Progestin-only methods of postcoital contraception were first introduced to the US market under the name Plan B the initial Plan B product consisted of two tablets of 0.75 mg of levonorgestrel taken 12 hours apart. All three methods are safe for the vast majority of women, and are safe for repeated use. 83,84 Preven, a combined estrogen and progestin method, was FDA approved as a dedicated product for postcoital contraception, but is no longer on the market in the United States.Ĭurrently available emergency contraceptive methods include levonorgestrel, ulipristal acetate, and the copper IUD. Studies demonstrated that this regimen had similar efficacy and decreased adverse side effects when compared with the 5-day estrogen regimens.
Two pills, each containing 0.05 mg ethinyl estradiol and 0.5 mg levonorgestrel, were given at two time points, 12 hours apart.
The Yuzpe method, developed in Canada in the 1970s, initially used four doses of the Ovral oral contraceptive pill. 82 If more than one act of intercourse occurred, or if the treatment was delayed, efficacy was decreased. If treatment was initiated within 72 hours of an isolated midcycle act of intercourse, the efficacy was estimated at 75%. The original methods of postcoital contraception consisted of 5 days of treatment with high doses of estrogen compounds. Both hormonal methods and the ParaGard IUD can be used as effective postcoital contraception. For women who have had known unprotected intercourse (did not use or inconsistently used a primary method of contraception, or had a known or suspected failure of a barrier method), postcoital contraception provides a second opportunity to prevent pregnancy. Postcoital contraception, also known as emergency contraception or the “morning after pill,” is a method used after unprotected acts of intercourse. Method efficacy is limited by patient BMI, and only copper IUDs have been demonstrated as effective in women of all weights. ◆Īll methods are most effective within 24 hours of unprotected intercourse copper IUDs may be used for up to 5 days following unprotected intercourse. Levonorgestrel and ulipristal acetate tablets, as well as copper IUDs, are postcoital contraceptive methods available in the United States. A single report of retinal vein thrombosis after emergency contraception is to be found in the older literature ( 49 A). The high concentrations of factor VIII could have increased the risk of thrombosis in this case. She had low concentrations of antithrombin III and persistently high concentrations of factor VIII. She was successfully treated with heparin followed by oral anticoagulation. Magnetic resonance imaging (MRI) showed thrombosis of the superior sagittal, right transverse and right sigmoid sinuses. She took the same course at least three times more during the months that followed. Eight months before, after unprotected coitus, she had taken the Yuzpe regimen, involving two doses of ethinylestradiol 0.1 mg combined with levonorgestrel 0.5 mg, the doses being taken 12 hours apart. Ī 45-year-old woman developed progressive headache, blurred vision and vomiting over 2 weeks and had papilledema.Such a case has been described, in which repeated use of this method was followed by cerebral venous thrombosis ( 48 A).
However, it remains a technique that should probably be used only in exceptional circumstances, and one might expect its repeated or routine use to have certain ill effects, especially in patients predisposed to thrombotic or other complications. Apart from nausea and vomiting, which are common after the use of ‘morning-after pill’, emergency contraception is reasonably well tolerated.
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