Download PDF
Semin Reprod Med 2001; 19(4): 323-330
DOI: 10.1055/s-2001-18640
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Emergency Contraception

Charlotte Ellertson1 , James Trussell2 , Felicia Stewart3 , Jacqueline Koenig4 , Elizabeth G. Raymond5 , Tara Shochet6
  • 1Director of Reproductive Health for Latin America and the Caribbean, The Population Council-Mexico, Col. Villa Coyoacan, México
  • 2Professor of Economics and Public Affairs, Associate Dean, Woodrow Wilson School of Public and International Affairs, and Faculty Associate, Office of Population Research, Wallace Hall, Princeton University, Princeton, New Jersey
  • 3Co-Director, Center for Reproductive Health Research & Policy, University of California, San Francisco, California
  • 4Assistant Director, Online Outreach and Partnerships, The Henry J. Kaiser Family Foundation, Menlo Park, California
  • 5Associate Medical Director, Biomedical Affairs Division, Family Health International, Research Triangle Park, North Carolina
  • 6Research Assistant, Office of Population Research, Wallace Hall, Princeton University, Princeton, New Jersey
Further Information

Publication History

Publication Date:
29 November 2001 (online)

    Permissions and Reprints

ABSTRACT

Emergency contraceptives are methods that prevent pregnancy when used shortly after unprotected sex. Three different emergency contraceptive methods are safe, simple, and widely available in the United States. These are: (1) ordinary combined oral contraceptives containing ethinyl estradiol and levonorgestrel taken in a higher dose for a short period of time and started within a few days after unprotected intercourse; (2) levonorgestrel-only tablets used similarly; and (3) copper-bearing intrauterine devices inserted within approximately 1 week after unprotected intercourse. Emergency contraceptive use is best known for women who have been raped, but the methods are also appropriate for women who have experienced condom breaks, women who did not use any method because they were not planning on having sex, or women who had unprotected intercourse for any other reason. Unfortunately, few women know about emergency contraceptives, and few clinicians think to inform their patients routinely about the option. A nationwide toll-free hotline (1-888-NOT-2-LATE) and a website (http://not-2-late.com) can help women learn about these options. Sharing ``family planning's best-kept secret'' widely with women could prevent as many as a million unwanted pregnancies annually in the United States.

