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Emergency Contraception Advice Expanded
Emergency contraceptive pills (ECPs) should be taken as soon as possible after unprotected sex for maximum effectiveness. WHO now advises that they can be taken up to a maximum of 120 hours after unprotected sex, however, rather than the previously recommended maximum of 72 hours. The Expert Working Group also recommends a new regimen for ECPs—a single dose of 1.5 mg of levonorgestrel. In addition, the expert group reiterates earlier advice that a woman can have an advance supply of ECPs.
Take ECPs as soon as possible. The new WHO guidance supports previous advice to take ECPs as soon as possible after having unprotected sex—ideally within 72 hours. Recent research shows ECPs also can be effective if taken up to 120 hours after unprotected sex (15, 42, 46, 63). Still, the longer a woman waits to take them, the less likely they are to prevent pregnancy (15, 42,
46, 63).
Three dosage options. WHO recommends three options for ECP dosage:
- 1.5 mg of levonorgestrel in a single dose;
- Two doses of levonorgestrel (one dose of 0.75 mg of levonorgestrel, followed by a second dose of 0.75 mg of levonorgestrel 12 hours later); or
- Two doses of combined estrogen-levonorgestrel ECPs—the “Yuzpe regimen”3 of one dose of 100 µg of ethinyl estradiol plus 0.5 mg of levonorgestrel, followed by the same dose 12 hours later.
The first regimen is the best choice, the Expert Working Group advises. A single dose is the best option because people generally are more likely to take a single dose than multiple doses. In
addition, the levonorgestrel-only regimen causes less nausea and vomiting than the combined
formulation (see below).
The preferred regimen might not be available everywhere, however. The other two regimens are acceptable alternatives, the Expert Working Group concluded. In some places the regimens are prepared and labeled specifically for use as ECPs. They also can be prepared from a variety of OCs that contain levonorgestrel.
Levonorgestrel-only ECPs cause less nausea and vomiting. WHO recommends that women use levonorgestrel-only ECPs because they cause less nausea and vomiting than combined estrogen-levonorgestrel ECPs (26, 58). Nausea and vomiting are common side effects associated with ECP use (45, 58).
WHO does not recommend routine use of antiemetics (medication that helps prevent nausea and vomiting) before taking ECPs. Predicting which women will experience side effects usually is difficult, and many women taking ECPs do not experience nausea and vomiting. Antiemetics are effective for some women, however (43, 45). Thus the Expert Working Group advises that clinicians offer antiemetics on a case-by-case basis according to their medical judgment. Clinicians should take into account that antiemetics themselves may cause other side effects, such as drowsiness and dizziness.
Advance supply encouraged. The 2004 Expert Working Group supported previous recommendations that allow a woman to receive an advance supply of ECPs. The group based its recommendation on recent evidence that:
- A woman is more likely to take ECPs after unprotected sex if she has a supply on hand (7, 14, 21, 27, 38, 44, 48); and
- Having ECPs on hand does not affect a woman’s contraceptive use, does not increase her frequency of unprotected sex, and does not increase her frequency of ECP use (7, 14, 21, 27, 44, 48).
3The Yuzpe regimen is named after Canadian professor A. Albert Yuzpe, who published the first studies demonstrating the safety and effectivenss of using combined OCs as ECPs (67, 68).
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