Emergency Contraception Methods Research Articles

A qualitative exploration of emergency contraception users' willingness to select the copper IUD

Background The copper T intrauterine device (IUD) is an effective but underutilized method of emergency contraception (EC). This study investigates the factors influencing a woman's decision around which method of EC to select. Study Design In-depth interviews with 14 IUD and 14 oral EC users aged 18–30 years accessing public health clinics. Results Emergency contraception users associated long-term methods of contraception with long-term sexual relationships. Women were not aware of the possibility of using the copper IUD for EC. Cost was identified as a major barrier to accessing IUDs. Perceived side effects and impact on future pregnancies further influenced the EC method a participant selected. Conclusions Women think about contraception in the context of each separate relationship and not as a long-term individual plan. Most women were unaware of the copper IUD for EC. Furthermore, there is little discussion between women and their health-care providers around EC.

Examining barriers to emergency contraception use

Using a cross-sectional survey research design, this study examined barriers to emergency contraception (EC) use among a sample of 318 Turkish women. Only 34% of the respondents reported being aware of EC methods, and about 20% had actually used EC. More than 90% of the participant women considered use of EC methods as a sin. The results of the study showed that the major barriers to EC use are lack of awareness and common misconceptions about EC methods. This study highlights the need of education for Turkish women regarding EC to increase awareness and dispel misconceptions related to EC.

What influences young women to choose between the emergency contraceptive pill and an intrauterine device? A qualitative study

Objective To explore key factors influencing young women when choosing between two methods of emergency contraception (EC).Methods We interviewed 26 young women who accessed community sexual and reproductive health services for emergency contraception after they had chosen an EC.Results Most women had an unrealistically high expectation about efficacy of the emergency contraceptive pill (ECP) and lacked knowledge of the intrauterine device (IUD) as an alternative method of EC. Previous use, easy accessibility, ease of use, and advice from peers, influenced women to choose the ECP, whereas past experience of abortion, firm motivation to avoid pregnancy, presentation after 72 hours, and considering that an IUD may provide long-term contraception as well, inclined women to choose the IUD. When participants were shown the IUD, many found it to be smaller and less frightening than they had imagined.Conclusions Women need better information and education about the IUD as a highly effective method of EC. Health professionals must provide such information at every opportunity. Showing the IUD during counselling might help correct misconceptions and would improve acceptability. Wider availability of expertise concerning EC-IUDs is essential to assist more women in making informed decisions when choosing a method for EC.

Emergency contraception in the context of marriage in Upper Egypt

Objective To explore the degree of knowledge, perception, and practice of emergency contraception (EC) within marital relations in Egypt. Methods The present study was a pilot cross-sectional survey. Eligible participants were randomly selected from 4 governorates in Upper Egypt. A questionnaire was designed by the investigators and administered to an unselected sample of healthcare providers and potential users of EC. The questionnaire collected information in 4 domains: demographics; knowledge about EC; attitudes toward EC; and practice of EC in Egypt. Results In total, 240 healthcare providers and 60 potential users of EC completed the questionnaire. Approximately 85% of healthcare providers and 30% of potential users had heard about EC. A similar proportion of study participants said that EC methods are needed. Only 32.7% of healthcare providers and very few potential users had actually used EC. Conclusion There is a need for EC in Egypt. However, a big gap in knowledge leads to nonuse or incorrect use of EC and negative attitude toward it. If health service planners and policy makers could fill this gap, a considerable decline in the prevalence of unwanted pregnancy may be achieved by using EC.

Effect on pregnancy rates of the delay in the administration of levonorgestrel for emergency contraception: a combined analysis of four WHO trials

Background Levonorgestrel is an effective method for emergency contraception (EC) and is used worldwide. Consistent with its mechanism of action in delaying ovulation, the earlier it is administered within 72 h of an unprotected act of intercourse, the more effective it is. There is uncertainty, however, about its effectiveness after 72 h. This analysis explores the effect of 24-h intervals of delay in levonorgestrel administration on pregnancy rates when used until 120 h of an unprotected act of intercourse. Study Design Data were analyzed from 6794 women participating in four World Health Organization randomized trials and receiving 1.5 mg of levonorgestrel for EC in a single dose or split into two doses 12 h apart, within 48, 72 or 120 h of an act of unprotected intercourse. The pregnancy rates among women in successive days after an unprotected act of intercourse and odds ratios of pregnancy were calculated using logistic regression with the first day as the reference. Results For the four trials combined, odds ratios for pregnancy in the second, third and fourth day with respect to the first day were not significantly different from 1 at the 5% level of significance. On the fifth day, the odds ratio of pregnancy compared to the first day was almost 6. Conclusions Levonorgestrel for EC should be administered as soon as possible after unprotected intercourse. Delaying levonorgestrel administration until the fifth day after unprotected intercourse increases the risk of pregnancy over five times compared with administration within 24 h. It is uncertain whether levonorgestrel administration on the fifth day still offers some protection against unwanted pregnancy.

