Emergency Contraception in the Emergency Department

Author: Matthew Rosen, MSIV
Medical Student 
Georgetown School of Medicine

This post was peer reviewed.
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Between the years 2006 and 2010 11% of women reported using emergency contraception at some point in their life; of those, 59% used emergency contraception once and almost a quarter used it twice.[2] Emergency contraception is any contraceptive method used after unprotected intercourse or contraceptive failure and before embryo implantation. Examples of indications for use are condom breaks or leaks, failure to use additional contraceptives when starting hormonal contraception, or non-consensual sex and sexual assault. In a study of one pediatric emergency department, 88% of patients who presented for emergency contraception had done so after sexual assault.[5]

When treating patients seeking emergency contraception, it is important for the clinician to offer pregnancy testing and evaluation for sexually transmitted infections in addition to offering emergency contraception. No matter which method of emergency contraception is used, the efficacy is greatest if administered early after unprotected intercourse.[8] Significant barriers to the use of emergency contraception include confusion about whether it is considered “medical abortion” and hesitance by health care providers to use it in sexual assault victims or adolescents. Awareness of available options will lead to better care for emergency department patients.

Summary:
The copper IUD is the most effective, however this option is usually not available in the emergency department. If the patient can follow up with her gynecologist within 5 days of needing emergency contraception, then this may be the best recommendation, especially if she is greater than 165 pounds and Ulipristal is unavailable to her. Plan B is safe and usually well tolerated, but it may have decreased effectiveness in those patients who weigh greater than 165 pounds and possibly no effect if they weigh more than 176 pounds.[3] For a woman who is already on combined (estrogen/progesterone) oral contraceptive pills (OCPs), it is possible to take multiple active pills as a form of emergency contraception; but it is best for her to ask her gynecologist before recommending this, as there are many varieties and brands of OCP's.[7]

References:

1. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 112: Emergency Contraception. Obstet Gynecol. 2010 May; 115(5) 1100-9

2. Daniels K, Jones J, Abma J. Use of emergency contraception among women aged 15 to 44: United States 2006-2010. NCHS Data Brief. Volume 112. February 2013. Pages 1-8

3. Glasier A, Cameron ST, Blithe D, Scherrer B, Mathe H, Levy D, Gainer E, Ulmann A. Can we identify women at risk of pregnancy despite using emergency contraception? Data from randomized trials of ulipristal acetate and levonorgestrel. Contraception. 2011 Oct; 84(4): 363-7

4. Patel, S, Miller, M. K, Dowd, M. D . Patient Characteristics and Provider Practice Patterns for Emergency Contraception in a Pediatric Emergency Department. Pediatric Emergency Care. Volume 26. Number 1. January 2010. Pages 6-9

5. Bond S. Intrauterine devices provide safe and effective contraception following unprotected intercourse and beyond. Journal of Midwifery Womens Health. 2012 Sep-Oct; 57(5):524-5

6. Lalitkumar PG, Berger C. Gemzell-Danielsson K. Emergency Contraception. Best Pract Res Clin Endocrinol Metabol. 2013 Feb; 27(1):91-101.

7. Dunn S, Guilbert E, Burnett M, et al. Society of Obstetricians and Gynecologists of Canada. Emergency Contraception: no. 280 (replaces no. 131, August 2013). Int J Gynaecol Obstet. 2013 Jan; 120 (1):102-7