Emergency contraception (hormonal)

Emergency contraception (EC) is used for providing safe means of preventing pregnancy following unprotected sexual intercourse or potential contraceptive failure (although the terms ‘post-coital contraception’ or ‘the morning-after pill’ are used it may be misleading hence the term emergency contraception is the preferred term).

Advance prescribing increases its use without increasing STIs or sexual risk-taking, even among adolescents (1)

• it is estimated that 40% of all pregnancies are unplanned out of which 60% end up as abortions
• around 53 million abortions are being performed each year throughout the world
• a higher rates of unplanned pregnancies and abortions are reported in the UK when compared to other European countries (2)
  • 200,000 pregnancies in the UK end in termination
  • around 90,000 teenagers become pregnant in England out of which there are 56,000 live birth
    • 2,200 are to girls aged 14 or under and 7,700 are to under 16 years age (3)
• primary care is responsible for issuing around a third of all EC prescriptions (2)

There are 4 types; (4)

• Progestogen-only emergency contraception (levonorgestrel)
• Selective progesterone-receptor modulator (ulipristal)
• Copper IUD
• Oestrogen/progestogen emergency contraception (Yuzpe regimen).

The levenorgestrel (LNG)-only postcoital contraception; this method has fewer side-effects than the previously used combined hormonal preparation (Schering PC4)

• criteria for use (5):
  • any individual presenting for emergency contraception (EC) between 0 and 96 hours following UPSI or when regular contraception has been compromised or used incorrectly.
  • no contraindications to the medication
  • informed consent given
  • see linked item below
    
    

• ulipristal acetate (ellaOne) (6):
  • is a selective progesterone-receptor modulator that seems to be as effective as levonorgestrel for prevention of pregnancy. Ulipristal acetate may be used up to 120h after unprotected sexual intercourse or contraceptive failure
  • orally active and taken as a single dose
  • more detailed information about ulipristal acetate is provided in the linked menu item
    
    
• intra-uterine contraceptive device - failure rate of 0.1% and efficacious up to 5 days after unprotected intercourse. It has the advantage of being an ongoing contraceptive but may be less suited for nulliparous women who wish children in the future.

In all cases, follow up is essential and should occur 3-4 weeks after the initial treatment.

For hormonal emergency contraception, taking the first dose as soon as possible following unprotected sexual intercourse increases efficacy (7).

References:

1. Meyer JL, Gold MA, Haggerty CL. Advance provision of emergency contraception among adolescent and young adult women: a systematic review of literature. J Pediatr Adolesc Gynecol. 2011 Feb;24(1):2-9.
2. Masson C. Emergency contraception. InnovAiT2011;4(5)
3. Sharma A. Emergency contraception. BJMP 2009: 2(3) 64-65
4. American College of Obstetricians and Gynecologists. Practice bulletin no. 152: emergency contraception. Sep 2015 [internet publication].
5. Patient Group Direction (PGD) (NHS Specialist Pharmacy Service). Supply and/or administration of levonorgestrel 1500micrograms tablet(s) for emergency contraception.
6. Patient Group Direction (PGD) (NHS Specialist Pharmacy Service). Supply and/or administration of ulipristal acetate 30mg tablet for emergency contraception.
7. Piaggio G, Kapp N, von Hertzen H. Effect on pregnancy rates of the delay in the administration of levonorgestrel for emergency contraception: a combined analysis of four WHO trials. Contraception. 2011 Jul;84(1):35-9.