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Semin Reprod Med 2010; 28(2): 095-102
DOI: 10.1055/s-0030-1248133
© Thieme Medical Publishers

Emergency Contraception: Update and Review

Aileen Langston1
  • 1Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York
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Publication History

Publication Date:
29 March 2010 (online)

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ABSTRACT

Emergency contraception (EC) is the postcoital method of pregnancy prevention. Three methods of EC are used in the United States: (1) levonorgestrel-only pills, Plan B (Barr Pharmaceuticals, LLC, New Jersey) (2) combined estrogen and progestin pills, and (3) the copper intrauterine device. Used within 120 hours after unprotected sexual intercourse, EC reduces the risk of pregnancy by 60 to 94%. EC is a critical component of medical care for sexual assault survivors, and several states have laws mandating this standard of care. Levonorgestrel-only EC is available to women ≥17 years of age without a prescription. Women who were counseled by their clinician about EC were 11 times more likely to use EC in the following 12 months. Advance provision of EC to women has not been found to decrease rates of unintended pregnancy compared with routine pharmacy access; however, women routinely prefer advance provision. The newly approved by the Food and Drug Administration single-dose EC, Plan B One-Step (Barr Pharmaceuticals, LLC), may affect unintended pregnancy rates among EC users by simplifying use.

KEYWORDS

Contraception - postcoital - Plan B - levonorgestrel

REFERENCES

  • 1 Finer L B, Henshaw S K. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001.  Perspect Sex Reprod Health. 2006;  38(2) 90-96
    CrossrefPubMedGoogle Scholar
  • 2 Henshaw S K. Unintended pregnancy in the United States.  Fam Plann Perspect. 1998;  30(1) 24-29, 46
    CrossrefPubMedGoogle Scholar
  • 3 Practice Bulletin ACOG . ACOG Practice Bulletin. Clinical Management Guidelines for Obstetrician-Gynecologists, No. 69, December 2005 (replaces Practice Bulletin No. 25, March 2001). Emergency contraception.  Obstet Gynecol. 2005;  106(6) 1443-1452
    CrossrefPubMedGoogle Scholar
  • 4 AMA National Advisory Council on Violence and Abuse .Policy Compendium, Access to Emergency Contraception, 2008. http://Available at: www.ama.org Accessed September 15, 2009
    Google Scholar
  • 5 Policy Statements ACEP. Management of the patient with the complaint of sexual assault. ACEP Policy Statements [Web site]. 2002; Policies of the national organization of emergency medicine practitioners in the United States. http://Available at: www.acep.org Accessed August 25, 2009
    Google Scholar
  • 6 Harper C C, Ellertson C E. The emergency contraceptive pill: a survey of knowledge and attitudes among students at Princeton University.  Am J Obstet Gynecol. 1995;  173(5) 1438-1445
    CrossrefPubMedGoogle Scholar
  • 7 Cheng L, Gülmezoglu A M, Piaggio G, Ezcurra E, Van Look P F. Interventions for emergency contraception.  Cochrane Database Syst Rev. 2008;  (2) CD001324
    PubMedGoogle Scholar
  • 8 Ragland D, West D. Pharmacy students' knowledge, attitudes, and behaviors regarding emergency contraception.  Am J Pharm Educ. 2009;  73(2) 26
    PubMedGoogle Scholar
  • 9 Trussell J, Stewart F, Guest F, Hatcher R A. Emergency contraceptive pills: a simple proposal to reduce unintended pregnancies.  Fam Plann Perspect. 1992;  24(6) 269-273
    CrossrefPubMedGoogle Scholar
  • 10 Van Look P F, von Hertzen H. Clinical uses of antiprogestogens.  Hum Reprod Update. 1995;  1(1) 19-34
    CrossrefPubMedGoogle Scholar
  • 11 Haddad L B, Nour N M. Unsafe abortion: unnecessary maternal mortality.  Rev Obstet Gynecol. 2009;  2(2) 122-126
    PubMedGoogle Scholar
  • 12 Singh S. Hospital admissions resulting from unsafe abortion: estimates from 13 developing countries.  Lancet. 2006;  368(9550) 1887-1892
    CrossrefPubMedGoogle Scholar
