Effectiveness of emergency contraceptive pills between 72 and 120 hours after unprotected sexual intercourse

doi:10.1067/mob.2001.111102

American Journal of Obstetrics and Gynecology

Volume 184, Issue 4, March 2001, Pages 531-537

https://doi.org/10.1067/mob.2001.111102 Get rights and content

Abstract

Objective: This article reopens the issue of a medical practice that has been well established for more than three decades by proposing an extension of the period during which treatment with the “morning-after” pill is currently prescribed. The objective is to determine the effectiveness of the regimen of Yuzpe and Lancee when it is administered between 72 and 120 hours after sexual intercourse. Study Design: We conducted an observational study comparing 2 groups of women for whom the regimen of Yuzpe and Lancee was administered after unprotected sexual intercourse. One group (usual time frame treatment group) sought consultation within 72 hours (n = 131), and the other (extended time frame treatment group) after 72 to 120 hours (n = 169). Results: The pregnancy rate was 0.8% for the <72-hour group and 1.8% for the 72- to 120-hour group. The effectiveness rate varied from 87% to 90% for the <72-hour group and from 72% to 87% for the 72- to 120-hour group. In both groups the χ² tests showed that emergency contraceptive pills significantly reduced the risk of pregnancy. Conclusions: Women should be encouraged to seek consultation as quickly as possible after unprotected sexual intercourse. However, if the usual time limit (<72 hours) has expired, the so-called “morning-after” pill should be recommended if an intrauterine contraceptive device is not available. Emergency contraceptive pills have a favorable success rate after 72 hours, with a pregnancy rate that is significantly lower than would be expected if no contraceptive were administered. (Am J Obstet Gynecol 2001;184:531-7.)

Section snippets

Study group

A total of 425 women in need of emergency contraception were invited to participate in this study. The inclusion criteria at recruitment included unprotected sexual intercourse in the preceding 120 hours and age between 14 and 45 years. Exclusion criteria included delivery or abortion after which normal menses had not resumed, current breast-feeding, inability to provide informed consent, contraindication to hormonal medications, and use of oral contraceptives or postcoital pills since the last

Results

As shown in Fig 1, 108 of the 425 patients recruited were excluded, leaving 317 for analysis.

. Description of patients treated and classification for final analysis. Asterisk, Selected subgroups, defined in terms of a regular cycle and a single act of sexual intercourse; dagger, total number of women, including those with an irregular cycle or women with 1 or 2 instances of sexual intercourse or use of oral contraceptives during previous cycle; double dagger, excluded group, including women who

Comment

This study is the first one, to our knowledge, to call into question the upper limit of 72 hours for administering emergency contraceptive pills. Our study design has many shortcomings, such as the absence of a placebo group, information that is based on recall, the absence of proven fertility, and the fact that sexually active women may have engaged in sexual intercourse more than once during the study period. The pregnancy tests at the beginning enabled us to detect pregnancies resulting from

Acknowledgements

We thank the following participating clinics: the Local Center for Community Services (CLSC) de Gramby, CLSC Pierrefond, CLSC Centreville, Clinique des Jeunes Saint-Denis, Hôpital Sainte-Justine, CLSC du Marigot, CLSC Sainte-Thérèse, CLSC J.O. Chénier, CLSC Hochelaga-Maisonneuve, CLSC des Faubourgs, CLSC Lamater, CLSC Villeray, CLSC Saint-Hubert, CLSC Montréal Nord, CLSC Métro, CLSC Saint-Eustache, CLSC Rosemont, CLSC Lasalle, CLSC Verdun, CLSC Saint-Henri, CLSC Haute-Laurentide, CLSC de

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Cited by (148)

