Updated August 26, Accessed September 9, Levonorgestrel can be taken as a single dose of 1. Available since December , ulipristal is a progesterone receptor modulator and the newest FDA-approved medication for emergency contraception. The dosing is a single mg tablet taken within hours of unprotected intercourse. Unlike levonorgestrel, ulipristal is effective regardless of the luteinizing hormone peak.
For patients desiring long-term contraception, as well as emergency contraception, a copper IUD may be placed up to seven days after unprotected intercourse. There is a lack of studies comparing its effectiveness with any of the aforementioned regimens. Copper intrauterine device. Combined Yuzpe method. Information from references 3 , 12 , 16 , 26 , and There have been no reported cases of birth defects from the use of oral emergency contraception.
Investigation into the harms of high-dose contraception showed no risk to an already established pregnancy. Medical Eligibility Criteria for Contraceptive Use, , no conditions strictly prohibit the use of oral emergency contraception, with the exception of pregnancy. The same contraindications exist for the copper IUD whether used as emergency or routine contraception.
There is insufficient evidence to recommend against the use of emergency contraception in women with a body mass index greater than 30 kg per m 2 ; however, preliminary studies show that women with obesity may have a significantly higher failure rate when using levonorgestrel or ulipristal. Although emergency contraception reduces the risk of pregnancy following intercourse, routine contraception is most effective Table 3.
The prescribing information for ulipristal recommends the use of a reliable barrier method of contraception with subsequent acts of intercourse in the same menstrual cycle because ulipristal may reduce the contraceptive action of hormonal contraception. Access to emergency contraception was broadened in August , when the FDA approved nonprescription access to levonorgestrel for women 18 years and older.
Single-dose Plan B One-Step is now available over the counter without age restriction. The split-dose and generic single-dose options are still available behind the counter for those 17 years or older, and by prescription only for those 16 years or younger. Eighteen states and the District of Columbia require hospitals or health care facilities to provide information about or to initiate emergency contraception therapy to women who have been sexually assaulted. Advanced provision of emergency contraception i.
It is useful for patients who prefer ulipristal and for adolescents younger than 17 years who use the single- or split-dose levonorgestrel. Despite allowing women and adolescents to use emergency contraception in a timelier manner, advanced provision has not led to decreased rates of pregnancy. Although some methods of emergency contraception are now available without a prescription, most patients do not know how to use it correctly or how to obtain it.
This includes information about abstinence, and the provision of routine and emergency contraception. It also includes the discussion of all forms of contraception, where to obtain them, and the reliability of each. Data Sources : A PubMed search was completed using key terms contraception, postcoital, and emergency. Also searched were the Cochrane database and National Guideline Clearinghouse database. Search dates: July and September , and October Already a member or subscriber?
Log in. Interested in AAFP membership? Learn more. At the time the manuscript was written, Dr. Address correspondence to Michele C. Bosworth uthct. Reprints are not available from the authors. Mosher WD, Jones J. Use of contraception in the United States: — Vital Health Stat Disparities in rates of unintended pregnancy in the United States, and Perspect Sex Reprod Health. Effectiveness of emergency contraceptive pills between 72 and hours after unprotected sexual intercourse.
Am J Obstet Gynecol. Food and Drug Administration. FDA approves over-the-counter access for Plan B for women 18 and older: prescription remains required for those 17 and under. August 24, Accessed October 20, April 22, FDA approves Plan B One-Step emergency contraceptive for use without a prescription for all women of child-bearing potential. Accessed September 15, What is emergency contraception? Accessed September 29, A multicenter clinical investigation employing ethinyl estradiol combined with dl-norgestrel as postcoital contraceptive agent.
Fertil Steril. Measuring and reporting of the treatment effect of hormonal emergency contraceptives. Effectiveness of the Yuzpe regimen of emergency contraception by cycle day of intercourse: implications for mechanism of action. Interventions for emergency contraception. Cochrane Database Syst Rev. Metoclopramide pretreatment attenuates emergency contraceptive-associated nausea.
