Current Issues in Emergency Contraception: An Overview for Providers

Abstract and Introduction

Abstract

Emergency contraception has the potential to greatly reduce the number of unintended pregnancies occurring each year in the United States. Emergency contraception is a safe and effective intervention to which all women should have easy access in the event of an act of unprotected intercourse. Methods of emergency contraception include combined hormone oral contraceptive pills, progestin-only oral contraceptive pills, a dedicated progestin-only emergency contraceptive product, and insertion of a copper intrauterine device. Barriers exist to the increased use of emergency contraception, including the prescription-only status of all of the methods and lack of accurate knowledge on the part of health care providers and consumers. This article provides an overview of the clinical management of emergency contraception.

Introduction

Emergency contraception (EC) is the use of a contraceptive method after an act of unprotected intercourse. The most commonly used form of EC in the United States is emergency contraceptive pills (ECPs); other methods include combined oral contraceptive pills (OCPs), progestin-only pills, and insertion of a copper intrauterine device (IUD). An estimated 51,000 abortions were avoided in 2000 because of the use of ECPs, and 43% of the overall reduction in the US abortion rate between 1994 and 2000 is attributable to increased EC use.^[1,2]

Researchers estimate that approximately half of all pregnancies in the United States are unplanned, and of these, roughly half result in abortion.^[2] Young women are at particularly high risk, with women younger than 25 years old accounting for 51% of reported abortions.^[3] One strategy that has been proposed to help reduce the number of unplanned pregnancies is to increase the use of EC.

Although EC has been available since the 1960s, many women experience barriers to accessing it. In most states, a provider's prescription is required to obtain ECPs, and women and providers alike often lack the knowledge necessary for them to be used effectively. Misperceptions about EC have lead to ethical questions involving the mechanism of action and confusion of ECPs with mifepristone, one of the drugs used in medical abortion.

EC has great potential for further reducing rates of unintended pregnancy and abortion. Increased use of EC will require a proactive stance on the part of practitioners, public education to increase people's awareness, and quick, easy access for women.

Cite this: Current Issues in Emergency Contraception: An Overview for Providers - Medscape - Nov 01, 2006.

Table 1. Selected Combined Oral Contraceptives That May Be Used for EC
Total Hormonal Content Per Dose	Product Name	No. of Pills
Norgestrel 1 mg and ethinyl estradiol 100 mcg	Ovral	2 white pills at each dose
Norgestrel 1 mg and ethinyl estradiol 100 mcg	Lo-Ovral	4 white pills at each dose
Levonorgestrel .5 mg and ethinyl estradiol 100 mcg	Nordette	4 peach/light orange pills at each dose
Levonorgestrel .5 mg and ethinyl estradiol 100 mcg	Alesse	5 pink pills at each dose

Instructions
Two doses taken 12 hrs apart; may use antiemetic 1 hour prior to first dose.

Table 2. Selected Progestin-only Oral Contraceptives That May Be Used for EC
Hormone and Dose	Product Name	No. of Pills
Levonorgestrel 1.5 mg	Plan B	Two pills at once
Norgestrel 3.0 mg	Ovrette	40 pills at once, or divided into 2 doses of 20 pills taken 12 hours apart.

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