Emergency contraception* (EC)—a method of preventing pregnancy after sexual intercourse—is an important contraceptive option that could annually prevent at least 50 percent of unintended pregnancies among American women.[3] Experts estimate that timely use of EC could prevent up to 70 percent of abortions.[2] In fact, use of EC prevented about 51,000 abortions in 2000.[4]
EC Prevents Pregnancy and the Need for Abortion.
- EC is also known as postcoital contraception or the morning-after pill, but the term emergency contraception underscores that EC can be used up to 120 hours (five days) after unprotected sex.[5,6]
- EC delays or inhibits ovulation. It may prevent fertilization and may possibly prevent implantation.[7,8]
- EC does not affect an established pregnancy and does not cause abortion.[2] The National Institutes of Health, the American College of Obstetricians and Gynecologists (ACOG), and the American Medical Women's Association (AMWA) define pregnancy as beginning with implantation.[9,10,11] ACOG, AMWA, and other organizations, including the U.S. Food & Drug Administration (FDA), agree that EC has no effect once implantation has occurred.[10,11,12] Moreover, the Society for Adolescent Medicine (SAM) asserts that there is no evidence that EC affects a fertilized egg, even before implantation.[2]
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EC Is Safe and Effective.
- The FDA states that EC is safe and effective.[12] SAM, ACOG, AMWA, the American Medical Association, U.S. Department of Health & Human Services, and the World Health Organization all support women's access to EC.[2,10,11,13,14,15]
- Accidental use of EC during pregnancy will not cause birth defects.[2] Numerous studies for risk of birth defects during regular use of oral contraceptives (including older, higher dose preparations) found no increased risk.[10]
- EC is approximately 75 to 94 percent effective at preventing pregnancy, depending on how promptly a woman uses it, when during her cycle she had sex, and the kind of EC she takes. Some studies show EC is most effective when taken as soon as possible after unprotected sex. Progestin-only pills are more effective than combination pills (containing both estrogen and progestin).[2]
- The most common side effects associated with EC use are nausea (in 30 to 50 percent of women taking it) and vomiting (in 15 to 25 percent). Other less common side effects include fatigue, breast tenderness, headache, abdominal pain, and dizziness. These side effects are significantly more common for combination pills than for progestin-only pills.[2,16]
- In August 2006, the FDA determined that EC can be made available
without a prescription to women ages 18 and older. Women under age 18
will continue to need a prescription to get EC.
Please note (July 2009): The newly approved Plan B One-Step is now available without a prescription for women and men 17 and older.
Many Brands of Oral Contraceptives Are Used for EC in the United States.
- Progestin-only pills (Plan B® and Ovrette) are the preferred regimen to provide for EC due to their higher efficacy and lower side effects. Many combination pills, however, can also be used for EC.[2,17]
- Women should be counseled to follow up with their health care provider two weeks after using EC to ensure they did not become pregnant, to consider testing for sexually transmitted infections (STIs), including HIV, and to discuss effective contraceptive options.[2]
| Brand† | Pill Type | Pills per Dose‡ | Brand† | Pill Type | Pills per Dose‡ |
| Alesse | Combination | 5 pink pills | Nordette | Combination | 4 lt orange pills |
| Aviane | Combination | 5 orange pills | Ogestrel | Combination | 2 white pills |
| Cryselle | Combination | 4 white pills | Ovral | Combination | 2 white pills |
| Enpresse | Combination | 4 orange pills | Ovrette | Progestin-only | 20 yellow pills |
| Lessina | Combination | 5 pink pills | Plan B® | Progestin-only | 1 white pill |
| Levlen | Combination | 4 lt orange pills | Portia | Combination | 4 pink pills |
| Levlite | Combination | 5 pink pills | Seasonale | Combination | 4 pink pills |
| Levora | Combination | 4 white pills | Tri-Levlen | Combination | 4 yellow pills |
| Lo/Ovral | Combination | 4 white pills | Triphasil | Combination | 4 yellow pills |
| Low-Orgestrel | Combination | 4 white pills | Trivora | Combination | 4 pink pills |
| Lutera | Combination | 5 white pills | |||
| † Two doses are required; the first dose within 120 hours of unprotected sex and the second dose 12 hours after the first. ‡ Brands are frequently added to this chart. For the most current version of this chart (not in alphabetical order by brand names), visit http://ec.princeton.edu/questions/dose.html. |
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- Women should take one dose within 120 hours after unprotected sex and another dose 12 hours later. Research indicates taking both doses of progestin-only pills at once is as effective as splitting the dose in two, and is not associated with more side effects when compared with the standard, two dose regimen.[2,17] And, taking both doses at once may increase women's compliance with instructions for taking EC.