KEYWORD

Emergency contraception - postcoital - Yuzpe - levonorgestrel - copper-IUD

REFERENCES

  • 1 Henshaw S K. Unintended pregnancy in the United States.  Fam Plann Perspect . 1998;  30 24-46
    CrossrefPubMedGoogle Scholar
  • 2 Trussell J, Stewart F, Guest F, Hatcher R A. Emergency contraceptive pills: a simple proposal to reduce unintended pregnancies.  Fam Plann Perspect . 1992;  24 269-273
    CrossrefPubMedGoogle Scholar
  • 3 Abma J C, Chandra A, Mosher W D, Peterson L S, Piccinino L J. Fertility, family planning, and women's health: new data from the 1995 National Survey of Family Growth. Vital Health Stat 1997; Series 23, No. 19
    Google Scholar
  • 4 Van Look P F A, Stewart F. Emergency contraception. In: Hatcher RA, Trussell J, Stewart F, et al, eds. Contraceptive Technology 17th revised ed. New York: Ardent Media 1998: 277-295
    Google Scholar
  • 5 Glasier A. Emergency postcoital contraception.  N Engl J Med . 1997;  337 1058-1064
    CrossrefPubMedGoogle Scholar
  • 6 Hatcher R A, Trussell J, Stewart F, Howells S, Russell C R, Kowal D. Emergency Contraception: The Nation's Best Kept Secret.  Decatur, GA: Bridging the Gap Communications; 1995
    Google Scholar
  • 7 Trussell J, Koenig J, Ellertson C, Stewart F. Preventing unintended pregnancy: the cost-effectiveness of three methods of emergency contraception.  Am J Public Health . 1997;  87 932-937
    PubMedGoogle Scholar
  • 8 Ellertson C, Webb A, Blanchard K. Three simplifications of the Yuzpe regimen of emergency contraception: results of a randomized, controlled trial in five centers.  Work in progress.
    PubMedGoogle Scholar
  • 9 Trussell J, Ellertson C, Stewart F. The effectiveness of the Yuzpe regimen of emergency contraception.  Fam Plann Perspect . 1996;  28 58-87
    PubMedGoogle Scholar
  • 10 Trussell J, Rodríguez G, Ellertson C. New estimates of the effectiveness of the Yuzpe regimen of emergency contraception.  Contraception . 1998;  57 363-369
    CrossrefPubMedGoogle Scholar
  • 11 Trussell J, Rodríguez G, Ellertson C. Updated estimates of the effectiveness of the Yuzpe regimen of emergency contraception.  Contraception . 1999;  59 147-151
    CrossrefPubMedGoogle Scholar
  • 12 Task Force on Postovulatory Methods of Fertility Regulation. Randomised controlled trial of levonorgestrel versus the Yuzpe regimen of combined oral contraceptives for emergency contraception.  Lancet . 1998;  352 428-433
    CrossrefPubMedGoogle Scholar
  • 13 Piaggio G, von Hertzen H, Grimes D A, Van Look F A P. Timing of emergency contraception with levonorgestrel or the Yuzpe regimen.  Lancet . 1999;  353 721
    CrossrefPubMedGoogle Scholar
  • 14 Grou F, Rodrigues I. The morning-after pill: how long after?.  Am J Obstet Gynecol . 1994;  171 1529-1534
    PubMedGoogle Scholar
  • 15 Sánchez-Borrego R, Balasch J. Ethinyl oestradiol plus dl*-norgestrel or levonorgestrel in the Yuzpe method for post-coital contraception: results of an observational study.  Hum Reprod . 1996;  11 2449-2453
    PubMedGoogle Scholar
  • 16 Raymond E G, Creinin M D, Barnhart K T, Lovvorn A E, Rountree W, Trussell J. Meclizine for prevention of nausea associated with emergency contraceptive pills: a randomized trial.  Obstet Gynecol . 2000;  95 271-277
    CrossrefPubMedGoogle Scholar
  • 17 Improving access to quality care in family planning. Geneva: World Health Organization; 2000 . 
    Google Scholar
  • 18 Webb A. How safe is the Yuzpe method of emergency contraception?.  Fert Control Rev . 1995;  4 16-18
    PubMedGoogle Scholar
  • 19 Webb A, Taberner D. Clotting factors after emergency contraception.  Adv Contracept . 1993;  9 75-82
    CrossrefPubMedGoogle Scholar
  • 20 Raman-Wilms L, Tseng A L, Wighardt S, Einarson T R, Koren G. Fetal genital effects of first-trimester sex hormone exposure: a meta-analysis.  Obstet Gynecol . 1995;  85 141-149
    CrossrefPubMedGoogle Scholar
