Emergency Contraception Options Research Articles

Emergency contraception: society of family planning clinical recommendation (2023)

Emergency contraception (EC) refers to several contraceptive options that can be used within a few days after unprotected or under protected intercourse or sexual assault to reduce the risk of pregnancy. Current EC options available in the United States include the copper intrauterine device (IUD), levonorgestrel (LNG) 52 mg IUD, oral LNG, and oral ulipristal acetate (UPА).
 These clinical recommendations review the indications, effectiveness, safety, and side effects of emergency contraceptive methods; considerations for the use of EC by specific patient populations and in specific clinical circumstances and current barriers to emergency contraceptive access. Further research is needed to evaluate the effectiveness of LNG IUDs for emergency contraceptive use; address the effects of repeated use of UPА at different times in the same menstrual cycle; assess the impact on ovulation of initiating or reinitiating different regimens of regular hormonal contraception following UPА use; and elucidate effective emergency contraceptive pill options by body mass indices or weight.

Forensic Nurses' Understanding of Emergency Contraception Mechanisms: Implications for Access to Emergency Contraception.

An estimated 25,000 pregnancies result from sexual assault in the United States annually. Numerous professional healthcare organizations endorse offering emergency contraception (EC) as an integrated aspect of post-sexual-assault care. Lack of knowledge surrounding EC's mechanism of action, including misinterpreting ECs as abortifacients, might restrict patient access to this important healthcare option. We evaluated sexual assault nurse examiners' understanding of the mechanism of action of oral ECs levonorgestrel (LNG) and ulipristal acetate (UPA). A cross-sectional survey of practicing sexual assault nurse examiners was conducted through the International Association of Forensic Nurses. Among 173 respondents, 96.53% reported they prescribed/dispensed EC at the time of medical forensic examinations. LNG was prescribed more frequently than UPA (57.80% vs. 38.2%, respectively). When asked if they agreed or disagreed if LNG and UPA can disrupt an established pregnancy, 83.2% selected disagree/strongly disagree for LNG versus 78.6% for UPA, which were not significantly different. When asked whether the Supreme Court ruling overturning Roe v. Wade would change their EC prescribing, 79.77% reported it will have no change, 6.94% said it would increase, and 12.72% reported they were unsure. Several commented they were concerned whether state laws would prohibit EC and at least one program stopped prescribing EC because of their state laws. Addressing misinformation regarding EC's mechanism of action and increasing access to oral EC options after sexual assault have the potential to reduce the incidence of rape-related pregnancy.

Educational Intervention Among Adolescents and Young Adults on Emergency Contraception Options

PurposeEmergency contraception (EC), the ‘last chance’ contraceptive method, has gained significance post-Roe, but most young people do not know their options. MethodsWe conducted an educational intervention on EC among 1,053 students aged 18–25 years. We assessed changes in knowledge of key aspects of EC using generalized estimating equations. ResultsAt baseline, virtually no one was aware of the intrauterine device for EC (4%), but postintervention, 89% correctly identified intrauterine devices as the most effective EC (adjusted odds ratio [aOR] = 116.6; 95% confidence interval [CI] 62.4, 217.8). Knowledge that levonorgestrel pills could be accessed without a prescription grew (60%–90%; aOR = 9.7, 95% CI 6.7–14.0), as did knowledge that pills work best when taken as soon as possible (75%–95%; aOR = 9.6, 95% CI 6.1–14.9). Multivariate results showed adolescent and young adult participants absorbed these key concepts across age, gender, and sexual orientation. DiscussionTimely interventions are needed to empower youth with knowledge of EC options.

The key role of hepatology providers in optimizing reproductive care in patients with liver disease: A call to action.

The key role of hepatology providers in optimizing reproductive care in patients with liver disease: A call to action.

Contraception: assessing immediate contraceptive needs.

Unintended pregnancies are linked to multiple poor maternal and child outcomes. In Britain one in six pregnancies is unplanned (Wellings et al, 2013). Each time a patient presents to hospital, there is an opportunity to address any unmet contraceptive needs, giving patients greater control over pregnancy planning. This article outlines the three options for emergency contraception and discusses simple options for starting an ongoing, regular method of contraception in hospital. The authors recommend signposting patients to online information sources, sexual health centres or their GP for further management.

