Emergency Contraception: Know the Options

By Pelin Batur, MD

Emergency contraception may be indicated to prevent unintended pregnancy following sexual assault, unprotected intercourse or contraceptive failure. Yet it remains underutilized for many reasons that include unfamiliarity with options and widespread misconception that emergency contraception methods cause abortion.

No study has ever found that approved emergency contraception methods interfere with implantation of a fertilized egg or an established pregnancy. Rather, oral emergency contraceptives delay ovulation — which is why they are not effective after ovulation has occurred.

Usual contraindications to the use of hormonal contraceptives do not apply to emergency oral contraceptives, due to their short duration of use. There is no medical condition in which emergency contraception is contraindicated.

Four types of emergency contraception are available in the U.S. They have varying degrees of effectiveness. All can be used within five days of intercourse. This is what you need to know about them.

The copper intrauterine device (IUD)

The copper IUD interferes with the sperm’s ability to fertilize an egg. It is the most effective form of emergency contraception, with reports of 99 percent effectiveness when inserted within 120 hours after intercourse. The IUD may be left in place up to 10 years, is reversible, convenient, safe and cost-effective. Because it has no hormones, it is safe for most patients, including those who have had breast cancer or are breastfeeding.

Contrary to popular belief, it is unnecessary to insert an IUD during menses, nor to screen for sexually transmitted diseases prior to insertion. Adolescents and those who have never had children can safely use an IUD. In fact, more than 80 percent of women who have the IUD inserted as emergency contraception retain it as their primary form of contraception.

Ulipristal acetate (UPA)

This selective progestin receptor modulator is the most effective oral emergency contraceptive. In one randomized, controlled trial, UPA prevented twice as many pregnancies as levonogestrel (LNG). However, the two oral contraceptives were similarly effective when used within 72 hours: Between 72 and 120 hours, there were no pregnancies in the UPA group and three in the LNG group.

UPA was approved for use in 2010. Post-marketing surveillance shows a good safety profile, with no adverse pregnancy outcomes. The most common side effects are minor and include nausea, headache and a delayed menstrual cycle.

The IUD and UPA should be recommended for women who are overweight or obese, as these methods are the most effective. Levonogestrel may not be as effective in women who are above their ideal weight.

Levonogestrel (LNG)

Pure progestin is an alternative to UPA. It is available over the counter with no age restrictions in single-dose and split-dose (two pills taken 12 hours apart) formulations. The pills in the split dose regimen may be taken safely at the same time for convenience.

LNG works by delaying ovulation. It is effective when used within 120 hours following intercourse, but is most effective when used within 72 hours.

Yupze regimen

The Yupze regimen of combined oral contraceptive pills is the least-effective method of emergency contraception. It is important to encourage the use of more effective methods when a woman has had intercourse near the time of ovulation.

Reminder

It is important to discuss emergency contraception options with women of reproductive age. Any woman who needs emergency contraception often should be counseled on long-term contraception options.

For more information and advice on approaching the topic during a routine health visit, attend the 2016 Primary Care Women’s Health: Essentials and Beyond CME course on September 22. Please register today.