  • 13 Governments worldwide put emergency contraception into women's hands; 2004. http://Available at: www.reproductiverights.org Accessed September 15, 2009
    Google Scholar
  • 14 Glasier A. Emergency postcoital contraception.  N Engl J Med. 1997;  337(15) 1058-1064
    CrossrefPubMedGoogle Scholar
  • 15 Stewart F, Trussell J, Van Look P FA. Emergency contraception. In: Contraceptive Technology. 19th ed. New York, NY; Ardent Media 2008: 87-109
    Google Scholar
  • 16 Ellertson C, Trussell J, Stewart F, Koenig J, Raymond E G, Shochet T. Emergency contraception.  Semin Reprod Med. 2001;  19(4) 323-330
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Morris J M, Van Wagenen G. Compounds interfering with ovum implantation and development. 3. The role of estrogens.  Am J Obstet Gynecol. 1966;  96(6) 804-815
    PubMedGoogle Scholar
  • 18 Yuzpe A A, Thurlow H J, Ramzy I, Leyshon J I. Post coital contraception—a pilot study.  J Reprod Med. 1974;  13(2) 53-58
    PubMedGoogle Scholar
  • 19 FDA approves generic prescription-only version of Plan B emergency contraceptive for women ages 17 and under; 2009. http://Available at: www.fda.gov/newsevents Accessed August 27, 2009
    Google Scholar
  • 20 Randomised controlled trial of levonorgestrel versus the Yuzpe regimen of combined oral contraceptives for emergency contraception. Task Force on Postovulatory Methods of Fertility Regulation.  Lancet. 1998;  352(9126) 428-433
    CrossrefPubMedGoogle Scholar
  • 21 Reports OPRR. Protection of Human Subjects. Code of Federal Regulations 45 CFR 46. National Institutes of Health 1983
    Google Scholar
  • 22 Hughes E C. Committee on Terminology of the American College of Obstetricians and Gynecologists .Obstetric-Gynecologic Terminology. Philadelphia, PA; F.A. Davis 1972
    Google Scholar
  • 23 Durand M, del Carmen Cravioto M, Raymond E G et al.. On the mechanisms of action of short-term levonorgestrel administration in emergency contraception.  Contraception. 2001;  64(4) 227-234
    CrossrefPubMedGoogle Scholar
  • 24 Hapangama D, Glasier A F, Baird D T. The effects of peri-ovulatory administration of levonorgestrel on the menstrual cycle.  Contraception. 2001;  63(3) 123-129
    CrossrefPubMedGoogle Scholar
  • 25 Marions L, Hultenby K, Lindell I, Sun X, Ståbi B, Gemzell Danielsson K. Emergency contraception with mifepristone and levonorgestrel: mechanism of action.  Obstet Gynecol. 2002;  100(1) 65-71
    CrossrefPubMedGoogle Scholar
  • 26 Marions L, Cekan S Z, Bygdeman M, Gemzell-Danielsson K. Effect of emergency contraception with levonorgestrel or mifepristone on ovarian function.  Contraception. 2004;  69(5) 373-377
    CrossrefPubMedGoogle Scholar
  • 27 Trussell J, Ellertson C, von Hertzen H et al.. Estimating the effectiveness of emergency contraceptive pills.  Contraception. 2003;  67(4) 259-265
    CrossrefPubMedGoogle Scholar
  • 28 Wilcox A J, Weinberg C R, Baird D D. Timing of sexual intercourse in relation to ovulation. Effects on the probability of conception, survival of the pregnancy, and sex of the baby.  N Engl J Med. 1995;  333(23) 1517-1521
    CrossrefPubMedGoogle Scholar
  • 29 Trussell J, Raymond E G. Statistical evidence about the mechanism of action of the Yuzpe regimen of emergency contraception.  Obstet Gynecol. 1999;  93(5 Pt 2) 872-876
    CrossrefPubMedGoogle Scholar
  • 30 Raymond E G, Lovely L P, Chen-Mok M, Seppälä M, Kurman R J, Lessey B A. Effect of the Yuzpe regimen of emergency contraception on markers of endometrial receptivity.  Hum Reprod. 2000;  15(11) 2351-2355
    CrossrefPubMedGoogle Scholar
  • 31 Taskin O, Brown R W, Young D C, Poindexter A N, Wiehle R D. High doses of oral contraceptives do not alter endometrial alpha 1 and alpha v beta 3 integrins in the late implantation window.  Fertil Steril. 1994;  61(5) 850-855
    PubMedGoogle Scholar
  • 32 Hansen L B, Saseen J J, Teal S B. Levonorgestrel-only dosing strategies for emergency contraception.  Pharmacotherapy. 2007;  27(2) 278-284
