Emergency Contraception – An Overview

Journal für Reproduktionsmedizin und Endokrinologie - Journal of Reproductive Medicine and Endocrinology 2015; 12 (4): 260-267

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Keywords: Cu-IUD,  emergency contraception,  Levonorgestrel,  mifepristone,  ulipristal acetate

The ability to control fertility through the use of effective and safe contraception is essential in preventive medicine. EC offers a second chance to prevent an unwanted pregnancy after the event of an UPSI, contraceptive failure or after rape. Health care providers should routinely and more frequently recognize and inform women about the risk of an unintended pregnancy and EC options to avoid this and women should be provided the correct information about the mechanism of action of various EC options. Lack of knowledge on the mechanisms of action obstructs wide spread access and use globally. Currently, the three most commonly licensed methods of EC are insertion of a Cu-IUD or the hormonal pills UPA 30 mg or LNG 1.5 mg. All EC methods are safe with almost no contraindications and minimal side effects. Considering that ovulation and the fertile window are difficult to assess, it is recommended that EC is administered after an UPSI, regardless of cycle day.
With an extremely low failure rate, the Cu-IUD is an attractive option for EC regardless of the woman’s weight or concomitant medication and has the additional propensity to serve as a long-term contraceptive after insertion including if further acts of UPSI should take place in the same cycle. A Cu-IUD inserted within 5 days after ovulation, or when not known 5 days after UPSI, should be the first method of choice if available and suitable. The additional post-ovulatory effect makes the Cu-IUD a superior EC method.
Of the available hormonal EC treatments, UPA 30 mg should be the first choice being the most effective option with a wider window of effect than LNG. UPA has the ability to delay or inhibit ovulation beyond the life span of sperm even when given at an advanced follicular phase when the risk of pregnancy is high. In comparison, LNG has a narrower window of effect on ovulation with no effect after LH has started to rise, but LNG in a dose of 1.5 mg is recommended where UPA is not available. It is of great importance that any ECP is administered as soon as possible after an UPSI since the risk of nearing an anticipated ovulation increases if treatment is delayed, should the timing be pre-ovulatory.
There is no evidence of teratogenic effects of currently available EC methods, although data on UPA is still scarce. It should be pointed out that an ECP is not as effective as regular contraception. There is an opportunity to introduce a long-term contraceptive method to a woman when she seeks EC, which preferably should be a non-user dependent option, such as a non-forgettable LARC.