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Emergency Contraception

David A. Grimes, MD; and Elizabeth G. Raymond, MD, MPH
[+] Article, Author, and Disclosure Information

From Family Health International, Research Triangle Park, North Carolina.

Disclosure: Dr. Grimes provided one-time consulting services to Gynetics, for which he received an honorarium. Family Health International has been working with Women's Capital Corporation to bring Plan B to the U.S. market and to assist with its transition to over-the-counter status. However, Family Health International has no commercial interest in Women's Capital Corporation.

Grant Support: By an unrestricted grant to Family Health International from The William and Flora Hewlett Foundation, Menlo Park, California.

Requests for Single Reprints: David A. Grimes, MD, Family Health International, PO Box 13950, Research Triangle Park, NC 27709; e-mail, dgrimes@fhi.org.

Current Author Addresses: Drs. Grimes and Raymond: Family Health International, PO Box 13950, Research Triangle Park, NC 27709.

Ann Intern Med. 2002;137(3):180-189. doi:10.7326/0003-4819-137-3-200208060-00010
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Emergency contraception is used to prevent pregnancy after a coital act not adequately protected by a regular method of contraception. In contrast to early medical abortion, emergency contraception prevents a pregnancy from starting and does not disrupt an established pregnancy. The most commonly used approaches consist of two oral doses of contraceptive steroids. The levonorgestrel-only regimen (levonorgestrel, 0.75 mg, repeated in 12 hours) appears to be more effective and better tolerated than the Yuzpe regimen (ethinyl estradiol, 100 µg, and levonorgestrel, 0.5 mg, repeated in 12 hours). In the largest randomized, controlled trial to date, levonorgestrel prevented about 85% of pregnancies that would have occurred without its use. Hormonal emergency contraception has no known medical contraindications, although it is not indicated for suspected or confirmed pregnancy. However, if hormonal emergency contraception is inadvertently taken in early pregnancy, neither the woman nor the fetus will be harmed. Nausea and vomiting associated with the Yuzpe regimen can be reduced by prophylactic use of meclizine. A strong medical and legal case exists for making hormonal emergency contraception available over the counter, as has happened in countries other than the United States. Easier access to and wider use of emergency contraception could dramatically lower the high rates of unintended pregnancy and induced abortion in the United States.





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