    CrossrefPubMedGoogle Scholar
  • 33 Kunz G, Beil D, Deininger H, Wildt L, Leyendecker G. The dynamics of rapid sperm transport through the female genital tract: evidence from vaginal sonography of uterine peristalsis and hysterosalpingoscintigraphy.  Hum Reprod. 1996;  11(3) 627-632
    PubMedGoogle Scholar
  • 34 Kesserü E, Garmendia F, Westphal N, Parada J. The hormonal and peripheral effects of d-norgestrel in postcoital contraception.  Contraception. 1974;  10(4) 411-424
    CrossrefPubMedGoogle Scholar
  • 35 Hamoda H, Ashok P W, Stalder C, Flett G M, Kennedy E, Templeton A. A randomized trial of mifepristone (10 mg) and levonorgestrel for emergency contraception.  Obstet Gynecol. 2004;  104(6) 1307-1313
    CrossrefPubMedGoogle Scholar
  • 36 von Hertzen H, Piaggio G, Ding J WHO Research Group on Post-ovulatory Methods of Fertility Regulation et al. Low dose mifepristone and two regimens of levonorgestrel for emergency contraception: a WHO multicentre randomised trial.  Lancet. 2002;  360(9348) 1803-1810
    CrossrefPubMedGoogle Scholar
  • 37 Ngai S W, Fan S, Li S et al.. A randomized trial to compare 24 h versus 12 h double dose regimen of levonorgestrel for emergency contraception.  Hum Reprod. 2005;  20(1) 307-311
    CrossrefPubMedGoogle Scholar
  • 38 Fincham J E, Harris C E, Fassett W E, Richards W. Over-the-counter availability of Plan B emergency contraception: further discussion and commentary.  Ann Pharmacother. 2005;  39(2) 346-351
    CrossrefPubMedGoogle Scholar
  • 39 State Policies in Brief .Emergency contraception. State policies in brief. Description of state laws and policies regarding emergency contraception in the United States. http://Available at: www.guttmacher.org Accessed August 25, 2009
    Google Scholar
  • 40 Plan B. OneStep Prescribing Information; 2009. http://Available at: www.accessdata.fda.gov/drugsatfda_docs/label/2009/021998lbl.pdf Accessed October 16, 2009
    Google Scholar
  • 41 ACOG statement on Single-Dose EC Reformulation. 2009. http://Available at: www.acog.org/from_home/publications/press_releases/nr07-15-09.cfm Accessed October 15, 2009
    Google Scholar
  • 42 Ho P C, Kwan M S. A prospective randomized comparison of levonorgestrel with the Yuzpe regimen in post-coital contraception.  Hum Reprod. 1993;  8(3) 389-392
    PubMedGoogle Scholar
  • 43 Arowojolu A O, Okewole I A, Adekunle A O. Comparative evaluation of the effectiveness and safety of two regimens of levonorgestrel for emergency contraception in Nigerians.  Contraception. 2002;  66(4) 269-273
    CrossrefPubMedGoogle Scholar
  • 44 Devoto L, Fuentes A, Palomino A et al.. Pharmacokinetics and endometrial tissue levels of levonorgestrel after administration of a single 1.5-mg dose by the oral and vaginal route.  Fertil Steril. 2005;  84(1) 46-51
    CrossrefPubMedGoogle Scholar
  • 45 Yuzpe A A, Lancee W J. Ethinylestradiol and dl-norgestrel as a postcoital contraceptive.  Fertil Steril. 1977;  28(9) 932-936
    PubMedGoogle Scholar
  • 46 Van Santen M R, Haspels A A. Interception II: postcoital low-dose estrogens and norgestrel combination in 633 women.  Contraception. 1985;  31(3) 275-293
    CrossrefPubMedGoogle Scholar
  • 47 Percival-Smith R K, Abercrombie B. Postcoital contraception with dl-norgestrel/ethinyl estradiol combination: six years experience in a student medical clinic.  Contraception. 1987;  36(3) 287-293
    CrossrefPubMedGoogle Scholar
  • 48 Rodrigues I, Grou F, Joly J. Effectiveness of emergency contraceptive pills between 72 and 120 hours after unprotected sexual intercourse.  Am J Obstet Gynecol. 2001;  184(4) 531-537
    CrossrefPubMedGoogle Scholar
  • 49 First emergency contraceptive product hits U.S. market shelves.  Contracept Technol Update. 1998;  19(11) 141-143
    PubMedGoogle Scholar
  • 50 And then there was one: Barr withdraws Preven. Contraceptive Technology Update, Executive Summary; 2004. http://Available at: www.accessmylibrary.com/article/print/1G1-120976676 Accessed September 9, 2009
