In a statement published in the October 2005 issue of Pediatrics, the American Academy of Pediatrics (AAP) recommends that education and counseling about emergency contraception be incorporated into the annual preventive visits of adolescent patients when issues of sexuality are addressed. Physicians also should provide community-specific guidance on access and availability of emergency contraception and consider writing an advance prescription. The full policy statement, “Emergency Contraception,” is available online athttp://www.pediatrics.org/cgi/content/full/116/4/1026.
Emergency contraception is approximately 80 percent effective for preventing pregnancy when the first dose is taken within 72 hours of sexual intercourse. Two medications have been approved by the U.S. Food and Drug Administration (FDA) for use as emergency contraception—a combination estrogen/progestin pill (Preven) and a progestin-only formulation (Plan B). In addition, the off-label use of combination oral contraceptives at higher dosages (e.g., two doses taken 12 hours apart, each containing at least 100 mcg of ethinyl estradiol and at least 0.50 mg of levonorgestrel) has been declared safe and effective by the FDA Reproductive Health Advisory Committee.
Emergency contraception is indicated when unprotected or inadequately protected sex has taken place within the previous 72 to 120 hours (although the FDA approves the use only within 72 hours). The AAP states that progestin-only emergency contraception may be prescribed over the telephone, but an office visit should be scheduled for 10 to 14 days after use to exclude pregnancy and to provide contraceptive advice and screening for sexually transmitted diseases.
The AAP report suggests that an antiemetic agent taken one hour before estrogen-containing medication may decrease the risk and severity of nausea. The progestin-only method is better tolerated and may be more effective than combination methods. Because of the short duration of use, combination emergency contraception may be offered to patients with chronic conditions in whom estrogen-containing oral contraceptives are contraindicated. There are no contraindications for the use of progestin-only emergency contraception. Almost all patients menstruate within three weeks of taking emergency contraception; patients who have not menstruated within three weeks should be tested for pregnancy.