Emergency contraception: Difference between revisions
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==Progestin ([[levonorgestrel]])-Only Regimen==
==Overview==
===General===
====Most to least effective<ref>ACOG. Emergency Contraception. https://www.acog.org/womens-health/faqs/emergency-contraception </ref>====
#Copper IUD
#Ulipristal (''Ella'')
#Progestin-only regimen
#Combination estrogen-progestin regimen
 
==Copper 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%)<ref>http://ec.princeton.edu/questions/ec-review.pdf#page=3</ref>
**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 a very feasible method in the ED
 
==Ulipristal (Ella)==
*Progesterone-receptor modulator, effective up to 120 hours after unprotected sex
*May be more effective than levonorgestrel in overweight patients<ref>Glasier A, Cameron ST, Blithe D, Scherrer B, Mathe H, Levy D, Gainer E, Ulmann A. Can we identify women at risk of pregnancy despite using emergency contraception? Data from randomized trials of ulipristal acetate and levonorgestrel. Contraception. 2011;84:363-7.</ref>
*30 mg PO in single dose
*Safe in breast feeding women, but FDA recommends discarding breast milk for 24 hrs after taking
*Adverse effects: Nausea (~13%), abdominal pain (8-15%), headache (19%)<ref>Micromedex</ref>
*Disadvantages:
**Not available from many hospital pharmacies, so patient often cannot get dose immediately, increasing the risk that they never receive therapy if unable to obtain at outside pharmacy.
**More expensive than other therapies
 
==Progestin-only Regimen==
====General====
*First dose within 48 hours after unprotected intercourse followed by second dose 12 hours later
*First dose within 48 hours after unprotected intercourse followed by second dose 12 hours later
**May also be taken as single dose (double dose)
**May also be taken as single dose (double dose)
*Relative risk reduction of pregnancy = 89% (1% with vs 8% without)
*Relative risk reduction of pregnancy = 89% (1% with vs 8% without)
**Effectiveness may be reduced in obese patients; some emerging evidence suggests doubling dose for obese patients<ref>Edelman A, Cherala G, Blue S, Erikson D, Jensen J. Impact of obesity on the pharmacokinetics of levonorgestrel-based emergency contraception: single and double dosing. Contraception. 2016 ;94:52-57.</ref>
**Effectiveness may be reduced in obese patients; some emerging evidence suggests doubling dose for obese patients<ref>Edelman A, Cherala G, Blue S, Erikson D, Jensen J. Impact of obesity on the pharmacokinetics of levonorgestrel-based emergency contraception: single and double dosing. Contraception. 2016 ;94:52-57.</ref>
*Adverse effects: Nausea (23%), vomiting (6%)


===Adverse Reactions===
====Dosing====
*Nausea (23%)
*Plan B (marketed specifically for emergency contraception) - levonorgestrel 0.75mg PO per pill  
*Vomiting (6%)
**Should be given as soon as possible after intercourse; labeled for use up to 72 hours post-coitus, however may still be moderately effective up to 5 days after<ref>Practice Bulletin No. 152: Emergency Contraception. Obstet Gynecol. 2015 Sep;126(3):e1-e11. doi: 10.1097/AOG.0000000000001047. PMID: 26287787.</ref>
*No teratogenesis
**[[Levonorgestrel]] (Plan B and generics) 0.75mg PO Q12H x2 doses
 
===Dosing===
*Plan B (marketed specifically for emergency contraception) - levonorgestrel 0.75mg PO per pill
**[[levonorgestrel]] (Plan B and generics) 0.75mg PO Q12H x2 doses
*May also be taken as one-time dose of levonorgestrel 1.5mg PO once
*May also be taken as one-time dose of levonorgestrel 1.5mg PO once


==Yuzpe Regimen (Combination OCPs)==
==Combination OCPs (AKA Yuzpe Regimen)==
===General===
====General====
*First dose within 72 hours after unprotected intercourse followed by second dose 12 hours later
*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)
*May be given up to 120 hours later (but efficacy reduced)
*Reduces risk of pregnancy by 75% (2% with vs 8% without)
*Reduces risk of pregnancy by 75% (2% with vs 8% without)
*Adverse effects: Nausea (50%), vomiting (20%)


