Recently, the World Health Organization (WHO) released a fact sheet on emergency contraception.

Background Information

What is Emergency Contraception?

It refers to methods of contraception that can be used to prevent pregnancy in the first 5 days after sexual intercourse. 

Disclaimer 1: Emergency contraception is effective only in the first few days following intercourse before the ovum is released from the ovary and before the sperm fertilizes the ovum.

Disclaimer 2: Emergency contraception cannot interrupt an established pregnancy or harm a developing embryo.

Key Messages:

Any woman or girl of reproductive age may need emergency contraception to avoid an unwanted pregnancy.

Emergency contraception can be used in a number of situations following sexual intercourse:

• When no contraceptive has been used.
• In cases of rape or coerced sex when the woman was not protected by an effective contraceptive method.
• When there is a contraceptive failure or incorrect use

There are 3 methods of emergency contraception:

 

1. Emergency Contraception Pills (ECPs): 

WHO recommends either of the following drugs for emergency contraception, for use within 5 days (120 hours) of unprotected sexual intercourse:

• Levonorgestrel taken as a single dose (1.5 mg) Or
• Levonorgestrel taken in 2 doses (0.75 mg each, 12 hours apart) Or
• Ulipristal acetate, taken as a single dose at 30 mg.

Safety: 

Levonorgestrel-alone emergency contraception pills are very safe and do not cause abortion or harm future fertility. Side-effects are uncommon and generally mild.

Contraindications and Precautions: 

They should not be given to a woman who already has a confirmed pregnancy. If a woman inadvertently takes the pills after she becomes pregnant, however, the available evidence suggests that the drugs will not harm either the mother or her fetus.

These 2 drugs are not used for termination of pregnancy.

Emergency contraceptive pills may be less effective in obese women (body mass index more than 30 kg/m²) but there are no safety concerns.

2. The Yuzpe method (combined Oral Contraceptive Pills)

The pills are taken in 2 doses.

Each dose must contain estrogen (100–120 mg ethinyl estradiol) and progestin (0.50–0.60 mg levonorgestrel (LNG) or 1.0–1.2 mg norgestrel).

The first dose should be taken as soon as possible after unprotected intercourse (preferably within 72 hours but as late as 120 hours, or 5 days) and the second dose should be taken 12 hours later.

If vomiting occurs within 2 hours of taking a dose, the dose should be repeated.

3. Copper-bearing Intrauterine Devices (IUDs)

WHO recommends that a copper-bearing IUD, when used as an emergency contraceptive method, be inserted within 5 days of unprotected intercourse.

This method is particularly appropriate for a woman who would like to start using a highly effective, long-acting and reversible contraceptive method.

Effectiveness:

When inserted within 5 days of unprotected intercourse, a copper-bearing IUD is over 99% effective in preventing pregnancy. This is the most effective form of emergency contraception available.

Safety:

A copper-bearing IUD is a safe form of emergency contraception. The risks of infection, expulsion or perforation are low.

Contraindications:

The only situation in which a copper-bearing IUD should never be used as emergency contraception is when a woman is already pregnant.

Other contraindications:

• severe thrombo-cytopenia,
• unexplained vaginal bleeding,
• cervical cancer,
• endometrial cancer and
• current Pelvic Inflammatory Disease (PID)

Useful Links:

Link to the fact sheet:

http://who.int/mediacentre/factsheets/fs244/en/

Link to WHO’s Medical Eligibility Criteria for Contraceptive Use (5th Edition) [English]:

http://apps.who.int/iris/bitstream/10665/181468/1/9789241549158_eng.pdf?ua=1

Link to Executive Summary of Medical Eligibility Criteria for Contraceptive Use (5th Edition) [English]:

http://apps.who.int/iris/bitstream/10665/172915/1/WHO_RHR_15.07_eng.pdf?ua=1

Link to Executive Summary of Medical Eligibility Criteria for Contraceptive Use (5th Edition) [French]:

http://apps.who.int/iris/bitstream/10665/204135/1/WHO_RHR_15.07_fre.pdf?ua=1

Link to Medical Eligibility Criteria Wheel for Contraceptive Use 2015:

http://apps.who.int/iris/bitstream/10665/173585/1/9789241549257_eng.pdf?ua=1