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From:
Cynthia Visness <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Fri, 21 Nov 1997 08:43:33 -0500
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Methotrexate is a drug approved by the FDA for chemotherapy in a variety
of cancers and for treatment of psoriasis and rheumatoid arthritis.
There are reports of its use for treatment of ectopic pregnancy going
back to the early 1980s. In some countries (e.g. Brazil) where
methotrexate can be obtained over the counter or on the black market, it
is used to induce an abortion (which is often incomplete, leading to
hospitalization). Methotrexate in combination with misoprostol, which
stimulates uterine contractions, is reasonably effective in inducing a
medical abortion, and I'm pretty sure someone is doing a clinical trial
of this. Both of these drugs are approved (for other uses) and available
in the U.S. Anyway, methotrexate appears to decrease the occurrence of
*persistent* ectopic pregnancy following surgery.

Emergency contraceptive pills (ECPs or "morning-after" pills) are
regular birth-control pills. If using the common lower-dose pills (30
mcg ethinyl estradiol), the regimen would be to take FOUR pills within
72 hours of unprotected intercourse and then take FOUR more pills 12
hours later. The WHO has put out "medical eligibility criteria" for
every contraceptive method, including ECPs. Their document was very
careful about breastfeeding women, but does not mention anything about
breastfeeding in the ECP chapter. Because the hormone dose is small and
short-term, ECPs are safe for women who otherwise should not take oral
contraceptives such as women with focal migraine, heart disease, etc.
The effect on breastfeeding should be minimal and short-lived.

>Cynthia M.Visness
>Research Associate, Contraceptive Use and Epidemiology Division
>Family Health International
>Phone: (919) 544-7040     Voicemail: (919) 544-6979, ext. 586
>Fax: (919) 544-7261
>Internet: [log in to unmask]

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