A survey of women obtaining emergency contraception: are they interested in using the copper IUD?

Background This study aims to determine if women presenting for emergency contraception (EC) at family planning clinics may be interested in using the copper intrauterine device (IUD) for EC. Study Design This convenience sample survey was offered to women who presented for EC at four participating clinics in urban Utah. Anonymous written questionnaires were distributed. The outcome variable of interest was interest in using the copper IUD for EC. Results Of survey respondents, 320 (34.0%) of 941 said they would be interested in an EC method that was long term, highly effective and reversible. Interested women were not significantly different from noninterested women in relation to age, marital status, education, household income, gravidity, previous abortions, previous sexually transmitted infections (STIs) or relationship status. One hundred twenty women (37.5% of those interested or 12.8% of all those surveyed) would wait an hour, undergo a pelvic exam to get the method and would still want the method knowing it was an IUD. However, only 12.3% of these women could also pay $350 or more for the device. Multivariable regression found the following predictors of interest in the IUD among EC users: non-Hispanic minorities (OR=2.12, 95% CI=1.14–3.93), desire to never be pregnant in the future (OR=2.87, 95% CI=1.38–5.66) and interest in adoption (OR=1.96, 95% CI=1.00–5.73) or abortion (OR=2.68, 95% CI=1.24–4.14) if pregnant when presenting for EC. Conclusion While one third of EC users surveyed at family planning clinics were interested in a long-term, highly effective method of contraception, only a small portion of all EC users may be interested in the copper IUD for EC. Cost is a potential barrier.

The future of women's contraception: stakes and modalities

The two main contraceptive methods are the combined pill and the intrauterine device. In several countries, sterilization is a commonly used alternative. The current goals of contraception remain to achieve effective, accessible, reversible, and well-tolerated birth control for everyone. Despite progress, these goals have not been reached. To achieve these goals, it is mandatory to create new hormonal combinations and to discover new contraceptive targets. Recent innovations associate the development of new progestogens, selective progesterone receptor modulators, and the creation of new contraceptive combinations. Other innovations involve the use of natural estrogens but also optimizing existing treatment regimens and doses, as well as the development of new methods of emergency contraception. Finally, a major step will be to invent an efficient contraceptive that carries the lowest possible risk associated with methods protecting against sexually transmitted diseases. In the future, in relation to progress in the fields of genomics, proteomics, and immunology, new methods of contraception will be developed. These methods will be more targeted and will eventually be nonhormonal and independent of sexual activity.

Copper T380A intrauterine device for emergency contraception: a prospective, multicentre, cohort clinical trial

Please cite this paper as: Wu S, Godfrey E, Wojdyla D, Dong J, Cong J, Wang C, von Hertzen H. Copper T380A intrauterine device for emergency contraception: a prospective, multicentre, cohort clinical trial. BJOG 2010;117:1205–1210.Objective To determine the effectiveness of the Copper T380A (CuT380A) intrauterine device (IUD) as an emergency contraceptive in women.Design Prospective, multicentre, cohort clinical trial.Setting Eighteen family planning clinics in China.Sample A cohort of 1963 women, aged 18–44 years, requesting emergency contraception within 120 hours of unprotected sexual intercourse.Methods Women requesting emergency contraception were followed at 1, 3 and 12 months after the insertion of CuT380A.Main outcome measures Efficacy of CuT380A as emergency contraception and for up to 12 months of postinsertion use. Insertion complication rates, reported side‐effects and continuation rates at 12 months were also recorded.Results No pregnancies occurred prior to or at the first follow‐up visit, making CuT380A 100% effective as emergency contraception in this study. The pregnancy rate over the 12‐month period was 0.23 per 100 women. In all, 29 (1.5%) women experienced a difficult IUD insertion process, requiring local anaesthesia or prophylactic antibiotics. No uterine perforations occurred. The main side‐effects were increased menstrual bleeding and menstrual disturbances. The 12‐month postinsertion continuation rate was 94.0 per 100 woman‐years.Conclusions CuT380A is a safe and effective method for emergency contraception. The advantages of CuT380A include its ability to provide effective, long‐term contraception.

