Emergency contraception

Abstract

The standard method for emergency contraception used to be the Yuzpe regimen, which consists of two doses of combined oral contraceptive pills at 12 h interval. It can prevent 74% of the expected pregnancies but the incidence of side effects like nausea and vomiting is high. Recent studies have shown that both mifepristone and levonorgestrel are more effective and better tolerated than the Yuzpe regimen. The dose of mifepristone can be reduced to 10 mg without affecting its efficacy. However, 10 mg tablets of mifepristone are not commercially available except in China. A single dose of 1.5 mg of levonorgestrel is as effective as two doses of 0.75 mg levonorgestrel given at 12 h interval or 10 mg of mifepristone. This is likely to become the hormonal method of choice in many countries. The insertion of a copper intrauterine contraceptive device is probably the most effective method of emergency contraception, preventing over 90% of the pregnancies. However, it may not be suitable for women with high risk factors for pelvic inflammatory disease. There has been an increase in the awareness of emergency contraception in the recent decade but the knowledge is still poor in some countries. There is also a need to improve the access to emergency contraception. © 2003 Elsevier Science B.V. All rights reserved.