There are now multiple options for emergency contraception, which is a safe and effective way to prevent pregnancy after unprotected intercourse, contraceptive failure, or sexual assault. Emergency contraception should not be confused with mifepristone (commonly referred to as "RU-486"), the drug used in combination with misoprostol for medical abortion; emergency contraception is neither an abortifacient or teratogenic.[1] This article provides a guide for healthcare providers to help their patients get emergency contraception in a timely manner, when they need it.
Available Methods
Available methods of emergency contraception in the United States include emergency contraceptive pills (ECPs) and the copper intrauterine device (Cu-IUD) (Table 1). Emergency contraception methods that are approved by the US Food and Drug Administration are the progesterone receptor modulator ulipristal acetate (UPA) and progestin-only pills (levonorgestrel [LNG]).
Table 1. Emergency Contraceptive Methods and Accessibility
| Plan B One-Step® | My Way®; Next Choice One Dose®; Take Action™ | Levonorgestrel Tablets | ella® | ParaGard® | Yuzpe Method | |
|---|---|---|---|---|---|---|
| Method | Levonorgestrel | Ulipristal acetate | Cu-IUD | Combination oral contraceptive pills | ||
| Dose | 1.5 mg | 0.75 mg (2 pills taken once) | 30 mg | Hormone free | ||
| Window of efficacy | 0-120 hr (less effective 72-120 hr)[2]
May be less effective if BMI ≥ 30 kg/m2[3,4] |
0-120 hours | 0-120 hr | 0-72 hr | ||
| Efficacy[5] | 52%-100% | 62%-85% | > 99% | 56%-89% | ||
| Approximate cost | $48[6] | $41[6] | $50[6]; $59 through online service | ≥ $700 a [7] | Varies | |
| Restrictions | OTC for men and women of all ages; identification not requiredb | Behind-the-counter for women aged ≥ 17 yr; prescription required for women aged < 17 yr | Prescription required for all ages; online prescription service available | Available for women of all ages, but requires insertion by clinician | Prescription required | |
| Prescription recommended for insurance coverage | ||||||
BMI = body mass index; Cu-IUD = copper intrauterine device; OTC = over the counter. Adapted from Physicians for Reproductive Health: https://prh.org/resources/emergency-contraception-a-practitioners-guide. a Wholesale price for ParaGard; the actual price also depends on the cost of the office visit and insertion. b One-pill generics are approved for OTC use for all women (identification not required), with the exception that the label must clearly state that its intended use is for women aged ≥ 17 years.[8,9]
The only UPA ECP available in the United States is ella®, which requires a prescription.
Currently available one-pill LNG oral emergency contraception products include the brand-name Plan B One-Step® and generic versions My Way™, Next Choice One Dose™, and Take Action™. Although all forms of one-pill LNG emergency contraception products are approved for over-the-counter (OTC) sale to men and women of all ages without identification, confusion and barriers remain.[8,9] Patients may find that they encounter various practices at different pharmacies. LNG tablets are available behind the counter for women aged 17 years or older with identification, and are available for younger women with a prescription.[8]
The Yuzpe method is another approach to emergency contraception. It consists of using a specific number of brand-name combined oral contraceptive pills containing estradiol and LNG.[10] The Yuzpe method is not considered first line, however, because of increased side effects and reduced efficacy compared with LNG and UPA methods.
Medscape Ob/Gyn © 2014
WebMD, LLC
Cite this: A Clinician's Guide to Emergency Contraception - Medscape - Sep 19, 2014.
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