Wednesday, October 2, 2013

First abortions of the school year

Oops! Guess who’s 4 days late starting her next pack of pills!

Birth control at colleges and Prep schools: Most female students still use oral contraceptives (mostly the combined, estrogen/progestin, pill) for birth control and many of them don’t take them correctly and consistently causing that method on average to be about 92% effective. We are about six weeks into the school year and are beginning to see the first of the students with unintended pregnancies come in for terminations.

Being on hormonal contraceptives takes more care than just taking a pill every day at the same time. That’s primary of course, but the pill and even implants, transdermal, and transvaginal methods, hormonal IUDs and injection methods can be compromised by other meds and supplements. There are a lot of reasons that young women don’t take their contraceptive meds as they should or take interacting meds or supplements: Lack of an effective regimen at the same time every day. Unpleasant side effects that tend to cause users to ‘forget’ to take their pills.

And things to avoid that should have been explained to them such as: weight loss pills taken to counteract the ‘freshman fifteen’ can speed the metabolism to the extent that the contraceptive hormones don’t stay long enough in the bloodstream to keep an effective level to suppress ovulation. Or taking the EC drug ella and then not using another effective method for the rest of that cycle, because the steroid in ella binds with the woman’s progestin receptors and prevents progestin from any pills taken for the next several weeks from being used by her body, leaving her open to ovulation and conception after the encounter of concern for which ella was taken had long passed. And then there is reduced effectiveness caused by some antibiotics. Or Vomiting within two hours after taking a pill and the hormones may not have been digested.

Hormonal contraceptive side effects:

99% effective when used correctly
Regulates cycles
Decreases menstrual bleeding and discomfort
Can help clear some cases of acne 

Negative side effects for some women:
Estrogen withdrawal headaches
Vaginal dryness
Breast tenderness
Weight gain
Loss of libido
Hair loss
Small but real Increased risk of blood clots and strokes especially for Newer Progestins like etonogestrel (Nexplanon & NuvaRing) and Drospirenone (Yaz, Beyaz & generics)
Must be taken correctly, consistently and on time
Effectiveness lessened by some meds and supplements..

My Wards after school Jobs: I’m pleased that we got Bea, Cyndi and the Swan twins using GyneFix copper IUDs so they can continue to cycle while being very effectively protected from pregnancy. That way they can be as sexually active as they like with only having STIs to worry about. I’ve been able to get the twins onto the male escort trainee’s partners list so they will get the benefit of training with professionals. The wide range of escort trainee partners who are clean and frequently checked gives them a very large pool of gorgeous and very experienced men to train with just like Bea and Cyndi who are continuing to volunteer as partners to help train the escorts. Their volunteer effort is superb training for the girls as it lets them experience a wide range of male sexual techniques and they are being paid pocket money for something that they love doing.

Our termination clinic: We are seeing mostly college age girls as they are away from home and are not as closely supervised as students in female prep schools in the area, including St Lucy’s.  All so far have been either hormonal conceptive, or both condoms and hormonal contraceptive failures. From what the patients say it is the newness of their surroundings and the frantic pace of trying to be popular and do everything at once that has caused them not to put as much emphasis on contraception as they should have while sampling the physical delights that new male friends can provide. That part of our clinic is very private with individual waiting rooms (with shielded Wi-Fi for their personal electronics)  and separate entrances and exits so no one sees anyone else while arriving or leaving so the patient’s identities are protected.

At St Lucy’s we have already administered flu shots for the 2013-14 Flu season first thing if the student hadn’t already gotten one. I mention this here because many students who get Flu will try to treat it with an antibiotic retained from a bacterial illness or gotten from a friend; only to find much to their dismay that not only did the antibiotic not treat the Flu, but reduced the effectiveness of her birth control resulting in her carrying someone baby. If she is lucky she knows who’s so she can go to him for support if she wants to.

Most students seeking a termination want a vacuum aspiration.  While it is a bit uncomfortable it’s over in a half hour or so, while with Mifeprex, RU486, the process takes several days and still may require a vacuum aspiration. Too, there have been some fatalities with women using Mifeprex so it doesn’t have quite the cachet it had when first introduced several years ago.  


  1. Jill, I don't know if you've heard about this, but here in Iowa, our state's Board of Medicine recently outlawed telemedical abortions, practiced mostly by Planned Parenthood. For the most part, a doctor in a larger city, like Des Moines, Waterloo, Cedar Rapids or whatnot, consults via the Internet with a patient in a PP office in a smaller town and a remote dispenser gives the abortive drug to the woman. It's usually a two-dose regimen, so the doctor has the woman take the first dose while in the consultation room and lets her take the second when prescribed.

    Well, the board, which is loaded with anti-abortion Republicans appointed by our Republican Gov. Terry Branstad, had outlawed only that form of telemedicine. The anti-abortion people tried to do the same thing about four or five years ago, when the board had more Democrats on it appointed by the last two governors, current U.S. Ag Secretary Tom Vilsack and former Gov. Chet Culver, and the board had denied the petition. Now PP is going to take the board to court to overturn the ban.

    I'm wondering what you think about telemedical abortions?

    1. Hi Eric,

      Yes I’ve heard of the ban on telemedical abortions in Iowa. I’m of two minds about it. I think Mifeprex should be as widely available to women in need as possible, but distribution should be closely monitored. A PP health Center licensed to dispense Mifeprex telemedically should have the capability to treat severely hemorrhaging patients 24/7 or there should be an ER within 20 minutes (in bad weather) of the patient’s home. If the patient is in a rural community with no 24 hour medical service available and she takes Mifeprex and the fetus detaches or partially detaches and she begins to hemorrhage in the middle of the night she could bleed to death even if there is someone to driver her to a far off emergency room. I would not recommend that any woman take Mifeprex while in a remote location with poor access to emergency medical attention. I think there could be too much risk.

