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Emergency Contraception

Overview :

Although emergency contraception—sometimes called post-coital or morning-after contraception—has been available for over a quarter of a century, almost one-half of the 6.3 million pregnancies in the United States each year are unintended. Among teen pregnancies 80% are unintentional. About one-half of unintended pregnancies are caused by contraceptive failure, either a failure of the method or a mistake by the user. The remainder of unintended pregnancies occurs because birth control was not employed. Emergency contraception could help prevent some of the 1.4 million abortions that take place in the United States every year.

Emergency contraception prevents pregnancy by one of the following methods:

  • delaying or inhibiting ovulation—the release of eggs from the ovary
  • altering the transport of the sperm or egg, thereby preventing fertilization of the egg by a sperm
  • altering the endometrium or uterine lining, thereby preventing implantation—the attachment of the fertilized egg to the wall of the uterus

The mechanism by which ECPs prevent pregnancy depends on the stage of the woman's menstrual cycle. In most cases ECPs delay or inhibit ovulation and have no effect on implantation. IUDs used as emergency contraception appear to interfere with implantation of the fertilized egg; although they also may prevent fertilization, as they are thought to do when they are used as a regular method of birth control.

Emergency contraceptive pills (ECPs)

ECPs contain synthetic hormones that mimic the hormones produced by a woman's body. Many common brands of birth control pills can be used for emergency contraception even though they are not labeled for that use. Any of the first 21 pills in a regular 28-pill package of oral contraceptives can be used for emergency contraception. The last seven pills in 28-pill packs do not contain hormones. The number of pills that constitute an emergency contraceptive dose depends on the brand of pill. The same brand should be used for both doses of ECPs. Many ECPs are available outside of the United States, where they are packaged, labeled, and sold for emergency contraceptive purposes.

COMBINED ECPS. Combined ECPs available in the United States contain 100 micrograms of the synthetic estrogen, ethinyl estradiol, and 0.5-0.6 mg of the synthetic progestin levonorgestrel per dose. Combined ECPs are taken according to the Yuzpe Regimen, named after A. Albert Yuzpe, the Canadian researcher who first demonstrated their safety and effectiveness in 1974. With the Yuzpe Regimen, the first dose of combined ECPs is taken as soon as possible after unprotected intercourse and the second dose is taken 12 hours later. However the timing of the second dose can vary by a few hours without diminishing its effectiveness. The Preven Emergency Contraceptive Kit—the first product to be specifically labeled and marketed for emergency contraception—is no longer available.

Combined ECPs available in the United States include:

  • Alesse, manufactured by Wyeth-Ayerst; five pink pills per dose
  • Aviane, manufactured by Duramed; five orange pills per dose
  • Cryselle, manufactured by Barr; four white pills per dose
  • Enpresse from Barr; four orange pills per dose
  • Lessina from Barr; five pink pills per dose
  • Levlen from Berlex; four light orange pills per dose
  • Levlite from Berlex; five pink pills per dose
  • Levora from Watson; four white pills per dose
  • Lo/Ovral from Wyeth-Ayerst; four white pills per dose
  • Low-Ogestrel from Watson; four white pills per dose
  • Lutera from Watson; five white pills per dose
  • Nordette from Wyeth-Ayerst; four light orange pills per dose
  • Ogestrel from Watson; two white pills per dose
  • Ovral from Wyeth-Ayerst; two white pills per dose
  • Portia from Barr; four pink pills per dose
  • Seasonale from Barr; four pink pills per dose
  • Tri-Levlen from Berlex; four yellow pills per dose
  • Triphasil from Wyeth-Ayerst; four yellow pills per dose
  • Trivora from Watson; four pink pills per dose

PROGESTIN-ONLY ECPS. Progestin-only ECPs (POPs) are prescribed frequently, particularly for women who cannot take estrogen or who are breastfeeding. POPs contain 0.75 mg of levonorgestrel per dose. They are equally effective regardless of whether the two doses are taken simultaneously or 12-24 hours apart. POPs are most effective if taken within 72 hours of unprotected intercourse; however they reduce the risk of pregnancy if taken within 120 hours.

Progestin-only pills include:

  • Plan B from Barr is the only drug available in the United States that is specifically designed and designated as an ECP—one white pill per dose.
  • Ovrette from Wyeth-Ayerth requires swallowing 20 yellow pills for each dose.

The Copper-T IUD

The Copper-T 380A IUD (ParaGard) is a T-shaped device that provides emergency contraception if inserted into the uterus by a healthcare provider within seven days after unprotected intercourse. It can be removed by the healthcare provider after the woman's next menstrual period begins or it can remain in place for up to 10-12 years as an effective method of birth control.


In most of the United States, emergency contraception requires a special prescription or a prescription for a monthly supply of an appropriate oral contraceptive. Most physicians do not routinely discuss the use of emergency contraception with their patients and some pharmacies refuse to carry ECPs.

Emergency contraception is available from:

  • public and college health clinics
  • women's health centers
  • Planned Parenthood clinics
  • private doctors
  • hospital emergency rooms, except those affiliated with a religion that opposes the use of birth control
  • pharmacists directly, in a small number of states.

Some healthcare providers may prescribe ECPs over the telephone. Sexual assault victims may be offered ECPs in the hospital emergency room.

In many countries ECPs are available without a prescription. However in the United States emergency contraception remains controversial. In September of 2004, the U. S. Department of Justice released guidelines for the treatment of sexual assault victims without mentioning the option of emergency contraception. As of early 2005, the U.S. Food and Drug Administration (FDA) had delayed approval of over-the-counter (OTC) status for Plan B. However many professional healthcare organizations and advocacy groups for women's reproductive rights were working to make ECPs available without a prescription in the United States.


The cost of emergency contraception varies greatly according to region and location and any additional required services. Family-planning clinics and public healthcare centers may provide lower-cost emergency contraception or charge according to an income-based sliding scale.

As of 2005, estimated costs for emergency contraception were:

  • $8-$35 for Plan B
  • $20-$50 for combined ECPs
  • $50-$70 for other progestin-only ECPs
  • $35-$150 for a visit to a healthcare provider
  • $10-$20 for a pregnancy test
  • about $400 for an exam, IUD, and insertion; however the IUD can remain in place for up to 12 years.

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