ACOG Updates Emergency Contraception Guidelines

Laurie Barclay, MD

August 20, 2015

The American College of Obstetricians and Gynecologists (ACOG) published a Practice Bulletin concerning emergency contraception online August 19 and in the September issue of Obstetrics & Gynecology. The new recommendations, which update those published by ACOG in May 2010, include an expanded discussion and guidance on the use of ulipristal acetate and new data regarding the effect of body weight on emergency contraception efficacy.

"Emergency contraception, also known as postcoital contraception, is therapy used to prevent pregnancy after an unprotected or inadequately protected act of sexual intercourse," the authors write. "Common indications for emergency contraception include contraceptive failure (eg, condom breakage or missed doses of oral contraceptives) and failure to use any form of contraception."

Since 1998, when the US Food and Drug Administration approved the first dedicated product for emergency contraception, several types of products have been developed, including oral administration of combined estrogen and progestin, progestin only, or selective progesterone receptor modulators and insertion of a copper intrauterine device (IUD).

The objectives of this bulletin were to summarize data regarding the efficacy and safety of available emergency contraceptives and to educate obstetrician-gynecologists and other gynecologic providers regarding these methods and ACOG's recommendations. The authors note that many women do not realize that emergency contraception is available or have misconceptions regarding its use and safety.

Specific recommendations include the following:

  • Compared with the levonorgestrel-only regimen, ulipristal acetate is more effective and maintains its efficacy for up to 5 days (Level A recommendation).

  • Compared with the combined hormonal regimen, the levonorgestrel-only regimen for emergency contraception is more effective and is associated with less nausea and vomiting (Level A).

  • The most effective method of emergency contraception is copper IUD insertion (Level A).

  • Before providing or prescribing emergency contraception, clinical examination or pregnancy testing is not required (Level B).

  • To maximize efficacy, give emergency contraception as soon as possible after unprotected or inadequately protected sexual intercourse (Level B).

  • Emergency contraceptive pills or the copper IUD should be made available to women up to 5 days after unprotected or inadequately protected sexual intercourse (Level B).

  • For obese women, a copper IUD may be preferred to oral emergency contraception, because body weight affects the efficacy of oral emergency contraception but not of the copper IUD. However, do not withhold oral emergency contraception from overweight or obese women (Level B).

  • Women with contraindications to conventional oral contraceptives may receive any emergency contraceptive regimen (Level C).

  • Even within the same menstrual cycle, oral emergency contraception may be used more than once (Level C).

  • Clinicians should educate women about the availability of emergency contraception before they need it (Level C).

  • Give information about effective long-term contraceptive methods to women requesting emergency contraception (Level C).

  • Evaluate women who have used emergency contraception if menses are delayed by a week or more or if they develop lower abdominal pain or persistent irregular bleeding (Level C).

  • Women who meet standard criteria for an IUD and who desire long-acting contraception may use the copper IUD as emergency contraception (Level C).

The authors have disclosed no relevant financial relationships.

Obstet Gynecol. 2015;126:685-686. Abstract

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