      The last two paragraphs. Of Brenda’s comment (below) illustrate how widely available products sold as RU486 are if someone wants it. Also addressed is the seller’s recognition of the very real chance of an RU486 termination requiring emergency medical intervention. There may be a few cases with circumstances that might call for taking RU486 w/o medical assistance being quickly available, but I wouldn’t want a friend or relative of mine to chance it.

  2. What a rich posting, made even richer by Eric's observation. I have a long posting on another site entitled "Caution: Take Only As Directed." All contraceptives, especially the pill, are more effective, real-life, in 30 yo women than in 19 yo women. Difference: an understanding of how they work and do not work. The diaphragm is not effective in the medicine chest; condom, in a purse; spermicide, still in the tube. How the pill, or any hormonal system, works is less noticeable.

    All drugs have both a "therapeutic level" and a "half life." The therapeutic level is the amount of the drug required in the blood to do what it is supposed to do. In this case, the amount hormone required to inhibit ovulation. The half life is amount of time it takes from the last dose until one-half of the drug has left the system, think peed away. Pills are compounded to reach the therapeutic level about forty-five minutes after the second dose of the month and to remain above that level for about thirty hours. That means taking the pill daily gives about a six hour safety cushion. If a woman takes a pill three hours early one night and three hours late the next, she is at risk of pregnancy. Too many women who were placed on the pill at fifteen to "control her cycle" become cavalier and have no discipline in taking their pill at the same time every night. Though that same young woman has a cell phone welded to her palm which can be easily set to remind her.

    The second big problem is, as you point out, drugs or supplements that disable contraception. Many anti-biotics, some psychotropic drugs and many supplements counter hormonal birth control. Women should always check with both the doctor and pharmacist about interactions.

    Those women I have interviewed who have used mifepristone (RU-486) at one time and vacuum evacuation or D&C at another would choose the vacuum. The mife takes bot longer and involves much more discomfort with less predictable results.

    Eric, as long as the patient is taking the mife with competent assistance (nurse, doctor, trained mid-wife) observing, whether a doctor is present or watching on tv really does not matter. All women who use mifepristone should have a follow up two weeks after the regimen is complete. Up to ten percent of all women, depending upon length of pregnancy and specific regimen, will have an incomplete abortion. The remnants will cause, at least, heavy bleeding. This follow up by a trained technician or doctor is much more important than the presence of a doctor as the mife is swallowed.

    What scares me is the number of sites who sell mife over the net. The place of manufacture is unknown; the place of prescription is unknown; the sites are contradictory in their regimens. I found one that has a "medical questionnairre" to be filled out. I filled it out as a 23 yo woman, good health, no children and got to the point where filling in credit card numbers would have resulted in "a doctor's review" and mailing the drug to me. The only items that may have alerted a woman to dangers were: "Is there an emergency room within 100km?" Do you have a friend or family who could drive you there? and "Do you have a friend or family member who can be with you while you take the drug?"

    Mail order abortions are really scary.

    1. Hi Brenda,

      What a great comment! Thank you!

      "Is there an emergency room within 100km?"

      OMG! 100km, really? In the winter, in Iowa or Idaho or Wyoming, or Yorkshire 100 km might be several days away. Sigh! I know it might take some planning, but I think a vacuum aspiration is the safest and quickest way to have an abortion.

      Mail order abortions are indeed scary!

    2. 100 km is a little more than 60 miles, which in dry weather is an hour's drive, and I would say three or four hours tops in a blizzard. The only way it would be several days is if you're walking.

    3. >100 km is a little more than 60 miles, which in dry weather is an hour's drive.

      Possibly, if you have a good car, good weather and someone to drive you, but an hour when you are hemorrhaging heavily is dangerous. Believe me when I say that you don’t want to be 60 miles from professional medical attention when you are hemorrhaging heavily!

      I don’t think using Mifeprex in remote communities is worth the risk.

  3. My interest in "mail order abortion" was generated by an article in The Economist (Anglo-American newsweekly) about two years ago. The story was a 23 yo, single mother of three in Northern Idaho, "near the Canadian border." She discovered the only abortion services were in Boise, "a several hour drive," and would require two trips (this, of course sent me for a U.S. gazetteer). Lacking money, time or child care, she went to the internet and ordered mife. (RU-486 is a uniquely American title).No idea what medical facilities were available in the area.

    Fortunately, all went well, she was alone throughout, until she did not know how to dispose of the aborted foetus and it was discovered, frozen, on her stoop. The medical examiner estimated it to be at about twenty-four weeks and she was charged with mishandling a corpse or some such.

    Mifeprex is actually two drugs taken in a strict regimen over a few days: mifepristone kills the foetus and postaglandin (or a manufactured facsimile) causes contractions to expel the remains. Incomplete expulsion is the most common problem and I have seen women in the ER a few days after beginning the regimen with hemorrhage that could kill them in an hour if attempting to drive.

    Further curiousity sent me to the website for Boise Planned Parenthood. They offer medical abortion (RU-486) up to nine weeks and the page I visited had a warning in red, bold, oversize typeface that any woman seeking medical abortion should be prepared to follow up with surgical (usually vacuum aspiration, perhaps d&c) abortion.

    This stuff is not to be messed with. But for those who argue that women could be driven back to coat hangers and back street abortion, the current generation turns to the internet first.

    Thanks, Jill, for opening this up.


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Powys , Wales, United Kingdom
I'm a classically trained dancer and SAB grad. A Dance Captain and go-to girl overseeing high-roller entertainment for a major casino/resort