A series of randomized trials examining the efficacy of LNG have demonstrated that for the single-dose regimen (1.5 mg), the failure rate ranges from 0.3–2.6%. Plan B One-Step (1.5 mg) has a half-life of approximately 27.5 ± 5.6 h. Subsequent to taking LNG, it is safe to start or resume ongoing contraception methods immediately, sometimes referred to as quick-starting. In the case that the patient vomits within 3 h of consumption of LNG, the patient should take a second dose. When post-coital emergency contraception is needed, when feasible and welcome, it is recommended that providers offer counseling on long -term contraception plans for patients as well as physical and psychological assessments in instances of sexual assault/rape, while being sensitive to women who are not emotionally ready to talk. It can be administered regardless of timing of a patient’s menstrual cycle. No physical exams, laboratory tests, or pregnancy tests are required before taking LNG. Administration: Timing and importance of long-term contraception plans Progestin-only ECPs are ineffective after an embryo has implanted in the uterus and thus cannot work as an abortifacient. The best available evidence suggests that progestin-only ECPs work only before ovulation has occurred and do not inhibit implantation of a fertilized egg. Studies are inconclusive in showing whether it may also interfere with fertilization by thickening cervical mucus and impairing tubal transport of sperm or the egg. The primary mechanism of action of LNG is suppression of luteinizing hormone, which delays or inhibits ovulation. The two-dose version is no longer sold in the United States. It sometimes referred to colloquially as “the morning-after pill” and was originally sold as Plan B, which included two doses (0.75 mg) to be administered 12 h apart before studies showed the single dose to be as effective as the staggered doses. It is sold in the United States as Plan B One-Step® (1.5 mg) as a single dose and is sold under several generic labels, including Take Action, My Way, AfterPill (available only online), Aftera, and Option 2. Levonorgestrel (LNG) is a progestin-only emergency contraception pill (ECP) that should be taken orally as soon as possible, within a 72-h window following sexual intercourse, although some studies suggest moderate efficacy up to 120 h post-coitus. Our intent is to give an overview of the options for emergency contraception currently available in the United States address misconceptions about emergency contraception and issues of access and barriers review emergency contraception in special populations and touch on future research. Among both medical providers and the general population, there is a gap in knowledge as well as persistent misperceptions about the options for emergency contraception, the timing, side effects, and mechanism of action. Multiple options for emergency contraception exist however, the options vary in efficacy. Since 1995, ever-use of emergency contraception has increased among women age 15–44 from 0.8% in 1995 to 20.0% from 2011 to 2015 (see Fig. Indications for emergency contraception include any situation in which sexual intercourse is unprotected, including reproductive coercion, sexual assault, and contraceptive failure. The vast majority of unintended pregnancy is due to inconsistent use or non-use of contraception, and this is where emergency contraception has a potentially important role. Although 68% of women at risk for unintended pregnancy consistently used contraception, these women account for only 5% of unintended pregnancies. In the US, 45% of pregnancies were unintended in 2011, dropping from 51% in 2008. Continuing areas of research, including the impact of body weight on the efficacy of emergency contraceptive pills and potential interactions between ulipristal acetate and ongoing hormonal contraceptives, are also addressed. This paper will address barriers such as gaps in knowledge, and financial, health systems, and practice barriers. It will also review current misconceptions about emergency contraception and access for subpopulations, including adolescents, immigrants, survivors of sexual assault, rural populations, and military/veteran women.
This paper provides an overview of levonorgestrel (Plan B One-Step and generic counterparts), ulipristal acetate (sold as ella), and the copper intrauterine device (IUD, sold as ParaGard), including the mechanisms of action, administration, efficacy, drug interactions, safety, side effects, advantages, and drawbacks. Options for emergency contraception vary by efficacy as well as accessibility within the U.S. It plays a role in averting unintended pregnancies due to inconsistent use or non-use of contraception.
Emergency contraception is indicated in instances of unprotected sexual intercourse, including reproductive coercion, sexual assault, and contraceptive failure.