  • 21 Bracken M B. Oral contraception and congenital malformations in offspring: a review and meta-analysis of the prospective studies.  Obstet Gynecol . 1990;  76 552-557
    PubMedGoogle Scholar
  • 22 Simpson J L, Phillips O P. Spermicides, hormonal contraception and congenital malformations.  Adv Contracept . 1990;  6 141-167
    CrossrefPubMedGoogle Scholar
  • 23 Food and Drug Administration. Prescription drug products: certain combined oral contraceptives for use as postcoital emergency contraception.  Federal Regist . 1997;  62 8610-8612
    PubMedGoogle Scholar
  • 24 Swahn M L, Westlund P, Johannisson E, Bygdeman M. Effect of post-coital contraceptive methods on the endometrium and the menstrual cycle.  Acta Obstet Gynecol Scand . 1996;  75 738-744
    PubMedGoogle Scholar
  • 25 Ling W Y, Robichaud A, Zayid I, Wrixon W, MacLeod S C. Mode of action of dl-norgestrel and ethinylestradiol combination in postcoital contraception.  Fertil Steril . 1979;  32 297-302
    PubMedGoogle Scholar
  • 26 Rowlands S, Kubba A A, Guillebaud J, Bounds W. A possible mechanism of action of danazol and an ethinylestradiol/ norgestrel combination used as postcoital contraceptive agents.  Contraception . 1986;  33 539-545
    CrossrefPubMedGoogle Scholar
  • 27 Kubba A A, White J O, Guillebaud J, Elder M G. The biochemistry of human endometrium after two regimens of postcoital contraception: a dl-norgestrel/ethinylestradiol combination or danazol.  Fertil Steril . 1986;  45 512-516
    PubMedGoogle Scholar
  • 28 Ling W Y, Wrixon W, Zayid I, Acorn T, Popat R, Wilson E. Mode of action of dl-norgestrel and ethinylestradiol combination in postcoital contraception II: effect of postovulatory administration on ovarian function and endometrium.  Fertil Steril . 1983;  39 292-297
    PubMedGoogle Scholar
  • 29 Yuzpe A A, Thurlow H J, Ramzy I, Leyshon J I. Post coital contraception: a pilot study.  J Reprod Med . 1974;  13 53-58
    PubMedGoogle Scholar
  • 30 Taskin O, Brown R W, Young D C, Poindexter A N, Wiehle R D. High doses of oral contraceptives do not alter endometrial α1 and ανβ3 integrins in the late implantation window.  Fertil Steril . 1994;  61 850-855
    PubMedGoogle Scholar
  • 31 Raymond E G, Lovely L P, Chen-Mok M, Seppala M, Kurman R J, Lessey B A. Effect of the Yuzpe regimen of emergency contraception on markers of endometrial receptivity.  Hum Reprod . 2000;  15 2351-2355
    CrossrefPubMedGoogle Scholar
  • 32 Ling W Y, Wrixon W, Acorn T, Wilson E, Collins J. Mode of action of dl-norgestrel and ethinylestradiol combination in postcoital contraception III: effect of preovulatory administration following the luteinizing hormone surge on ovarian steroidogenesis.  Fertil Steril . 1983;  40 631-636
    PubMedGoogle Scholar
  • 33 Trussell J, Raymond E G. Statistical evidence concerning the mechanism of action of the Yuzpe regimen of emergency contraception.  Obstet Gynecol . 1999;  93 872-876
    CrossrefPubMedGoogle Scholar
  • 34 Protection of Human Subjects. OPRR Reports, Code of Federal Regulations 45CFR 46, March 8, 1983
  • 35 Hughes E C. Committee on Terminology, The American College of Obstetricians and Gynecologists, Obstetric-Gynecologic Terminology.  Philadelphia: F.A. Davis Company; 1972
    Google Scholar
  • 36 Statement on Contraceptive Methods. Washington DC: American College of Obstetricians and Gynecologists; July 1998
  • 37 Kennedy K I, Trussell J. Postpartum contraception and lactation. In: Hatcher RA, Trussell J, Stewart F, et al, eds. Contraceptive Technology 17th revised ed. New York: Ardent Media; 1998
    Google Scholar
  • 38 Trussell J, Ellertson C. Efficacy of emergency contraception.  Fert Control Rev . 1995;  4 8-11
    PubMedGoogle Scholar
  • 39 Farley T MM, Rosenberg M J, Rowe P J, Chen J-H, Meirik O. Intrauterine devices and pelvic inflammatory disease: an international perspective.  Lancet . 1992;  339 785-788
    CrossrefPubMedGoogle Scholar
  • 40 Food and Drug Administration. Use of approved drugs for unlabeled indications.  FDA Drug Bull . 1982;  12 4-5
