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For further information, see CMDT Part 20-10: Contraception & Family Planning

KEY FEATURES

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

  • All survivors of sexual assault should be offered emergency contraception

  • Clinicians need to be aware of laws regarding availability of emergency contraception in the jurisdiction of their practice

  • Levonorgestrel emergency contraception (eg, Plan B One-Step, Next Choice One Dose) is available without a prescription at many drug stores and at clinics such as Planned Parenthood

TREATMENT

Medication

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

    • Levonorgestrel, 1.5 mg given orally in single dose

      • Has a 1–3% failure rate when taken within 72 hours and is associated with less nausea and vomiting than ethinyl estradiol plus norgestrel

      • Available pre-packaged as Plan B in the United States

    • Ulipristal acetate, 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 women who are overweight or obese

      • Patients should wait 5 days after taking ulipristal to start or restart a hormonal contraceptive method

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

Intrauterine Devices

  • Copper-bearing or levonorgestrel 52-mg intrauterine devices (IUDs) inserted within 5 days after one episode of unprotected midcycle coitus will prevent pregnancy

  • Copper IUD use for emergency contraception is the most effective available method, with first cycle pregnancy rates of 0.1%

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

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