Emergency contraception

Emergency contraception (EC) is an effective way to prevent an unintended or unplanned pregnancy. EC is available in two forms in Canada: a progestin-only method and a combined hormonal method, also known as the Yuzpe regimen. EC has been proven to be most effective within 72 h and up to 120 h after unprotected sexual intercourse. To date, the progestin-only method is the preferred method of EC recommended to teens because it is known for higher efficacy and fewer side effects, and is, therefore, more widely accepted over the combined method. Teens should also be counselled that the progestin-only method is widely available without a doctor’s prescription across Canada.

Immediate pre-ovulatory administration of 30 mg ulipristal acetate significantly delays follicular rupture

Current methods of hormonal emergency contraception (EC) are ineffective in preventing follicular rupture when administered in the advanced pre-ovulatory phase. This study was designed to determine the capacity of ulipristal acetate (UPA), a selective progesterone receptor modulator developed for EC, to block follicular rupture when administered with a follicle of >or=18 mm. This was a double-blind, crossover, randomized, placebo-controlled study. Thirty-five women contributed with UPA (30 mg. oral) and a placebo cycle. Serial blood sampling for luteinizing hormone (LH), estradiol and progesterone measurements and follicular monitoring by ultrasound were performed before and for 5 days following treatment. Follicular rupture inhibition was assessed in the overall study population and in subgroups of women stratified by when treatment was administered in relation to LH levels (before the onset of the LH surge, after the onset of the surge but before the LH peak or after the LH peak). Follicular rupture failed to occur for at least 5 days following UPA administration in 20/34 cycles [59%; 95% confidence interval (CI) (40.7-75.4%)], whereas rupture took place in all cycles within 5 days of placebo intake. When UPA was administered before the onset of the LH surge, or after the onset but before the LH peak, follicle rupture had not occurred within 5 days in 8/8 (100%) and 11/14 [78.6%; 95% CI (49.2-95.3)] cycles, respectively. In contrast, when UPA was given after the LH peak, follicle rupture inhibition was only observed in 1/12 [8.3%; 95% CI (0.2-38.5)] cycles. This study demonstrates that UPA can significantly delay follicular rupture when given immediately before ovulation. This new generation EC compound could possibly prevent pregnancy when administered in the advanced follicular phase, even if LH levels have already begun to rise, a time when levonorgestrel EC is no longer effective in inhibiting ovulation.

Pattern of use of emergency oral contraception among Portuguese women

This study describes the purchasers' profile and characterizes the pattern of use of emergency oral contraception among pharmacy users. The study was carried out in 455 Portuguese pharmacies. A cross-sectional study was undertaken in which pharmacists selected the first six purchasers of emergency oral contraception between May and June of 2006. Only user-purchasers were eligible to answer the questions about emergency oral contraception use. Participants completed a questionnaire on sociodemographic data and variables concerning contraceptive methods (including the emergency oral contraceptive acquired, the source of information about the availability of this emergency contraceptive method, prior use of emergency oral contraception, the frequency of use in the current cycle, the frequency of use in the preceding year, the time elapsed between unprotected sexual intercourse and the acquisition of emergency oral contraception, the reason for use and the regular method of contraception used). Although these drugs are available outside pharmacies--in some shops and supermarkets--their pattern of use was only assessed among pharmacy users. Descriptive statistics were used to characterize data. Prevalence of correct use, which was defined as the proportion of user-purchasers who acquired emergency oral contraception up to 72 h after unprotected sexual intercourse and had never used it in the current cycle. The sample comprised 1466 user-purchasers (72.6%) and 552 purchasers for another person's use (27.4%). Levonorgestrel-only contraceptives represented 96.1% of the emergency oral contraception acquired. User-purchasers aged between 18 and 30 represented 65.2% and 42.3% had attended secondary school. The majority of them (79.5%) were using a regular method of contraception and 62.6% were first-time users of emergency oral contraception. In 59.0% of the situations the reason for use was failure of the contraceptive used. Emergency oral contraception was used correctly by 96.9% of user-purchasers.