    PubMedGoogle Scholar
  • 41 Delbanco S F, Stewart F H, Koenig J D, Parker M L, Hoff T, McIntosh M. Are we making progress with emergency contraception: recent findings on American adults and health professionals.  J Am Med Wom Assoc . 1998 (suppl 2);  53 (242-246)
    PubMedGoogle Scholar
  • 42 Harper C, Ellertson C. The emergency contraceptive pill: a survey of knowledge and attitudes among students at Princeton University.  Am J Obstet Gynecol . 1995;  173 1438-1445
    CrossrefPubMedGoogle Scholar
  • 43 Glasier A, Baird D. The effects of self-administering emergency contraception.  N Engl J Med . 1998;  339 1-4
    CrossrefPubMedGoogle Scholar
  • 44 Kosunen E, Sihvo S, Hemminki E. Knowledge and use of hormonal emergency contraception in Finland.  Contraception . 1997;  55 153-157
    CrossrefPubMedGoogle Scholar
  • 45 Raine T, Harper C, Leon K, Darney P. Emergency contraception: advance provision in a young, high-risk clinic population.  Obstet Gynecol . 2000;  96 1-7
    CrossrefPubMedGoogle Scholar
  • 46 Trussell J, Bull J, Koenig J, Bass M, Allina A, Gamble V N. Call 1-888-NOT-2-LATE: promoting emergency contraception in the United States.  J Am Med Wom Assoc . 1998 (suppl 2);  53 (247-250)
    PubMedGoogle Scholar
  • 47 Ellertson C, Trussell J, Stewart F, Winikoff B. Should emergency contraceptive pills be available without prescription?.  J Am Med Wom Assoc . 1998 (suppl 2);  53 (226-232)
    PubMedGoogle Scholar
  • 48 American College of Obstetricians and Gynecologists press release, 14 February 2001. Available at: http://www.acog.org/ from_home/publications/press_releases/nr02-14-01.htm. Accessed February 14, 2001
  • 49 Center for Reproductive Law and Policy press release, 14 February 2001. Available at: http://www.crlp.org/ pr_01_214 ecpetition.html. Accessed February 14, 2001
    Google Scholar
  • 50 ``Groups push for over-the-counter emergency contraceptive pill,'' Associated Press, 13 February 2001. Available at: http://www.msnbc.com/news/530547.asp?cp1=1. Accessed February 14, 2001
    Google Scholar
  • 51 Wells E S, Hutchings J, Gardiner J S. Using pharmacies in Washington State to expand access to emergency contraception.  Fam Plann Perspect . 1998;  30 288-290
    PubMedGoogle Scholar
  • 52 The Henry J. Kaiser Family Foundation. Kaiser Daily Reproductive Health Report. Available at: http://report.kff.org/archive/repro/2001/1/kr010126.6.htm. Accessed February 14, 2001
  • 53 The Henry J. Kaiser Family Foundation. Available at: http://www.kff.org/content/2000/20001115a/. Accessed February 15, 2001
    Google Scholar
  • 54 Emergency Oral Contraception. ACOG Practice Patterns.  No. 3. Washington DC: The American College of Obstetricians and Gynecologists; December 1996
    Google Scholar
  • 55 Emergency Contraceptive Pills: Common Legal Questions about Prescribing, Dispensing, Repackaging, and Advertising. New York: The Center for Reproductive Law and Policy; 1999
  • 56 Wells E, Crook B, Muller N. Emergency Contraception: Resources for Providers.  Seattle, WA: Program for Appropriate Technology in Health; 1997
    Google Scholar
  • 57 Emergency Contraception: Client Materials for Diverse Audiences. Seattle, WA: Program for Appropriate Technology in Health; 1998
  • 58 Trussell J, Leveque J A, Koenig J D. The economic value of contraception: a comparison of 15 methods.  Am J Public Health . 1995;  85 494-503
    PubMedGoogle Scholar
  • 59 Trussell J, Koenig J, Stewart F, Darroch J E. Medical care cost savings from adolescent contraceptive use.  Fam Plann Perspect . 1997;  29 248-295
    PubMedGoogle Scholar
  • 60 Brown S S, Eisenberg L. The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families.  Washington, DC: National Academy Press; 1995
    Google Scholar
  • 61 Ellertson C, Koenig J, Trussell J, Bull J. How many U.S. women need emergency contraception?.  Contemp Ob Gyn . 1997;  42 102-128
    PubMedGoogle Scholar