===Adverse Reactions===
====FDA approved regimens====
*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
*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
*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
*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
*Triphasil, Tri-Levlen, Trivora - 4 pills (120 ug ethiny estradiol/0.5mg levonorgestrel) per dose; repeat in 12h
==Ulipristal acetate (Ella)==
*Progesterone-receptor modulator, effective up to 120 hours after unprotected sex
*May be more effective than levonorgestrel in overweight patients<ref>Glasier A, Cameron ST, Blithe D, Scherrer B, Mathe H, Levy D, Gainer E, Ulmann A. Can we identify women at risk of pregnancy despite using emergency contraception? Data from randomized trials of ulipristal acetate and levonorgestrel. Contraception. 2011;84:363-7.</ref>
*30 mg PO in single dose
*Safe in breast feeding women, but FDA recommends discarding breast milk for 24 hrs after taking
*Adverse effects: Nausea (~13%), abdominal pain (8-15%), headache (19%)<ref>Micromedex</ref>
==[[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%)<ref>http://ec.princeton.edu/questions/ec-review.pdf#page=3</ref>
**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 a very feasible method in the ED


==See Also==
==See Also==

Latest revision as of 18:50, 8 September 2023

Overview

Most to least effective[1]

  1. Copper IUD
  2. Ulipristal (Ella)
  3. Progestin-only regimen
  4. Combination estrogen-progestin regimen

Copper 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%)[2]
    • 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 a very feasible method in the ED

Ulipristal (Ella)

  • Progesterone-receptor modulator, effective up to 120 hours after unprotected sex
  • May be more effective than levonorgestrel in overweight patients[3]
  • 30 mg PO in single dose
  • Safe in breast feeding women, but FDA recommends discarding breast milk for 24 hrs after taking
  • Adverse effects: Nausea (~13%), abdominal pain (8-15%), headache (19%)[4]
  • Disadvantages:
    • Not available from many hospital pharmacies, so patient often cannot get dose immediately, increasing the risk that they never receive therapy if unable to obtain at outside pharmacy.
    • More expensive than other therapies

Progestin-only Regimen

General

  • First dose within 48 hours after unprotected intercourse followed by second dose 12 hours later
    • May also be taken as single dose (double dose)
  • Relative risk reduction of pregnancy = 89% (1% with vs 8% without)
    • Effectiveness may be reduced in obese patients; some emerging evidence suggests doubling dose for obese patients[5]
  • Adverse effects: Nausea (23%), vomiting (6%)

Dosing

  • Plan B (marketed specifically for emergency contraception) - levonorgestrel 0.75mg PO per pill
    • Should be given as soon as possible after intercourse; labeled for use up to 72 hours post-coitus, however may still be moderately effective up to 5 days after[6]
    • Levonorgestrel (Plan B and generics) 0.75mg PO Q12H x2 doses
  • May also be taken as one-time dose of levonorgestrel 1.5mg PO once

Combination OCPs (AKA Yuzpe Regimen)

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 effects: Nausea (50%), vomiting (20%)

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

See Also

References

  1. ↑ ACOG. Emergency Contraception. https://www.acog.org/womens-health/faqs/emergency-contraception
  2. ↑ http://ec.princeton.edu/questions/ec-review.pdf#page=3
  3. ↑ Glasier A, Cameron ST, Blithe D, Scherrer B, Mathe H, Levy D, Gainer E, Ulmann A. Can we identify women at risk of pregnancy despite using emergency contraception? Data from randomized trials of ulipristal acetate and levonorgestrel. Contraception. 2011;84:363-7.
  4. ↑ Micromedex
  5. ↑ Edelman A, Cherala G, Blue S, Erikson D, Jensen J. Impact of obesity on the pharmacokinetics of levonorgestrel-based emergency contraception: single and double dosing. Contraception. 2016 ;94:52-57.
  6. ↑ Practice Bulletin No. 152: Emergency Contraception. Obstet Gynecol. 2015 Sep;126(3):e1-e11. doi: 10.1097/AOG.0000000000001047. PMID: 26287787.
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