    Google Scholar
  • 51 Trussell J, Rodríguez G, Ellertson C. New estimates of the effectiveness of the Yuzpe regimen of emergency contraception.  Contraception. 1998;  57(6) 363-369
    CrossrefPubMedGoogle Scholar
  • 52 Trussell J, Rodríguez G, Ellertson C. Updated estimates of the effectiveness of the Yuzpe regimen of emergency contraception.  Contraception. 1999;  59(3) 147-151
    CrossrefPubMedGoogle Scholar
  • 53 Ragan R E, Rock R W, Buck H W. Metoclopramide pretreatment attenuates emergency contraceptive-associated nausea.  Am J Obstet Gynecol. 2003;  188(2) 330-333
    CrossrefPubMedGoogle Scholar
  • 54 Emergency Contraception .2005. http://Available at: www.who.int/mediacentre/factsheets/fs244/en/print.html Accessed September 15, 2009
    Google Scholar
  • 55 Prescription drug products: certain combined oral contraceptives for use as postcoital emergency contraception.  Fed Regist. 1997;  62 8609
    PubMedGoogle Scholar
  • 56 Webb A, Taberner D. Clotting factors after emergency contraception.  Adv Contracept. 1993;  9(1) 75-82
    CrossrefPubMedGoogle Scholar
  • 57 Balter M. Profile. For ‘father’ of abortion drug, vindication at last.  Science. 2000;  290(5489) 39
    CrossrefPubMedGoogle Scholar
  • 58 Gemzell-Danielsson K, Marions L. Mechanisms of action of mifepristone and levonorgestrel when used for emergency contraception.  Hum Reprod Update. 2004;  10(4) 341-348
    CrossrefPubMedGoogle Scholar
  • 59 Rowlands S. New technologies in contraception.  BJOG. 2009;  116(2) 230-239
    PubMedGoogle Scholar
  • 60 Comparison of three single doses of mifepristone as emergency contraception: a randomised trial. Task Force on Postovulatory Methods of Fertility Regulation.  Lancet. 1999;  353(9154) 697-702
    CrossrefPubMedGoogle Scholar
  • 61 Lippes J, Malik T, Tatum H J. The postcoital copper-T.  Adv Plan Parent. 1976;  11(1) 24-29
    PubMedGoogle Scholar
  • 62 Faculty of Family Planning and Reproductive Health Care Clinical Effectiveness Unit . FFPRHC Guidance: Emergency contraception (April 2003).  J Fam Plann Reprod Health Care. 2003;  29(2) 9-16
    PubMedGoogle Scholar
  • 63 Grimes D A, Schulz K F. Antibiotic prophylaxis for intrauterine contraceptive device insertion.  Cochrane Database Syst Rev. 2001;  (2) CD001327
    PubMedGoogle Scholar
  • 64 Penney G, Brechin S, de Souza A Faculty of Family Planning and Reproductive Health Care Clinical Effectiveness Unit et al. FFPRHC Guidance (January 2004). The copper intrauterine device as long-term contraception.  J Fam Plann Reprod Health Care. 2004;  30(1) 29-41, quiz 42
    CrossrefPubMedGoogle Scholar
  • 65 Segal S J, Alvarez-Sanchez F, Adejuwon C A, Brache de Mejia V, Leon P, Faundes A. Absence of chorionic gonadotropin in sera of women who use intrauterine devices.  Fertil Steril. 1985;  44(2) 214-218
    PubMedGoogle Scholar
  • 66 Stanford J B, Mikolajczyk R T. Mechanisms of action of intrauterine devices: update and estimation of postfertilization effects.  Am J Obstet Gynecol. 2002;  187(6) 1699-1708
    CrossrefPubMedGoogle Scholar
  • 67 Askalani A H, Al-Senity A M, Al-Agizy H M, Salam H I, Al-Masry G I, El-Sadek S M. Evaluation of copper T-200 as a post-coital contraceptive.  Egyptian J Obstet Gynecol. 1987;  13 63-66
    PubMedGoogle Scholar
  • 68 Trussell J. Contraceptive efficacy.  Arch Dermatol. 1995;  131(9) 1064-1068
    CrossrefPubMedGoogle Scholar
  • 69 Grimes D A, Lopez L M, Manion C, Schulz K F. Cochrane systematic reviews of IUD trials: lessons learned.  Contraception. 2007;  75(6, suppl) S55-S59
    CrossrefPubMedGoogle Scholar
  • 70 Criminal Victimization in the United States—Statistical Tables .Data from National Crime Victimization Survey presented in tables. http://Available at: www.ojp.usdoj.gov/bjs/abstract/cvusst.htm Accessed September 17, 2009
    Google Scholar
