriage only. My wife is not keen on doing evaluations, so we have no children. Should I give up, must I be a father in my old age?"

Dear Reader,

I am sorry to hear that you and your wife have been unable to conceive but I think the decision about the next step is best made between the both of you. An evaluation may help in identifying a cause of the problem. However, it does not guarantee a treatable cause and the likelihood of achieving pregnancy is less with prolonged infertility. That being said, successful pregnancy has been achieved for many couples over 40 although some require advanced fertility treatment.

I think that you and your wife should consider consultation with a gynaecologist to discuss this issue further.

Dr. Monique Rainford is a consulting obstetrician and gynaecologist; email: yourhealth@gleanerjm.com.