Emergency Contraceptive Choices
Harold J. DeMonaco, MS, Director of Drug Therapy Management
Volume XII, Issue 5
According to at least some experts, emergency contraception remains one of the best-kept secrets in medicine1--this despite a wealth of literature beginning with the landmark article by Yuzpe in 1977.2 The so-called Yuzpe Method consists of two doses of combination oral contraceptives (OCP) taken within 72 hours of unprotected sex, followed by a second dose 12 hours later. Emergency contraception, by definition, prevents pregnancy from occurring.
A number of resources related to emergency contraceptive choices are available to both patients and clinicians. While the options include the use of combination and progestogen-only oral contraceptives, copper-containing intrauterine devices (IUDs) and mifepristone (previously known as RU 486) can also be used.3
|
Method |
Advantage |
Disadvantage |
|
Estrogen-progestogen combination OCP |
-Established safety and efficacy -Can continue to use as regular contraceptive |
-Nausea and vomiting are common -72-hour window -Not all women can take |
|
Progestogen-only OCP |
-Well tolerated |
-72-hour window -Not all women can take |
|
IUD |
-Can be inserted up to 5 days after unprotected sex -Can continue for long-term contraception |
-Requires an office visit for insertion -Not all women are eligible for use |
|
Mifepristone (aka RU 486) |
-Highly efficacious and well-tolerated -Can be used up to 5 days after unprotected sex |
-Limited availability in the US -abortifacient at higher dose |
Adapted from reference 3
Oral contraceptives for emergency contraception
The use of oral contraceptives within 72 hours of unprotected sex followed by a second dose 12 hours later has about a 75% success rate. This statistic needs to put into perspective. Unprotected sex without regard to the time of the month carries with it about an 8% incidence of pregnancy. The use of emergency combination contraceptives reduces the incidence to about 2%.
The following table lists the oral contraceptives that have been used in this fashion:3
IUD for emergency contraception
A copper-containing IUD has been shown to be effective if it is inserted within 5 days of unprotected sex. The IUD has the advantage of a longer window (5 days) but is more expensive than the use of OCPs and requires a physician visit for insertion.
Resources for your patients:
References: