Abstract
Emergency contraception refers to several contraceptive options that can be used within
a few days after unprotected or underprotected intercourse or sexual assault to reduce
the risk of pregnancy. Current emergency contraception options available in the United
States include the copper intrauterine device (IUD), levonorgestrel (LNG) 52mg IUD,
oral levonorgestrel (such as Plan B One-Step®, My Way®, Take Action®), and oral ulipristal
acetate (UPA) (ella®). These clinical recommendations review the indications, effectiveness,
safety, and side effects of emergency contraceptive methods; considerations for the
use of emergency contraception by specific patient populations and in specific clinical
circumstances, and current barriers to emergency contraceptive access. Further research
is needed to evaluate the effectiveness of levonorgestrel IUDs for emergency contraceptive
use; address the effects of repeated use of ulipristal acetate at different times
in the same menstrual cycle; assess the impact on ovulation of initiating or reinitiating
different regimens of regular hormonal contraception following ulipristal acetate
use; and elucidate effective emergency contraceptive pill options by body mass indices
or weight.
Keywords
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References
- Estimating the effectiveness of emergency contraceptive pills.Contraception. 2003 Apr; 67: 259-265
- Low dose mifepristone and two regimens of levonorgestrel for emergency contraception: a WHO multicentre randomised trial.Lancet. 2002 Dec 7; 360: 1803-1810
- The rationale for use of Ulipristal Acetate as first line in emergency contraception: biological and clinical evidence.Gynecol Endocrinol. 2014 Oct; 30: 688-690
- Emergency contraception review: Evidence-based recommendations for clinicians.Clin Obstet Gynecol. 2014 Dec; 57: 741-750
- Pregnancy Risk by Frequency and Timing of Unprotected Intercourse Before Intrauterine Device Placement for Emergency Contraception.Obstet Gynecol. 2021 Jul 1; 138: 79-84
- Unprotected intercourse in the 2 weeks prior to requesting emergency intrauterine contraception.Am J Obstet Gynecol. 2016 Nov; 215 (592.e1-592.e5)
- ACOG Committee Opinion No. 777: Sexual Assault.ObstetGynecol. 2019; 133: e296-e302
- The prevalence of sexual assault against people who identify as gay, lesbian, or bisexual in the United States: a systematic review.Trauma Violence Abuse. 2011; 12 (Apr): 55-66
- Peer Victimization of Sexual Minority and Transgender Youth: A Cross-Sectional Study of High School Students.Psychol Violence. 2020; 10: 201-211
- Effect on pregnancy rates of the delay in the administration of levonorgestrel for emergency contraception: a combined analysis of four WHO trials.Contraception. 2011 Jul; 84: 35-39
International Consortium for Emergency Contraception. EC pill types and countries of availability, by brand, https://toolkits.knowledgesuccess.org/toolkits/emergency-contraception/emergency-contraceptive-pills-registration-status-country; 2022 [accessed 29 December 2022].
- Safety data for levonorgestrel, ulipristal acetate and Yuzpe regimens for emergency contraception.Contraception. 2016 Feb 1; 93: 93-112
- Effectiveness of levonorgestrel emergency contraception given before or after ovulation - a pilot study.Contraception. 2007 Feb; 75: 112-118
- Contraceptive efficacy of emergency contraception with levonorgestrel given before or after ovulation.Contraception. 2011 Nov; 84: 486-492
- Immediate pre-ovulatory administration of 30 mg ulipristal acetate significantly delays follicular rupture.Hum Reprod. 2010; 25: 2256-2263
- Efficacy of ulipristal acetate for emergency contraception and its effect on the subsequent bleeding pattern when administered before or after ovulation.Hum Reprod. 2016 Jun 15; 31: 1200-1207
Duramed Pharmaceuticals Inc. Plan B One-Step (levonorgestrel) tablet, 1.5 mg, for oral use [package insert], https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/021998lbl.pdf; 2009 [accessed 29 December 2022].
Watson Pharma Inc. Ella (ulipristal acetate) tablet [package insert], https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/022474s000lbl.pdf; 2010 [accessed 29 December 2022].
- Gemzell Danielsson K. Effect of levonorgestrel emergency contraception on implantation and fertility: A review.Contraception. 2022 May; 109: 8-18
- Does ulipristal acetate emergency contraception (ella®) interfere with implantation?.Contraception. 2019 Nov 1; 100: 386-390
- Benchmark pregnancy rates and the assessment of post-coital contraceptives: an update.Contraception. 2015 Apr; 91: 344-349
- Progesterone Receptor Modulator for Emergency Contraception: a randomized controlled trial.Obstet Gynecol. 2006 Nov; 108: 1089-1097
- Ulipristal acetate taken 48-120 hours after intercourse for emergency contraception.ObstetGynecol. 2010 Feb; 115: 257-263
- Ulipristal acetate versus levonorgestrel for emergency contraception: a randomised non-inferiority trial and meta-analysis.Lancet. 2010 Feb 13; 375: 555-562
- A randomized trial of mifepristone (10 mg) and levonorgestrel for emergency contraception.Obstet Gynecol. 2004 Dec; 104: 1307-1313
- Nigerian Network for Reproductive Health Research and Training. A randomized, double-blind, noninferiority study to compare two regimens of levonorgestrel for emergency contraception in Nigeria.Contraception. 2010 Oct; 82: 373-378
- Emergency contraception - mechanisms of action.Contraception. 2013 Mar; 87: 300-308
- Levonorgestrel vs. Copper Intrauterine Devices for Emergency Contraception.N Engl J Med. 2021 Jan 28; 384: 335-344
- Copper-T intrauterine device and levonorgestrel intrauterine system: biological bases of their mechanism of action.Contraception. 2007 Jun; 75: S16-S30
- Post-coital intrauterine device insertion - a further evaluation.Contraception. 1980 Dec; 22: 653-658
- Post-coital contraception with danazol, compared with an ethinyloestradiol-norgestrel combination or insertion of an intra-uterine device.J Obstet Gynaecol. 1983; 3: S64-S68
- The CatSper calcium channel in human sperm: Relation with motility and involvement in progesterone-induced acrosome reaction.Hum Reprod. 2014 Mar; 29: 418-428
- The efficacy of intrauterine devices for emergency contraception: a systematic review of 35 years of experience.Hum Reprod. 2012 Jul; 27: 1994-2000
- The efficacy of intrauterine devices for emergency contraception and beyond: a systematic review update.Int J Womens Health. 2019 Aug; 11: 471-479
- Preference for and efficacy of oral levonorgestrel for emergency contraception with concomitant placement of a levonorgestrel IUD: a prospective cohort study.Contraception. 2016 Jun 1; 93: 526-532
- U.S. Selected Practice Recommendations for Contraceptive Use, 2016.MMWR Recomm Rep. 2016 Jul 29; 65: 1-66
- Selected Rractice Recommendations for Contraceptive Use.3rd ed. World Health Organization, Geneva2016
- Clotting factors after emergency contraception.Adv Contracept. 1993 Mar; 9: 75-82
- Intrauterine devices and pelvic inflammatory disease: an international perspective.Lancet. 1992 Mar 28; 339: 785-788
- Controversies in family planning: intrauterine device placement in solid organ transplant patients.Contraception. 2019 Sep 1; 100: 250-252
- A case series on the use of levonorgestrel 52 mg intrauterine system after organ transplant.Contraception. 2018 Sep 1; 98: 252-254
- Is the intrauterine device appropriate contraception for HIV-1-infected women?.BJOG. 2001 Aug; 108: 784-790
- Use of the levonorgestrel 52-mg intrauterine system in adolescent and young adult solid organ transplant recipients: a case series.Contraception. 2017 Apr 1; 95: 378-381
- Immunologic evaluation of the endometrium with a levonorgestrel intrauterine device in solid organ transplant women and healthy controls.Contraception. 2016 Nov 1; 94: 534-540
- Risk of Pregnancy With Levonorgestrel-Releasing Intrauterine System Placement 6-14 Days After Unprotected Sexual Intercourse.Obstet Gynecol. 2021 Apr 1; 137: 623-625
- Copper intrauterine device placement 6–14 days after unprotected sex.Contraception. 2019 Sep 1; 100: 219-221
- Can we identify women at risk of pregnancy despite using emergency contraception? Data from randomized trials of ulipristal acetate and levonorgestrel.Contraception. 2011 Oct; 84: 363-367
- Effect of BMI and body weight on pregnancy rates with LNG as emergency contraception: analysis of four WHO HRP studies.Contraception. 2017 Jan 1; 95: 50-54
- Effect of body weight and BMI on the efficacy of levonorgestrel emergency contraception.Contraception. 2015 Feb 1; 91: 97-104
- Impact of obesity on the pharmacokinetics of levonorgestrel-based emergency contraception: Single and double dosing.Contraception. 2016 Jul 1; 94: 52-57
- Double Dosing Levonorgestrel-Based Emergency Contraception for Individuals With Obesity: A Randomized Controlled Trial.Obstet Gynecol. 2022 Jul 1; 140: 48-54
- Drug interactions between emergency contraceptive drugs and cytochrome inducers: literature review and quantitative prediction.Fundam Clin Pharmacol. 2021 Apr 1; 35: 208-216
- Pharmacokinetic interactions between the hormonal emergency contraception, levonorgestrel (Plan B), and efavirenz.Infect Dis Obstet Gynecol. 2012; 2012137192
- Effects of erythromycin at steady-state concentrations on the pharmacokinetics of ulipristal acetate.J Clin Pharm Ther. 2013 Dec; 38: 512-517
- The clinical pharmacology and pharmacokinetics of ulipristal acetate for the treatment of uterine fibroids.ReprodSci. 2015 Apr 15; 22: 476-483
- Clinical Pharmacology of Hormonal Emergency Contraceptive Pills.Int J Reprod Med. 2018 Oct 4; 20182785839
- Apparent interaction between warfarin and levonorgestrel used for emergency contraception.BMJ. 2000 Dec 2; 321: 1382
- Association between levonorgestrel emergency contraception and the risk of ectopic pregnancy: A multicenter case-control study.Sci Rep. 2015 Feb 12; 5: 8487
- A prospective, open-label, multicenter study to assess the pharmacodynamics and safety of repeated use of 30 mg ulipristal acetate.Contraception. 2016 Apr 1; 93: 310-316
Medicines and Healthcare products Regulatory Agency UK. Esmya (ulipristal acetate): suspension of the licence due to risk of serious liver injury, https://www.gov.uk/drug-safety-update/esmya-ulipristal-acetate-suspension-of-the-licence-due-to-risk-of-serious-liver-injury; 2021 [accessed 29 December 2022].
- Liver safety parameters of ulipristal acetate for the treatment of uterine fibroids: a comprehensive review of the clinical development program. Vol. 17.Expert Opin Drug Saf. 2018 Dec; 17: 1225-1232
- Liver Injury with Ulipristal Acetate: Exploring the Underlying Pharmacological Basis.Drug Saf. 2020 Dec 1; 43: 1277-1285
- Liver injury and ulipristal acetate: an overstated tragedy? Vol. 110.Fertil Steril. 2018 Sep; 110: 593-595
- Use of Ulipristal Acetate and Risk of Liver Disease: A Nationwide Cohort Study.Journal of Clinical Endocrinology and Metabolism. 2021 May 13; 106: 1773-1782
- Oral contraception and congenital malformations in offspring: a review and meta-analysis of the prospective studies.Obstet Gynecol. 1990 Sep; 76: 552-557
- Fetal genital effects of first-trimester sex hormone exposure: A meta-analysis.Obstet Gynecol. 1995 Jan; 85: 141-149
Levy DP, Jager M, Kapp N, Abitbol JL. Ulipristal acetate for emergency contraception: Postmarketing experience after use by more than 1 million women. Contraception. 2014 May;89(5):431–3.
- Estimates of human fertility and pregnancy loss.Fertil Steril. 1996 Mar; 65: 503-509
- Ectopic pregnancy and emergency contraceptive pills: a systematic review.Obstet Gynecol. 2010 Jun; 115: 1263-1266
- Ectopic Pregnancy.N Eng J Med. 2009 Jul 23; 361: 379-387
- Experience with same-day placement of the 52 mg levonorgestrel-releasing intrauterine system.Am J Obstet Gynecol. 2020 Apr 1; 222 (S883.e1-S883.e6)
- Pregnancy outcomes with an IUD in situ: a systematic review.Contraception. 2012 Feb; 85: 131-139
- Quick Start: novel oral contraceptive initiation method.Contraception. 2002 Sep; 66: 141-145
Nelson AL, Katz T. Initiation and continuation rates seen in 2-year experience with Same Day injections of DMPA. Contraception. 2007 Feb;75(2):84–7.
- A prospective, randomized, pharmacodynamic study of quick-starting a desogestrel progestin-only pill following ulipristal acetate for emergency contraception.Hum Reprod. 2015 Dec; 30: 2785-2793
- The effects on ovarian activity of ulipristal acetate when ‘quickstarting’ a combined oral contraceptive pill: A prospective, randomized, double-blind parallel-arm, placebo-controlled study.Hum Reprod. 2015 Jul; 30: 1566-1572
- Combined oral contraceptive interference with the ability of ulipristal acetate to delay ovulation: A prospective cohort study.Contraception. 2018 Dec 1; 98: 463-466
- The effects on ovarian activity of delaying versus immediately restarting combined oral contraception after missing three pills and taking ulipristal acetate 30 mg.Contraception. 2020 Sep 1; 102: 145-151
- Effect of missed combined hormonal contraceptives on contraceptive effectiveness: a systematic review.Contraception. 2013 May; 87: 685-700
- Diagnosis and Treatment of Sexually Transmitted Infections: A Review.JAMA. 2022 Jan 11; 327: 161-172
- Sexually Transmitted Infections Treatment Guidelines, 2021.MMWR Recomm Rep. 2021 Jul 23; 70: 1-187
- The safety of intrauterine contraception initiation among women with current asymptomatic cervical infections or at increased risk of sexually transmitted infections.Contraception. 2016 Dec 1; 94: 701-712
- Sex trafficking, violence victimization, and condom use among prostituted women in Nicaragua.Int J Gynaecol Obstet. 2009 Nov; 107: 151-152
- Intimate Partner Violence and Coerced Unprotected Sex Among Young Women Attending Community College.Arch Sex Behav. 2020 Apr 1; 49: 871-882
- Associations between Pregnancy Intention, Attitudes, and Contraceptive Use among Women Veterans in the ECUUN Study.Womens Health Issues. 2018 Nov-Dec; 28: 480-487
American Society for Emergency Contraception. Emergency Contraception for Transgender and Nonbinary patients, https://www.americansocietyforec.org/reports-and-factsheets; 2021 [accessed 29 December 2022].
- Society of Family Planning clinical recommendations: Contraceptive counseling for transgender and gender diverse people who were female sex assigned at birth.Contraception. 2020 Aug 1; 102: 70-82
- Emergency contraceptive pills as a backup for lactational amenorrhea method (LAM) of contraception: a randomized controlled trial.Contraception. 2013 Mar; 87: 363-369
- Levonorgestrel emergency contraceptive pills use during breastfeeding; effect on infants’ health and development.J Matern Fetal Neonatal Med. 2019 Aug 3; 32: 2524-2528
- Levonorgestrel pharmacokinetics in plasma and milk of lactating women who take 1.5 mg for emergency contraception.Hum Reprod. 2007 Jun; 22: 1578-1584
National Library of Medicine (US). Intrauterine Copper Contraceptive [Internet]. Available from: https://www.ncbi.nlm.nih.gov/books/
- The safety of intrauterine devices in breastfeeding women: a systematic review.Contraception. 2016 Dec 1; 94: 725-738
Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006–. Ulipristal. 2022 Jul 18.
- Familiarity with Long-acting Reversible Contraceptives among Obstetrics and Gynecology, Family Medicine, and Pediatrics Residents: Results of a 2015 National Survey and Implications for Contraceptive Provision for Adolescents.J Pediatr Adolesc Gynecol. 2018 Feb 1; 31: 40-44
- Access to the copper IUD as post-coital contraception: results from a mystery caller study.Contraception. 2016 Nov 1; 94: 561-566
- Implementing best practices for the provision of long-acting reversible contraception: a survey of obstetrician-gynecologists.Contraception. 2019 Aug 1; 100: 123-127
- A missed opportunity for care: two-visit IUD insertion protocols inhibit placement.Contraception. 2012 Dec; 86: 694-697
- Cost-effectiveness of emergency contraception options over 1 year.Am J Obstet Gynecol. 2018 May 1; 218 (508.e1-508.e9)
- Access to IUD removal: Data from a mystery-caller study.Contraception. 2020 Feb 1; 101: 122-129
- Contraceptive Coverage and the Affordable Care Act.Obstet Gynecol Clin North Am. 2015 Dec; 42: 605-617
- Access to Emergency Contraception in the Over-the-Counter Era.Womens Health Issues. 2016 Nov-Dec; 26: 622-627
- Over-the-counter access to levonorgestrel emergency contraception in South Texas: Does Over-the-counter mean ready to buy?.Contraception. 2021 Sep 1; 104: 271-274
- Emergency contraception: A multispecialty survey of clinician knowledge and practices.Contraception. 2016 Feb 1; 93: 145-152
- Oral and IUD emergency contraception provision among a national sample of obstetrician–gynecologists.Contraception. 2020 Dec 1; 102: 406-408
- Pharmacy access to Ulipristal acetate in major cities throughout the United States.Contraception. 2018 Mar 1; 97: 264-269
- Emergency Contraception: Do Your Patients Have a Plan B?.Obstetd Gynecol Clin North Am. 2015 Dec; 42: 699-712
Guttmacher Institute. Emergency Contraception, https://www.guttmacher.org/state-policy/explore/emergency-contraception; 2022 [accessed 29 December 2022].
American Society for Emergency Contraception. Emergency contraception: a guide for pharmacies and retailers, https://www.americansocietyforec.org/_files/ugd/7f2e0b_fc23debfbd29451685a17bec4cb8518f.pdf; 2020 [accessed 29 December 2022].
- Role of the community pharmacist in emergency contraception counseling and delivery in the United States: current trends and future prospects.Integr Pharm Res Pract. 2017 Mar; 6: 99-108
- Society of Family Planning Clinical Recommendations: Contraceptive Care in the Context of Pandemic Response.Contraception. 2022 Sep 1; 113: 1-12
- Rural-urban residence and emergency contraception use, access, and counseling in the United States, 2006-2017.Contracept X. 2021 Feb 8; 3100061
- A Needs Assessment and Educational Intervention Addressing the Care of Sexual Assault Patients in the Emergency Department.J Forensic Nurs. 2020 Apr 1; 16: 73-82
- Coverage of Over-the-Counter Drugs in Medicaid.National Health Law Program. 2022; ([accessed 29 December])
- Contraception across the transmasculine spectrum.Am J Obstet Gynecol. 2020 Feb 1; 222: 134-143
- Interest in a pericoital pill among women in family planning and abortion clinics.Contraception. 2013 Jul; 88: 141-146
- What some women want? On-demand oral contraception.Contraception. 2014; 90: 105-110
Hatcher R. Contraceptive Technology. 21st ed. 2018.
- Efficacy and side effects of immediate postcoital levonorgestrel used repeatedly for contraception. United Nations Development Programme/United Nations Population Fund/World Health Organization/World Bank Special Programme of Research, Development and Research Training in Human Reproduction.Task Force on on Post=Ovulatory Methods of Fertility Regulation. Contraception. 2000 May; 61: 303-308
- Repeat emergency contraception: facing our fears.Contraception. 2002 Jul; 66: 15-17
- Repeated use of pre- and postcoital hormonal contraception for prevention of pregnancy.Cochrane Database of Syst Revi. 2014 Sep 26; 2014CD007595
- A single-arm study to evaluate the efficacy, safety and acceptability of pericoital oral contraception with levonorgestrel.Contraception. 2014 Mar; 89: 215-221
- A prospective, open-label, single arm, multicentre study to evaluate efficacy, safety and acceptability of pericoital oral contraception using levonorgestrel 1.5 mg.Hum Reprod. 2016 Mar 1; 31: 530-540
- Pericoital contraception.Curr Opin Obstet Gynecol. 2018 Dec 1; 30: 400-406
Article info
Publication history
Accepted:
January 10,
2023
Received in revised form:
December 30,
2022
Received:
October 19,
2022
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
