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Emergency Contraception

By

Frances E. Casey

, MD, MPH, Virginia Commonwealth University Medical Center

Reviewed/Revised Jul 2023
View PATIENT EDUCATION

Emergency contraception may be used to prevent pregnancy for a short period of time after unprotected sex. Commonly used emergency contraception methods include

  • Insertion of an intrauterine copper contraceptive (T380A IUD) within 5 days of unprotected intercourse

  • Insertion of a 52-mg levonorgestrel-releasing IUD, which, like the copper IUD, probably requires insertion within 5 days of unprotected intercourse

  • Levonorgestrel 1.5 mg orally once within 120 hours of unprotected intercourse

  • Ulipristal 30 mg orally once within 120 hours of unprotected intercourse

For women who have regular menses, the risk of pregnancy after a single act of intercourse is approximately 5%. This risk is 20 to 30% if intercourse occurs at midcycle.

When an intrauterine copper contraceptive or 52-mg levonorgestrel-releasing IUD is used for emergency contraception, it must be inserted within 5 days of unprotected intercourse (or within 5 days of suspected ovulation, if the timing of ovulation can be estimated). The pregnancy rate with is 0.1% for emergency contraception with the copper-releasing IUD and 0.3% for the 52-mg levonorgestrel-releasing IUD (1 General reference Emergency contraception may be used to prevent pregnancy for a short period of time after unprotected sex. Commonly used emergency contraception methods include Insertion of an intrauterine... read more ). Also, the IUD can be left in place to be used for long-term contraception. As emergency contraception, the copper IUD may affect blastocyst implantation; however, it does not appear to disrupt an already established pregnancy. The resumption of menses plus a negative pregnancy test reliably excludes pregnancy; a pregnancy test should be done 2 to 3 weeks after insertion to be sure that an unintended pregnancy has not occurred before insertion.

Oral levonorgestrel (1.5 mg, single dose) used as emergency contraception prevents pregnancy by inhibiting or delaying ovulation. The probability of pregnancy is reduced by 85% after oral levonorgestrel emergency contraception, which has a pregnancy rate of 2 to 3%. However, overall risk reduction depends on the following:

  • The woman's risk of pregnancy without emergency contraception

  • The time in the menstrual cycle that emergency contraception is given

  • The woman's body mass index (BMI; levonorgestrel emergency contraception is less effective than ulipristal in women with a BMI > 30 kg/m2)

In the United States, oral levonorgestrel emergency contraception is available behind pharmacy counters without a prescription. A hormonal contraceptive may be started at the same time as use of oral levonorgestrel as part of a quick-start protocol. A backup method (such as a condom) is recommended for 7 days.

Ulipristal (a single oral dose of 30 mg), a progestin-receptor modulator, as emergency contraception has a pregnancy rate of about 1.5% and is thus more effective than oral levonorgestrel. Ulipristal, like levonorgestrel, prevents pregnancy primarily by delaying or inhibiting ovulation. Although ulipristal is more effective than levonorgestrel for women with a BMI > 30 kg/m2, its effectiveness also decreases as BMI increases. Thus, in women who are obese who strongly desire to avoid an unintended pregnancy, the copper IUD is the preferred method for emergency contraception. Ulipristal is available by prescription only. Hormonal birth control should not be started until 6 days after use of ulipristal, since progestins may interfere with emergency contraceptive efficacy. If hormonal contraception is started on day 6, a backup method (such as a condom) should be used for 7 days.

There are no absolute contraindications to levonorgestrel or ulipristal emergency contraception. Oral levonorgestrel and ulipristal emergency contraception should be taken as soon as possible and within 120 hours of unprotected intercourse.

The Yuzpe method is another regimen. It consists of 2 tablets, each containing ethinyl estradiol 50 mcg and levonorgestrel 0.25 mg, followed by 2 more tablets taken 12 hours later but within 72 hours of unprotected intercourse. The high estrogen dose often causes nausea and may cause vomiting. A hormonal contraceptive may be started at the same time as use of the Yuzpe method, as part of a quick-start protocol. A backup method (such as a condom) is recommended for 7 days. The Yuzpe method is less effective than other methods; thus, it is no longer recommended except when women do not have access to other methods.

A urine pregnancy test 2 weeks after use of emergency contraception is recommended.

General reference

  • 1. Turok DK, Gero A, Simmons RG, et al: Levonorgestrel vs. copper intrauterine devices for emergency contraception. N Engl J Med 384 (4):335–344, 2021. doi: 10.1056/NEJMoa2022141

Key Points

  • Oral methods of emergency contraception include ulipristal and levonorgestrel; they are taken within 120 hours after unprotected intercourse.

  • A copper IUD, inserted within 5 days of unprotected intercourse, is also effective and can be left in place for long-term contraception.

  • A 52-mg levonorgestrel-releasing IUD, inserted within 7 days of unprotected intercourse, is also effective.

  • Pregnancy rates are 1.5% with ulipristal, 2 to 3% with oral levonorgestrel, 0.1% with a copper IUD, and 0.3% with a 52-mg levonorgestrel-releasing IUD.

  • Likelihood of pregnancy after hormonal emergency contraception depends on pregnancy risk without emergency contraception, time in the menstrual cycle that emergency contraception is taken, and BMI.

Drugs Mentioned In This Article

Drug Name Select Trade
ParaGard T380A
AfterPill, EContra EZ, EContra One-Step, Fallback Solo, Kyleena , LILETTA, Mirena, My Choice, My Way, Next Choice, Next Choice One Dose, Norplant, Opcicon One-Step, Plan B, Plan B One-Step , Preventeza, React, Skyla, Take Action
ella
Alora, Climara, Delestrogen, Depgynogen, Depo-Estradiol, Depogen, Divigel, DOTTI, Elestrin, Esclim, Estrace, Estraderm, Estrasorb, Estring, EstroGel, Evamist, FemPatch, Femring, Femtrace, Gynodiol , Gynogen LA, Imvexxy, LYLLANA, Menostar, Minivelle, Vagifem, Valergen, Vivelle, Vivelle-Dot, Yuvafem
No brand name available
View PATIENT EDUCATION
NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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