Randomised controlled trial of levonorgestrel versus the Yuzpe regimen of combined oral contraceptives for emergency contraception. Low dose mifepristone and two regimens of levonorgestrel for emergency contraception: a WHO multicentre randomised trial. Emergency contraception. Gynecol Endocrinol. Levonorgestrel-only dosing strategies for emergency contraception. Contraceptive efficacy of emergency contraception with levonorgestrel given before or after ovulation.
Effect of emergency contraception with levonorgestrel or mifepristone on ovarian function. A single midcycle dose of levonorgestrel similar to emergency contraceptive does not alter the expression of the L-selectin ligand or molecular markers of endometrial receptivity.
Ulipristal acetate versus levonorgestrel for emergency contraception: a randomised non-inferiority trial and meta-analysis. Ulipristal acetate taken 48— hours after intercourse for emergency contraception. Obstet Gynecol. Immediate preovulatory administration of 30 mg ulipristal acetate significantly delays follicular rupture. Hum Reprod. Copper TA intrauterine device for emergency contraception: a prospective, multicentre, cohort clinical trial. ParaGard T A intrauterine copper contraceptive [prescribing information].
Sellersville, Pa. Accessed October 17, World Health Organization. Family planning. Updated May Accessed August 13, Centers for Disease Control and Prevention. Effectiveness of family planning methods. Accessed October 23, Medical Eligibility Criteria for Contraceptive Use, Obesity and contraception: metabolic changes, risk of thromboembolism, use of emergency contraceptives, and role of bariatric surgery.
Minerva Ginecol. Ella ulipristal acetate tablet [prescribing information]. ParaGard, the copper IUD , is actually the most effective form of emergency contraception out there. When inserted within five days after unprotected sex, it reduces the risk of pregnancy by 99 percent compared to the morning after pills' up to 95 percent, according to Planned Parenthood. It works by releasing copper, which creates an inflammatory response in the uterus that makes it toxic to sperm, according to Mayo Clinic.
But depending on your insurance, it may cost hundreds of dollars, plus it's a way bigger commitment than pills. But if that kind of commitment actually appeals to you and you're able to get an appointment ASAP, this can be a great option.
Otherwise, morning after pills might make more sense. They basically do the same jobs, but emergency contraception has amped up levels of hormones to prevent pregnancy in a pinch. As Soren notes, "It's not an abortion pill—once a pregnancy has started, [emergency contraception] does not stop it.
Then you can take two at your normal time, be caught up in your pill pack, and generally be protected. If you're looking for emergency-level protection, you'll have to take more than two. This is called the Yuzpe method. It's been used since the 70s and is FDA-approved to boot. For guidance on how to do it, Soren points to Bedsider. They have a great guide on how many birth control pills to take based on the brand you use. For example, if you're taking Aviane, you'd take five orange pills as your first dose, then five more orange pills 12 hours later.
Planned Parenthood is another excellent resource for this. Keep in mind that the Yuzpe method does best when used within 72 hours of unprotected sex, and it doesn't work for all brands, so checking those charts is important. Thanks to the big dose of hormones, you might have to deal with spotting, nausea, breast soreness, and other signature morning after pill side effects. And like with the morning after pill, throwing up soon after taking extra birth control as emergency contraception may render this method ineffective, in which case you should call a doctor or medical professional like a Planned Parenthood clinician to discuss your options.
The extra hormones can also make you slightly more prone to clotting , which Abdur-Rahman recommends taking into account if you have a family history of a clotting disorder. To be on the safe side, definitely check in with a doctor or medical professional,especially if this or any other side effect is a concern of yours.
When it comes to logistical issues, after using up a bunch of pills, you'll need a new birth control pack. Unfortunately, insurance often limits how many you can get in a certain time period. If you're feeling freaked out by the close call, know that some doctors recommend doubling up on safe-sex methods. That's because condoms are the best way for sexually active people to prevent sexually transmitted infections although they don't make it impossible to catch an STI or pass one along , but they're not as good at pregnancy prevention as other methods like the Pill.
Instead, it's that when used together, they might offer the peace of mind you need to fully enjoy yourself every time you have sex and spend the next day in a post-orgasm haze instead of in a panic.
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