Emergency contraception

Progestin-Only Regimen

General

• First dose within 48 hours after unprotected intercourse followed by second dose 12 hours later
  • may take both at once
• Relative risk reduction of pregnancy = 89% (1% with vs 8% without)

Adverse Reactions

• Nausea (23%)
• Vomiting (6%)
• No teratogenisis

FDA approved regimens

• Plan B (marketed specifically for emergency contraception) - 1 pill (0.75mg levonorgestrel) per dose
  • Plan B levonorgestrel 0.75mg po q12h x2

Yuzpe Regimen (Combination OCPs)

General

• First dose within 72 hours after unprotected intercourse followed by second dose 12 hours later
• May be given up to 120 hours later (but efficacy reduced)
• Reduces risk of pregnancy by 75% (2% with vs 8% without)

Adverse Reactions

• Nausea (50%)
• Vomiting (20%)

Safety

• No teratogenic effect

Contraindications

• Pregnancy

FDA approved regimens

• Ovral, Ogestrel - 2 pills (100 ug ethiny estradiol/0.5mg levonorgestrel) per dose; repeat in 12h
• Alesse, Aviane, Levlite - 5 pills (100 ug ethiny estradiol/0.5mg levonorgestrel) per dose; repeat in 12h
• Levlen, Levora, Lo/Ovral, Low-Ogestrel - 4 pills (120 ug ethiny estradiol/0.6mg levonorgestrel) per dose; repeat in 12h
• Triphasil, Tri-Levlen, Trivora - 4 pills (120 ug ethiny estradiol/0.5mg levonorgestrel) per dose; repeat in 12h

IUD

• Copper intrauterine device (Paragard) can be used as emergency contraception up to 120 hours after unprotected sex
• Advantages:
  • More effective than oral regimens (>99% vs ~88%)
  • Serves as long-acting reversible contraception for up to 12 years after insertion
• Disadvantages:
  • Contraindicated in patients with PID or active gonorrhea/chlamydia: STD screening recommended prior to insertion
  • Not likely feasible to get done in the ED

See Also

• Sexual assault