P060Utilization of larc methods at the time of emergency contraception visit: A prospective observational study

<h3>Objectives</h3> To compare long-acting reversible contraceptive (LARC) method initiation by device at time of emergency contraception (EC) request. <h3>Methods</h3> All clients who presented to four Planned Parenthood Association of Utah clinics for EC from February 2021 to April 2022 received printed information about three LARC options for EC in addition to oral options. LARC options included the copper T380A intrauterine device (IUD), 52 mg levonorgestrel (LNG) IUD, and the guideline-supported option for oral LNG with same-day etonogestrel (ENG) implant. Participants were aged 18–35, who reported unprotected intercourse within five days with negative pregnancy testing. We assessed demographic variables associated with method selection and reasons for method choice. LARC methods were available at no cost. <h3>Results</h3> A total of 194 EC clients (18% of 1,086 approached) requested LARC and 187 qualified: 24% (n=44) selected a copper IUD, 23% (n=43) a 52 mg LNG IUD, and 54% (n=100) an ENG implant and oral LNG. ENG implant users were younger (22.9) than those selecting the LNG IUD (25.4) or copper IUD (25.9, p<0.01). Copper IUD users had a lower mean BMI (24.0) than those selecting an LNG IUD (27.0) or ENG implant and oral LNG (27.1, p=0.01). Commonly cited reasons for choosing ENG implant and oral LNG included having friends using the same method (30.0%), wanting fewer side effects (20.0%), and wanting lighter or no bleeding (18.0%). <h3>Conclusions</h3> In this observational study of EC clients desiring LARC, participants more frequently selected the ENG implant with oral LNG over either IUD, despite a lack of EC efficacy data for the ENG implant with oral LNG.

Contraception

Most individuals will wish to avoid pregnancy for some part of their reproductive years. A variety of hormonal and nonhormonal contraceptive methods are available, which have different characteristics related to systemic effects, bleeding patterns, and effort required on the user’s part. The goal of contraceptive counseling is to identify a method that is safe and compatible with the individual’s preferences. Clinicians may often be able to help patients initiate contraception on the day of the initial office visit. They should remain available and supportive to patients who wish to switch methods and provide comprehensive counseling for all available contraceptive methods as well as emergency contraception options. This review contains 8 figures, 7 tables and 51 references Keywords: birth control, contraception, emergency contraception, Essure, hysteroscopy, interval, laparoscopy, microinserts, postpartum, salpingectomy, sterilization

Contraception

Most individuals will wish to avoid pregnancy for some part of their reproductive years. A variety of hormonal and nonhormonal contraceptive methods are available, which have different characteristics related to systemic effects, bleeding patterns, and effort required on the user’s part. The goal of contraceptive counseling is to identify a method that is safe and compatible with the individual’s preferences. Clinicians may often be able to help patients initiate contraception on the day of the initial office visit. They should remain available and supportive to patients who wish to switch methods and provide comprehensive counseling for all available contraceptive methods as well as emergency contraception options. This review contains 8 figures, 7 tables and 51 references Keywords: birth control, contraception, emergency contraception, Essure, hysteroscopy, interval, laparoscopy, microinserts, postpartum, salpingectomy, sterilization

Contraception

Most individuals will wish to avoid pregnancy for some part of their reproductive years. A variety of hormonal and nonhormonal contraceptive methods are available, which have different characteristics related to systemic effects, bleeding patterns, and effort required on the user’s part. The goal of contraceptive counseling is to identify a method that is safe and compatible with the individual’s preferences. Clinicians may often be able to help patients initiate contraception on the day of the initial office visit. They should remain available and supportive to patients who wish to switch methods and provide comprehensive counseling for all available contraceptive methods as well as emergency contraception options. This review contains 8 figures, 7 tables and 51 references Keywords: birth control, contraception, emergency contraception, Essure, hysteroscopy, interval, laparoscopy, microinserts, postpartum, salpingectomy, sterilization

Contraception

Most individuals will wish to avoid pregnancy for some part of their reproductive years. A variety of hormonal and nonhormonal contraceptive methods are available, which have different characteristics related to systemic effects, bleeding patterns, and effort required on the user’s part. The goal of contraceptive counseling is to identify a method that is safe and compatible with the individual’s preferences. Clinicians may often be able to help patients initiate contraception on the day of the initial office visit. They should remain available and supportive to patients who wish to switch methods and provide comprehensive counseling for all available contraceptive methods as well as emergency contraception options. This review contains 8 figures, 7 tables and 51 references Keywords: birth control, contraception, emergency contraception, Essure, hysteroscopy, interval, laparoscopy, microinserts, postpartum, salpingectomy, sterilization

Contraception in female travellers: challenges and solutions.

