Contraception, Emergency

Key Features

• Can be used to decrease the risk of pregnancy after intercourse but before the establishment of pregnancy

• Information on clinics or individual clinicians providing emergency contraception in the United States may be obtained by calling 1-888-668-2528

• All victims of sexual assault should be offered emergency contraception

Treatment

Medication

• The following methods should be started within 120 h after unprotected coitus:

  • Levonorgestrel, 1.5 mg given orally in single dose

    • Has a 1% failure rate and is associated with less nausea and vomiting than ethinyl estradiol plus norgestrel

    • Available in the United States prepackaged as Plan B

  • Ethinyl estradiol, 50 mcg, with 0.5 mg norgestrel

    • Given twice in 12 hours

    • Available in the United States prepackaged as Preven

  • A comparable regimen includes four pills 12 h apart of Lo/Ovral, Nordette, or Levlen or the same regimen with the yellow pills of Triphasil or Tri-Levlen

    • Failure rate is approximately 3%

    • Anti-nausea medication should be provided

  • Ulipristal, 30 mg orally as a single dose

    • Has been shown to be more effective than levonorgestrel, especially when used between 72 and 120 hours, particularly among overweight women

    • It is available by prescription in the United States and western Europe

Intrauterine Devices

• Copper-bearing intrauterine devices (IUDs) inserted within 5 days after one episode of unprotected midcycle coitus will prevent pregnancy

• The disadvantage of this method is possible infection, especially in rape cases

• The advantage is ongoing contraceptive protection if this is desired in a patient for whom the IUD is a suitable choice