Knowledge and Awareness of Emergency Contraception in Adolescents

Study Objective The purpose of this study was to (1) describe the awareness of emergency contraception among adolescent females, (2) identify factors that are associated with accurate knowledge of emergency contraception and (3) describe prior use of emergency contraception among adolescent females. Design Cross-sectional study. Setting The study procedures were carried out at Kapiolani Medical Center's Teen Clinic in Honolulu, Hawaii, which is comprised of an ambulatory university-based resident clinic. Participants English-speaking females who were between the ages of 14 and 19 were invited to participate. Interventions This study utilized a self-administered, anonymous survey that contained questions regarding emergency contraception as well as questions on reproductive and sexual health. Main Outcome Measure The primary outcome was percentage of adolescent women who were aware of emergency contraceptives. Results A total of 100 surveys were distributed and collected. Fifty-six percent of respondents had an awareness of emergency contraception and 69.6% of these adolescents were able to correctly list an emergency contraceptive method. Older teens were more likely to have an awareness of emergency contraception but we did not find any other factors that were associated with accurate knowledge of emergency contraception. Adolescents who had used emergency contraception in the past found it to be acceptable. Conclusions Despite being at high risk for unintended pregnancy, adolescents in this population had lower rates of emergency contraceptive awareness in than has been reported in adults.

Gestrinone Compared With Mifepristone for Emergency Contraception

To compare the efficacy of gestrinone with that of mifepristone for emergency contraception. A randomized double-blind trial was conducted in five family-planning clinics in China. We randomly assigned 998 healthy women with regular menstrual cycles and negative urine pregnancy tests who were requesting emergency contraception up to 72 hours after unprotected coitus to receive single-dose 10 mg gestrinone (n=499) or 10 mg mifepristone (n=499). We monitored them to 7 days after the expected first day of their next menstrual period. The study was powered to detect a 5% failure rate between the two regimens. The treatment groups did not differ significantly; posttreatment pregnancy rates were 2.4% in the gestrinone group compared with 1.8% in the mifepristone group (P=.51). The majority of women menstruated the first day of expected menses, and groups did not differ regarding side effects. The effectiveness of 10 mg gestrinone is not significantly different from 10 mg mifepristone as an emergency contraceptive method. ISRCTN Register, isrctn.org, ISRCTN87842530. I.

Le médecin généraliste et l’oubli de pilule

To explore general practitioners' (GPs) practice face of missed pill and prevention of such missings. Twenty-five GPs from Sarthe Department (Western France) took part in semistructured interview during which they expressed themselves on the prevention of missed pill and its consequences. Twelve out of 20 physicians stated positively that their female patients often forget their pill. However, they noted that missed pill was seldom a reason for phone call or consultation. During the initial pill prescription, GPs insisted on how to take the pill (14/25) as well as advice in case of a missed pill (22/25), their availability (12/25) and the instruction leaflet (16/25). But only five quoted the importance of involving women in the choice of contraception. On prescription renewal, only nine out of 25 ask their patients about observance defect and eight out of 25 repeated the information. If patients asked for further explanation, only two doctors out of 25 had practices in line with the French National Authority for Health's (HAS) recommandation guidelines. GPs' attitudes are partly due to a lack of practice's knowledge in primary and emergency contraception methods. It seems essential to promote GPs' training and to take into account their expectations and needs. Furthermore, female patient must be actor of the choice of her contraceptive method in order to improve compliance and, therefore, effectiveness.

Breaking the barriers to emergency contraception access in the USA: the time has come

Levonorgestrel (Plan B®) was approved as an over-the-counter medication for emergency contraception in 2006, but barriers to access still exist. Several studies have shown that emergency contraception does not increase promiscuity nor decrease condom use, but these erroneous beliefs are still widely held. Myths and political controversy about emergency contraception have limited its access to adolescent girls, despite its demonstrated safety and effectiveness. Other methods of emergency contraception, such as mifepristone, may actually be more effective in preventing unplanned pregnancies, but further research in the USA for this indication needs to be performed. Finally, while it is important to increase access to emergency contraception, it should not replace the promotion of long-acting reversible contraception.