Contraception is an important issue for female travelers, but one that is often neglected in the pre-travel consult. Options have expanded in the 21st century. Travel medicine practitioners should have a basic understanding of the choices available to their female patients, as well as the advantages and disadvantages of each. This paper will review the contraceptive methods available to female travelers, including newer methods, and discuss emergency contraception options.

Emergency Contraception Counseling in California Community Pharmacies: A Mystery Caller Study.

This study was conducted to determine which emergency contraception (EC) methods are offered by community pharmacists in response to patient calls. Female mystery callers called all community pharmacies in two California cities using standardized scripts. The callers inquired about options available to prevent pregnancy after sex and whether that method was available at the pharmacy, using follow-up probes if necessary. A total of 239 calls were completed in San Diego (n = 127, 53%) and San Francisco (n = 112, 47%). Pharmacists indicated availability at most sites (n = 220, 92%) with option(s) reported as levonorgestrel only (LNG; n = 211, 88.3%), both ulipristal acetate (UPA) and LNG (n = 4, 1.6%), UPA only (n = 1, 0.4%), or non-specific EC (n = 4, 1.7%). Nineteen pharmacies (7.9%) did not have EC available on the day of the call. Following additional probing, some pharmacists discussed UPA (n = 49, 20.5%) or the copper intrauterine device (n = 1, 0.4%) as EC options. LNG EC products were available same-day in 90.1% of pharmacies, whereas UPA was available same-day in 9.6% of pharmacies. The majority of pharmacies called in this study offered and stocked at least one EC option, but the focus of discussions was on LNG and matched what was in stock and available.

Video counseling about emergency contraception: an observational study

ObjectiveThis study assesses emergency contraception (EC) dispensed before and after a 3-min video counseling intervention on EC. MethodsWe used a quasi-experimental design and two data sources to assess the impact of offering the video counseling intervention. We used electronic health records from six Planned Parenthood Association of Utah health centers with onsite oral EC dispensing to determine pre- and postintervention EC distribution. Beginning July 2015, three participating locations offered the video counseling intervention to English-speaking EC clients. These clients completed a brief survey assessing EC knowledge and uptake, providing a patient-level data source. We used a difference-in-difference analysis of the clinic-level data to assess the effect of the video counseling intervention. This analysis compares the variation in oral EC distribution between clinics offering the video intervention and clinics not offering the video counseling before and after the video counseling was introduced. Multivariable logistic regression assessed client characteristics associated with receiving ulipristal. ResultsThe six health centers served 8269 English-language EC clients during 2015. At participating sites, provision of ulipristal increased from 12% (269/2315) preintervention to 28% (627/2266) postintervention (p<.001). Nonparticipating sites did not see a change. Clients seeking EC at sites offering video counseling were more likely to receive ulipristal even after controlling for age, insurance and ethnicity (adjusted OR 3.4, 95% CI 3.0–3.9). Using the difference-in-difference analysis, the video counseling intervention accounted for an 18% (95% CI 14%–21%) increase in ulipristal provision at the participating health centers. Among the 2266 women seeking EC who were offered video counseling, 19% (425/2266) watched the video, and 60% (254/425) reported the video affected their EC preferences. Knowledge of the IUD for EC increased, but reported uptake of this method remained low (6.8%). ConclusionsExposure to video counseling increased use of more effective oral EC and increased knowledge about all EC options. ImplicationsUse of a brief informational video about EC options at family planning clinics may increase the proportion of EC clients receiving more effective EC methods.