  • 71 Kaplan D W, Feinstein R A, Fisher M M Committee on Adolescence et al. Care of the adolescent sexual assault victim.  Pediatrics. 2001;  107(6) 1476-1479
    CrossrefPubMedGoogle Scholar
  • 72 Kavanaugh M L, Saladino R A, Gold M A. Emergency contraception services for adolescents: a National Survey of Children's Hospital Emergency Department Directors.  J Pediatr Adolesc Gynecol. 2009;  22(2) 111-119
    CrossrefPubMedGoogle Scholar
  • 73 Patel A, Panchal H, Piotrowski Z H, Patel D. Comprehensive medical care for victims of sexual assault: a survey of Illinois hospital emergency departments.  Contraception. 2008;  77(6) 426-430
    CrossrefPubMedGoogle Scholar
  • 74 Espey E, Ogburn T, Leeman L, Buchen E, Angeli E, Qualls C. Compliance with mandated emergency contraception in New Mexico emergency departments.  J Womens Health (Larchmt). 2009;  18(5) 619-623
    CrossrefPubMedGoogle Scholar
  • 75 Rosenberg K D, Demunter J K, Liu J. Emergency contraception in emergency departments in Oregon, 2003.  Am J Public Health. 2005;  95(8) 1453-1457
    CrossrefPubMedGoogle Scholar
  • 76 Woodell A T, Bowling J M, Moracco K E, Reed M L. Emergency contraception for sexual assault victims in North Carolina emergency departments.  N C Med J. 2007;  68(6) 399-403
    PubMedGoogle Scholar
  • 77 Emergency contraception for rape survivors; 2007. Available at: http://reproductiverights.org/en/document/emergency-contraception-for-rape-survivors Accessed September 17, 2009
    Google Scholar
  • 78 Committee for medicinal products for human use summary of positive opinion for Ellaone Doc.Ref.EMEA/CHMP/167750/2009. http://Available at: www.emea.europa.eu Accessed September 16, 2009
    Google Scholar
  • 79 International Consortium for Emergency Contraception .2009. http://Available at: www.cecinfo.org/inidex.php Accessed September 16, 2009
    Google Scholar
  • 80 Creinin M D, Schlaff W, Archer D F et al.. Progesterone receptor modulator for emergency contraception: a randomized controlled trial.  Obstet Gynecol. 2006;  108(5) 1089-1097
    CrossrefPubMedGoogle Scholar
  • 81 Polis C B, Schaffer K, Blanchard K, Glasier A, Harper C C, Grimes D A. Advance provision of emergency contraception for pregnancy prevention (full review).  Cochrane Database Syst Rev. 2007;  (2) CD005497
    PubMedGoogle Scholar
  • 82 National Survey of Women About Their Sexual Health: Take charge of your sexual health. 2003. Available at: http://www.kff.org/womenshealth/3341-index.cfm Accessed September 15, 2009
    Google Scholar
  • 83 Kavanaugh M L, Schwarz E B. Counseling about and use of emergency contraception in the United States.  Perspect Sex Reprod Health. 2008;  40(2) 81-86
    CrossrefPubMedGoogle Scholar
  • 84 Rocca C H, Schwarz E B, Stewart F H, Darney P D, Raine T R, Harper C C. Beyond access: acceptability, use and nonuse of emergency contraception among young women.  Am J Obstet Gynecol. 2007;  196(1) 21-26
    PubMedGoogle Scholar
  • 85 Raymond E G, Trussell J, Polis C B. Population effect of increased access to emergency contraceptive pills: a systematic review.  Obstet Gynecol. 2007;  109(1) 181-188
    CrossrefPubMedGoogle Scholar
  • 86 Brown S S, Eisenberg L. Institute of Medicine .(U.S.) Committee on Unintended Pregnancy. The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families. Washington, DC; National Academy Press 1995
    Google Scholar
  • 87 Turok D K, Simonsen S E, Marshall N. Trends in levonorgestrel emergency contraception use, births, and abortions: the Utah experience.  Medscape J Med. 2009;  11(1) 30
    PubMedGoogle Scholar
  • 88 Paraguard Product Information .Pharmaceutical product commercial Web site. http://Available at: www.paraguard.com Accessed September 16, 2009
    Google Scholar

Aileen LangstonM.D. 

Clinical Instructor, Department of Obstetrics and Gynecology, Columbia University Medical Center

622 West 168th Street, PH 1669, New York, NY 10032

Email: al2632@columbia.edu

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