Emergency Contraception

Journal für Reproduktionsmedizin und Endokrinologie - Journal of Reproductive Medicine and Endocrinology 2010; 7 (Sonderheft 1): 73-77

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Keywords: Kontrazeption,  Levonorgestrel,  contraception,  morning after pill

There have been numerous attempts to control fertility after unprotected sexual intercourse. From very bizarre methods like the vaginal application of Coca Cola to the more serious attempts using calcium antagonists influencing fertility parameters in sperm to hormonal methods or intrauterine devices. So far, hormonal methods preventing or delaying ovulation have proved to be the most popular starting with the combination of ethinyl estradiol and levonorgestrel, known as the Yuzpe regimen. The first dose had to be taken within 72 hours of unprotected intercourse, a second one 12 hours later. Later on, levonorgestrel alone, at first in a regimen similar to the Yuzpe method (2 × 0.75 mg 12 hours apart) showed to be more successful, eventually resulting in the development of a 1.5 mg levonorgestrel pill that combined good efficacy with a high ease of use. It has become the standard method used up to this day in most countries. Since the mid 1970s copper IUDs have been used for emergency contraception, which show a high efficacy. Their disadvantages lie in the fact that emergency contraception is considered an off label use and that they might not be acceptable for every patient. Mifepristone in doses of 10 or 25 mg is being used successfully as an emergency contraceptive in China, but has never received any significant consideration in Western countries. The most recent development is the approval of the selective progesterone receptor modulator ulipristal acetate in the dosage of 30 mg for emergency contraception up to 5 days after unprotected intercourse, combining the safe and easy application of the single dose levonorgestrel pill with an even higher efficacy. Several efficacious and easy to use methods for emergency contraception are available on the market today with the most widely spread being levonorgestrel in a single dose of 1.5 mg (given as one tablet of 1.5 mg or 2 tablets of 0.75 mg each) for administration up to 3 days after unprotected intercourse. Its limitations are the non-optimal efficacy which is decreasing the later the drug is taken and the fact that it can only be used for up to 72 hours after UPSI. Mifepristone in the dosages of 10 or 25 mg is used with good results as an emergency contraceptive in China for up to 120 hours after unprotected intercourse. Recently the selective progesterone receptor modulator (SPRM) ulipristal acetate in the dose of 30 mg has been introduced in Europe for emergency contraception. It has shown to be more efficacious than levonorgestrel and can be used for up to 120 hours after unprotected intercourse. Independent of the substance it should be noted that, if there is a choice, the intake of an oral emergency contraceptive pill should happen as soon as possible after the risk situation.