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Key content:
The progestogen-only postcoital pill (containing levonorgestrel) impairs
ovulation and inhibits fertilisation, but there is little evidence to support a direct
anti-implantation effect.
Ulipristal acetate acts primarily by inhibiting ovulation but it may also impair
implantation.
The copper-bearing intrauterine device prevents fertilisation and inhibits
implantation; it is the most effective method of emergency contraception.
The levonorgestrel-releasing intrauterine system is not suitable and is not licensed
for emergency contraception.
Learning objectives:
To learn about the options available to women when there is risk of pregnancy
following unprotected sexual intercourse.
To be aware of the use of the copper intrauterine device for emergency contraception.
To be aware of provisions for advance emergency contraception.
To understand the opportunity that emergency contraception offers for sexual
health risk assessment and testing, particularly regarding insertion of the
intrauterine device.
Ethical issues:
A womans beliefs may preclude intervention postcoitally or, more importantly,
post fertilisation.
If a practitioners own beliefs preclude similar interventions, the practitioner
should ensure timely referral to another practitioner.
Keywords copper intrauterine device / levonorgestrel-containing emergency
contraceptive pill / morning after pill / pregnancy rates/ ulipristal acetate
Please cite this article as: Bhathena RK, Guillebaud J. Postcoital contraception The Obstetrician & Gynaecologist 2011;13:2934.
Author details
Ruzva K Bhathena FRCOG MD FFSRH
Consultant Obstetrician and Gynaecologist,
BD Petit Parsee General and Masina
Hospitals, B Petit Road, Cumballa Hill,
Mumbai 400036, India
Email: rkbhathena@gmail.com
(corresponding author)
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Introduction
Postcoital or emergency contraception is used to
prevent unwanted pregnancy after unprotected
sexual intercourse or to avert potential contraceptive
failure. In the UK, oral progestogen-only emergency
contraception is available as the levonorgestrel
emergency contraceptive pill; the copper
intrauterine device (IUD) can also be inserted as a
postcoital contraceptive.1 The levonorgestrelreleasing intrauterine system is not suitable and is
not licensed for emergency contraception.2
Ulipristal acetate, a synthetic, orally active selective
progesterone receptor modulator, has recently been
licensed for emergency contraception in Europe and
has been marketed in the UK since October 2009.3
Box 1
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Method
Timing
Dosage
Efficacy
Table 1
Levonorgestrel pill
Summary of methods of
postcoital contraception
Copper IUD
Ulipristal acetate
Ulipristal acetate
In the past few years progesterone receptor modulators
have been studied for their effectiveness as postcoital
contraception.7,9 Mifepristone,a progestogen (the first
selective progesterone receptor modulator),has
proved effective when used in a single dose of 10 mg
within 120 hours of unprotected sexual
intercourse.7,9,2224 Adverse effects are minimal and
patient acceptability is high.6,24 However,mifepristone
is not licensed for emergency contraception in the UK.
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Provision of emergency
contraception
Clinical management
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Conclusions
The levonorgestrel emergency contraceptive pill,
licensed for use for up to 72 hours after unprotected
sexual intercourse, may be used as often as needed.
There is reduced effectiveness with a delay in
treatment. The observed failure to reduce
pregnancy rates in population studies is likely to be
due to insufficient use by those at greatest risk.
Ulipristal acetate, which was recently licensed as a
single-dose oral preparation for emergency
contraception for up to 120 hours after unprotected
sexual intercourse, appears to be more effective
than the levonorgestrel emergency contraceptive
pill within that time frame and for women
presenting in the first 24 hours.3,26
The copper IUD remains the postcoital method
with greatest efficacy when used within 5 days of
unprotected intercourse or up to 5 days after
ovulation when this can be satisfactorily estimated,
even in women who have had multiple episodes of
unprotected intercourse (Table 1).
Disclosure of interests
Ruzva K Bhathena has occasionally received travel
grants from pharmaceutical companies to
participate in academic meetings on reproductive
healthcare in the UK.
Professor John Guillebaud has received payments
from pharmaceutical companies distributing
contraceptives (including emergency
contraceptives) for lecture fees, travel and
accommodation expenses, short-term consultancy
work and occasional legal advice.
2011 Royal College of Obstetricians and Gynaecologists
2011;13:2934
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References
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