Health Care Providers Should Give Teens Information about and Access to EC.
Adolescents face cultural, financial, legal, psychological, and social barriers to accessing contraceptive information and services, especially EC-related information and services. SAM asserts its support for increasing awareness of and improving timely access to EC for teens. Specifically, SAM recommends that adolescent health care providers:- Maintain the same degree of confidentiality when providing EC as when providing other reproductive and sexual health care.[2]
- Counsel all adolescent men and women about EC during acute and routine health care visits.[2]
- Provide all women under 18 with an advance EC prescription or medication to take home for future use.[2]
- Provide EC without requiring adolescent women to receive a pregnancy test, pelvic exam, Pap smear, or STI/HIV test.[2]
- Develop protocols for telephone triage and prescribe EC over the telephone, whenever possible.[2]
- Counsel all adolescent women being treated for sexual assault about EC and offer them EC.[2]
- Support changing the status of EC from prescription-only to over-the-counter for all women without an age restriction.[2]
References
- Kahn JG et al. Pregnancies averted among U.S. teenagers by the use of contraceptives. Family Planning Perspectives 1999; 31:29-34.
- Society for Adolescent Medicine. Provision of emergency contraception to adolescents: position paper of the Society for Adolescent Medicine. Journal of Adolescent Health 2004; 35:66-70.
- Trussell J et al. Emergency contraceptive pills: a simple proposal to reduce unintended pregnancies. Family Planning Perspectives 1992; 24:269-73.
- Jones RK et al. Contraceptive use among U.S. women having abortions 2000-2001. Perspectives on Sexual and Reproductive Health 2002; 34:294-303.
- Ellertson C et al. Extending the time limit for starting the Yuzpe regimen of emergency contraception to 120 hours. Obstetrics & Gynecology 2003; 101:1168-1171.
- American College of Obstetricians and Gynecologists. Emergency contraception. ACOG Practice Bulletin, December 2005 (#69).
- International Consortium for Emergency Contraception. Emergency Contraceptive Pills: Medical and Service Delivery Guidelines, 2nd edition. New York: Author, 2004.
- Conard LAE, Gold MA. Emergency contraceptive pills: a review of the recent literature. Current Opinion in Obstetrics & Gynecology 2004; 16:389-395.
- Office for Protection from Research Risks, National Institutes of Health, Dept. of Health & Human Services. Protection of Human Subjects. Code of Federal Regulations 45 Part 46; rev. November 13, 2001. Accessed December 3, 2004. [http://www.hhs.gov/ohrp/humansubjects/guidance/45cfr46.htm]
- American College of Obstetricians & Gynecologists. Emergency oral contraception. ACOG Practice Patterns 1996; No. 3:1-8.
- American Medical Women's Association. Position Statement on Emergency Contraception. Alexandria, VA: Author, 1996.
- Government Printing Office. Prescription drug products: certain combined oral contraceptives for use as postcoital emergency contraception: notice. Federal Register 1997(February 25); 62:8609-12.
- American Medical Association. Access to Emergency Contraception [Report of the Council of Medical Service, CMS, Report 1-I-00] Chicago, IL: Author, 2000.
- U.S. Dept. Health & Human Services. Emergency Contraception [Memorandum: OPA Program Instruction Series, OPA 97-2] Rockville, MD: Author, 1997.
- World Health Organization. Improving Access to Quality Care in Family Planning: Medical Eligibility Criteria for Initiating and Continuing Use of Contraceptive Methods. [WHO/FRH/FPP/96.9] Geneva: WHO, 1996.
- Van Look PFA, Stewart F. Emergency contraception. In: Hatcher RA et al. Contraceptive Technology. 17th rev. edition. New York, NY: Ardent Media, 1998.
- Office of Population Research at Princeton University, Association of Reproductive Health Professionals. Twenty-one Brands of Oral Contraceptives that Can Be Used for Emergency Contraception in the United States. Princeton, NJ: Author, [2004?]. Accessed December 3, 2004. [http://ec.princeton.edu/questions/dose.html]
- Office of Population Research at Princeton University, Association of Reproductive Health Professionals. Copper-T IUD as Emergency Contraception. Princeton, NJ: Author, 2002. Accessed December 3, 2004. [http://ec.princeton.edu/info/eciud.html]
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