Cost-effectiveness of emergency contraception options over 1 year

The copper intrauterine device is the most effective form of emergency contraception and can also provide long-term contraception. The levonorgestrel intrauterine device has also been studied in combination with oral levonorgestrel for women seeking emergency contraception. However, intrauterine devices have higher up-front costs than oral methods, such as ulipristal acetate and levonorgestrel. Health care payers and decision makers (eg, health care insurers, government programs) with financial constraints must determine if the increased effectiveness of intrauterine device emergency contraception methods are worth the additional costs. We sought to compare the cost-effectiveness of 4 emergency contraception strategies-ulipristal acetate, oral levonorgestrel, copper intrauterine device, and oral levonorgestrel plus same-day levonorgestrel intrauterine device-over 1 year from a US payer perspective. Costs (2017 US dollars) and pregnancies were estimated over 1 year using a Markov model of 1000 women seeking emergency contraception. Every 28-day cycle, the model estimated the predicted number of pregnancy outcomes (ie, live birth, ectopic pregnancy, spontaneous abortion, or induced abortion) resulting from emergency contraception failure and subsequent contraception use. Model inputs were derived from published literature and national sources. An emergency contraception strategy was considered cost-effective if the incremental cost-effectiveness ratio (ie, the cost to prevent 1 additional pregnancy) was less than the weighted average cost of pregnancy outcomes in the United States ($5167). The incremental cost-effectiveness ratios and probability of being the most cost-effective emergency contraception strategy were calculated from 1000 probabilistic model iterations. One-way sensitivity analyses were used to examine uncertainty in the cost of emergency contraception, subsequent contraception, and pregnancy outcomes as well as the model probabilities. In 1000 women seeking emergency contraception, the model estimated direct medical costs of $1,228,000 and 137 unintended pregnancies with ulipristal acetate, compared to $1,279,000 and 150 unintended pregnancies with oral levonorgestrel, $1,376,000 and 61 unintended pregnancies with copper intrauterine devices, and $1,558,000 and 63 unintended pregnancies with oral levonorgestrel plus same-day levonorgestrel intrauterine device. The copper intrauterine device was the most cost-effective emergency contraception strategy in the majority (63.9%) of model iterations and, compared to ulipristal acetate, cost $1957 per additional pregnancy prevented. Model estimates were most sensitive to changes in the cost of the copper intrauterine device (with higher copper intrauterine device costs, oral levonorgestrel plus same-day levonorgestrel intrauterine device became the most cost-effective option) and the cost of a live birth (with lower-cost births, ulipristal acetate became the most cost-effective option). When the proportion of obese women in the population increased, the copper intrauterine device became even more most cost-effective. Over 1 year, the copper intrauterine device is currently the most cost-effective emergency contraception option. Policy makers and health care insurance companies should consider the potential for long-term savings when women seeking emergency contraception can promptly obtain whatever contraceptive best meets their personal preferences and needs; this will require removing barriers and promoting access to intrauterine devices at emergency contraception visits.

Update on emergency contraception.

Emergency contraception provides a critical and time-sensitive opportunity for women to prevent undesired pregnancy after intercourse. Both access and available options for emergency contraception have changed over the last several years. Emergency contraceptive pills can be less effective in obese women. The maximum achieved serum concentration of levonorgestrel (LNG) is lower in obese women than women of normal BMI, and doubling the dose of LNG (3 mg) increases its concentration maximum, approximating the level in normal BMI women receiving one dose of LNG. Repeated use of both LNG and ulipristal acetate (UPA) is well tolerated. Hormonal contraception can be immediately started following LNG use, but should be delayed for 5 days after UPA use to avoid dampening the efficacy of UPA. The copper intrauterine device (IUD) is the only IUD approved for emergency contraception (and the most effective method of emergency contraception), but use of LNG IUD as emergency contraception is currently being investigated. Accurate knowledge about emergency contraception remains low both for patients and healthcare providers. Emergency contraception is an important yet underutilized tool available to women to prevent pregnancy. Current options including copper IUD and emergency contraceptive pills are safe and well tolerated. Significant gaps in knowledge of emergency contraception on both the provider and user level exist, as do barriers to expedient access of emergency contraception.

