COMMENTARY

Emergency Contraception After Rape

Judith A. Linden, MD; Jasmine C. Mathews, MD

April 29, 2014

Introduction

The risk for pregnancy after rape is approximately 6%-7%.^[1,2,3] There are an estimated 25,000 rape-related pregnancies per year in the United States; if every woman who was raped took emergency contraception (EC), which is estimated to decrease risk for pregnancy by approximately 90%, 22,000 of those pregnancies could potentially be prevented.^[4]

Timely access to EC after assault is critical for this intervention to be effective. Over-the-counter access for women who do not present acutely is critical: According to the National Women's Study, only about 17% of women who were raped underwent a medical examination after sexual assault.^[5]

EC is now commonly available over the counter, and is available to women of all ages without identification. The use of EC after assault is the standard of care, and knowledge of ongoing advances regarding EC efficacy, side-effect profiles, and patient-specific limitations will aid providers in their recommendations.

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Table. Emergency Contraception Options: Summary
Method	Dose	Timing After Intercourse	Efficacy	Adverse Effects	Contraindications	Notes
Levonorgestrel Marketed brands: Plan B®, Plan B One-Step®, Next Choice (generic)	1.5 mg, or 0.75 mg × 2	To 72 hours (may be used up to 120 hours, with decreased efficacy)	88%	Nausea, vomiting, headache, menstrual changes	None	Plan B One-Step® and generics are available over the counter without a prescription. Efficacy may be decreased in women > 165 lb; may be ineffective in those > 175 lb and near time of ovulation
Ulipristal acetate Marketed brands: ella®, ellaOne®	30 mg	To 120 hours	85%	Nausea, vomiting, headache, menstrual changes	Absolute contraindications: sensitivity to lactose monohydrate (including galactose intolerance) Relative contraindications: renal/hepatic impairment, uncontrolled asthma, breastfeeding (pump and discard milk for 36 hours)	CYP3A4 inducers may decrease efficacy Efficacy may be decreased in women > 194 lb Limited safety data in women < 18 years, breastfeeding, and pregnancy
Copper IUD Marketed brand: ParaGard®	Single IUD	To 120 hours	> 99%	Pain, bleeding	Absolute contraindications: infection, copper allergy Relative contraindications: uterine anomalies, multiple sexual partners	Currently recommended as the best choice for obese women

IUD = intrauterine device

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Emergency Contraception After Rape

Introduction

Tables

References

Authors and Disclosures

Authors and Disclosures

Authors

Judith A. Linden, MD

Jasmine C. Mathews, MD

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