Emergency Contraception: Update and Review

Emergency contraception (EC) is the postcoital method of pregnancy prevention. Three methods of EC are used in the United States: (1) levonorgestrel-only pills, Plan B (Barr Pharmaceuticals, LLC, New Jersey) (2) combined estrogen and progestin pills, and (3) the copper intrauterine device. Used within 120 hours after unprotected sexual intercourse, EC reduces the risk of pregnancy by 60 to 94%. EC is a critical component of medical care for sexual assault survivors, and several states have laws mandating this standard of care. Levonorgestrel-only EC is available to women >or=17 years of age without a prescription. Women who were counseled by their clinician about EC were 11 times more likely to use EC in the following 12 months. Advance provision of EC to women has not been found to decrease rates of unintended pregnancy compared with routine pharmacy access; however, women routinely prefer advance provision. The newly approved by the Food and Drug Administration single-dose EC, Plan B One-Step (Barr Pharmaceuticals, LLC), may affect unintended pregnancy rates among EC users by simplifying use.

Contraception in the perimenopause – old and new

This review article discusses contraception for women in the perimenopause phase - the final period which is characterized by menstrual irregularity and the onset of menopausal symptoms such as hot flushes. It addresses the subject of choosing and using the appropriate contraception as well as discontinuing contraception. More specific information is provided on the different contraceptive options including: combined hormonal contraception progestogen-only contraception emergency contraception and barrier methods.

Awareness and use of emergency contraception by students of Federal University of Technology, Owerri

Questionnaires were distributed to 335 randomly selected female students of Federal University of Technology Owerri in order to determine the awareness, knowledge and sources of information on emergency contraception. It was found that 29.5% of the respondents had had an induced abortion while 74.6% had used family planning .The percentage that correctly identified postinor, oral contraceptive and intra uterine contraceptive as methods of emergency contraception was 9;15.7; and 4.3 % respectively. Only 16.5% knew the correct timing of emergency contraception and the main sources of information were doctors (19%) and pharmacists (15.8%) The potential benefits of emergency contraception remain largely untapped .It is suggested that all fresh students should be given talks on family planning as part of their orientation .

Comparison of contraceptive choices of rural and urban US adults aged 18-55 years: an analysis of 2004 behavioral risk factor surveillance survey data

Although sexually active US adults wanting to prevent pregnancy have a wide variety of birth control methods readily available, there is little research that documents the contraceptive choices of rural adults in comparison to urban adults. This study compared the contraceptive choices of rural with urban adults. The comparative analysis joins the recent dialog in population health focused on assessing health related differences to detect if these are indicative of rural health disparities. This was a cross-sectional study analyzing 2004 Behavioral Risk Factor Surveillance Survey (BRFSS) data. Place of residence was ascertained by re-coding the state/county FIPS code as either urban or rural, based on 2003 Rural-Urban Continuum Codes from the US Office of Management and Budget (setting: US households; participants: US adults 18-55 years). characteristics and contraceptive method choice of rural adults using birth control. A multivariate regression model performed with 'use of birth control' as the dependent variable yielded that rural in comparison with urban adults 18-55 years were more likely to use female or male sterilization, non-injectable and injectable hormones for birth control. They were less likely to use: condoms, a diaphragm or NuvaRing, emergency contraception, withdrawal or rhythm methods. Additionally, in comparison with urban adults, rural persons younger than 35 years, those who had children younger than 18 years living with them, those who were partnered, males and those living in households with an income of less than US$35,000 were more likely to report using some form of contraception. There were differences in the contraception choices of urban and rural adults. How much primary care provider preferences explains the differences is not known and bears further exploration. These results should prove useful to healthcare providers as well as public health family planning programs.

Developments and challenges in emergency contraception

Emergency contraception (EC) methods, available in oral and intra-uterine forms, seek to prevent pregnancy after unprotected intercourse or contraceptive failure. Levonorgestrel EC is more effective and has fewer side effects than the previously used combined oral hormonal method; the Yuzpe regimen. In recent years, levonorgestrel has increased in use, and has become available over the counter in pharmacies in many countries. Compared with oral methods, the copper intra-uterine device offers greater protection against unplanned pregnancy but requires a clinical consultation. The much hoped for potential of EC methods to reduce unintended pregnancy is yet to be demonstrated at population level.