Cost-effectiveness of emergency contraception options over 1 year

Background The copper intrauterine device is the most effective form of emergency contraception and can also provide long-term contraception. The levonorgestrel intrauterine device has also been studied in combination with oral levonorgestrel for women seeking emergency contraception. However, intrauterine devices have higher up-front costs than oral methods, such as ulipristal acetate and levonorgestrel. Health care payers and decision makers (eg, health care insurers, government programs) with financial constraints must determine if the increased effectiveness of intrauterine device emergency contraception methods are worth the additional costs. Objective We sought to compare the cost-effectiveness of 4 emergency contraception strategies–ulipristal acetate, oral levonorgestrel, copper intrauterine device, and oral levonorgestrel plus same-day levonorgestrel intrauterine device–over 1 year from a US payer perspective. Study Design Costs (2017 US dollars) and pregnancies were estimated over 1 year using a Markov model of 1000 women seeking emergency contraception. Every 28-day cycle, the model estimated the predicted number of pregnancy outcomes (ie, live birth, ectopic pregnancy, spontaneous abortion, or induced abortion) resulting from emergency contraception failure and subsequent contraception use. Model inputs were derived from published literature and national sources. An emergency contraception strategy was considered cost-effective if the incremental cost-effectiveness ratio (ie, the cost to prevent 1 additional pregnancy) was less than the weighted average cost of pregnancy outcomes in the United States ($5167). The incremental cost-effectiveness ratios and probability of being the most cost-effective emergency contraception strategy were calculated from 1000 probabilistic model iterations. One-way sensitivity analyses were used to examine uncertainty in the cost of emergency contraception, subsequent contraception, and pregnancy outcomes as well as the model probabilities. Results In 1000 women seeking emergency contraception, the model estimated direct medical costs of $1,228,000 and 137 unintended pregnancies with ulipristal acetate, compared to $1,279,000 and 150 unintended pregnancies with oral levonorgestrel, $1,376,000 and 61 unintended pregnancies with copper intrauterine devices, and $1,558,000 and 63 unintended pregnancies with oral levonorgestrel plus same-day levonorgestrel intrauterine device. The copper intrauterine device was the most cost-effective emergency contraception strategy in the majority (63.9%) of model iterations and, compared to ulipristal acetate, cost $1957 per additional pregnancy prevented. Model estimates were most sensitive to changes in the cost of the copper intrauterine device (with higher copper intrauterine device costs, oral levonorgestrel plus same-day levonorgestrel intrauterine device became the most cost-effective option) and the cost of a live birth (with lower-cost births, ulipristal acetate became the most cost-effective option). When the proportion of obese women in the population increased, the copper intrauterine device became even more most cost-effective. Conclusion Over 1 year, the copper intrauterine device is currently the most cost-effective emergency contraception option. Policy makers and health care insurance companies should consider the potential for long-term savings when women seeking emergency contraception can promptly obtain whatever contraceptive best meets their personal preferences and needs; this will require removing barriers and promoting access to intrauterine devices at emergency contraception visits.

Emergency Contraception: Review and Update

Unintended pregnancy continues to be a substantial public health problem. Emergency contraception (EC) provides a last chance at pregnancy prevention. Several safe and effective options for emergency contraception are currently available. The Yuzpe method, a combined hormonal regimen, was essentially replaced by other oral medications including levonorgestrel and the antiprogestin ulipristal. The antiprogestin mifepristone has been studied for use as emergency contraception. The most effective postcoital method of contraception is the copper intrauterine device (IUD). Obesity and the simultaneous initiation of progestin-containing contraception may decrease the effectiveness of some emergency contraception.

Emergency Contraception Review

Several options for emergency contraception are available in the United States. This article describes each method, including efficacy, mode of action, safety, side effect profile, and availability. The most effective emergency contraceptive is the copper intrauterine device (IUD), followed by ulipristal acetate and levonorgestrel pills. Levonorgestrel is available for sale without restrictions, whereas ulipristal acetate is available with prescription only, and the copper IUD must be inserted by a clinician. Although EC pills have not been shown to reduce pregnancy or abortion rates at the population level, they are an important option for individual women seeking to prevent pregnancy after sex.

Counseling for emergency contraception: time for a tiered approach

Typical counseling for emergency contraception (EC) does not take into account the relative effectiveness of the methods or client characteristics; new data and lessons from contraceptive counseling research suggest that it is time for this approach to change. The number of EC options available in the United States has grown in the last decade and now includes levonorgestrel (LNG) pills, ulipristal acetate (UPA) pills and a copper intrauterine device (IUD). Understanding of the relative effectiveness of EC options has also grown and is the subject of ongoing research.

Improving uptake of the copper intrauterine device for emergency contraception by educating pharmacists in the community

ObjectivesThe copper intrauterine device (Cu-IUD) is the most effective method of emergency contraception (EC) and provides ongoing contraception, yet few women choose this option. This study evaluates the impact of...