Contraception d'urgence
2016, Journal of Obstetrics and Gynaecology Canada
Analyser les connaissances actuelles au sujet de la contraception d’urgence (CU), y compris les options disponibles, leurs modes d’action, leur efficacité, leur innocuité et l’offre efficace d’une CU en milieu de pratique.
Le schéma posologique combiné estradiol-lévonorgestrel (schéma posologique Yuzpe) et le schéma posologique ne faisant appel qu’au lévonorgestrel, ainsi que l’utilisation postcoïtale de dispositifs intra-utérins de cuivre, font l’objet de notre analyse.
L’efficacité pour ce qui est de la réduction du risque de grossesse, l’innocuité et les effets indésirables des modes de CU et l’effet des moyens d’obtenir accès à la CU sur son utilisation appropriée et l’utilisation d’une contraception systématique.
Les études publiées en anglais entre janvier 1998 et mars 2010 ont été récupérées par l’intermédiaire de recherches menées dans Medline et la base de données Cochrane, au moyen de mots clés appropriés («emergency contraception», «post-coital contraception», «emergency contraceptive pills», «post-coital copper IUD»). Les directives cliniques et les déclarations de principe élaborées par des organisations de santé ou de planification familiale ont également été analysées.
Les études analysées ont été classées en fonction des critères décrits par le Groupe d’étude canadien sur les soins de santé préventifs et les recommandations visant la pratique ont été évaluées en fonction de cette classification (Tableau 1).
La présente directive clinique a pour objectif de contribuer à réduire le nombre de grossesses non souhaitées en accroissant la sensibilisation envers la CU et son utilisation appropriée.
Société des obstétriciens et gynécologues du Canada.
- 1.
  La contraception d’urgence hormonale peut être efficace lorsqu’elle est utilisée jusqu’à cinq jours à la suite de relations sexuelles non protégées. (II-2)
- 2.
  Plus la contraception d’urgence hormonale est utilisée tôt, plus elle est efficace. (II-2)
- 3.
  Un DIU de cuivre peut constituer un moyen de contraception d’urgence efficace, lorsqu’il est utilisé dans les sept jours suivant les relations sexuelles. (II-2)
- 4.
  Les schémas posologiques de contraception d’urgence faisant appel au lévonorgestrel sont plus efficaces et occasionnent moins d’effets indésirables que le schéma posologique Yuzpe. (I)
- 5.
  Le schéma posologique de contraception d’urgence faisant appel à une seule dose de lévonorgestrel (1,5 mg) et celui qui fait appel à deux doses de ce dernier (0,75 mg, à 12 heures d’intervalle) comptent une efficacité semblable et ne présentent aucune différence en matière d’effets indésirables. (I)
- 6.
  Parmi les schémas posologiques de contraception hormonale d’urgence disponibles au Canada, ceux qui ne font appel qu’au lévonorgestrel sont à privilégier. (I)
- 7.
  Les grossesses qui résultent de l’échec de la contraception d’urgence n’ont pas à faire l’objet d’une interruption. (I)
- 1.
  La contraception d’urgence devrait être utilisée dès que possible à la suite des relations sexuelles non protégées. (II-2A)
- 2.
  La contraception d’urgence devrait être offerte aux femmes lorsque les relations sexuelles non protégées ont eu lieu dans les limites de temps requises pour assurer l’efficacité de l’intervention (cinq jours pour les méthodes hormonales et jusqu’à sept jours pour le DIU de cuivre). (II-2B)
- 3.
  Une évaluation visant à déterminer la présence d’une grossesse devrait être menée en l’absence de règles dans les 21 jours suivant le traitement de contraception d’urgence. (III-A)
- 4.
  Au moment de l’examen de santé périodique ou dans le cadre de consultations portant sur des questions de santé génésique, toute femme en âge de procréer n’ayant pas été stérilisée pourrait bénéficier, de façon anticipée, de services de counseling au sujet de la contraception d’urgence et se voir remettre des renseignements détaillés sur la façon et le moment de l’utiliser. (III-C)
Acute Sexual Assault in the Pediatric and Adolescent Population
2016, Journal of Pediatric and Adolescent Gynecology
Citation Excerpt :
Emergency contraception should be offered to any adolescent at risk of pregnancy in whom a sexual assault took place within the prior 120 hours.23,71 A variety of options for emergency contraception exists however administering levonorgestrel 1.5 mg or ulipristal acetate 30 mg orally is preferred as they have lower rates of adverse effects, high efficacy rates and can be administered in the acute setting.71–73 Repeat testing should be conducted 2 to 3 weeks later whether or not emergency contraception was given.
Children and adolescents are at high risk for sexual assault. Early medical and mental health evaluation by professionals with advanced training in sexual victimization is imperative to assure appropriate assessment, forensic evidence collection, and follow-up. Moreover, continued research and outreach programs are needed for the development of preventative strategies that focus on this vulnerable population. In this review we highlight key concepts for assessment and include a discussion of risk factors, disclosure, sequelae, follow-up, and prevention.
Safety data for levonorgestrel, ulipristal acetate and Yuzpe regimens for emergency contraception
2016, Contraception
The World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC) provide recommendations for use of emergency contraceptive pills (ECPs), including levonorgestrel (LNG) and combined oral contraceptives (COCs). A new ECP formulation, ulipristal acetate (UPA), is now available worldwide. To determine whether LNG, UPA or COC (Yuzpe) ECPs are safe for women with certain characteristics or medical conditions, we searched the PubMed and Cochrane databases for articles published from date of inception until May 2015 pertaining to the safety of LNG, UPA or Yuzpe ECP use. For direct evidence, we considered studies that looked at safety outcomes among women with certain medical conditions or characteristics taking ECPs compared with women not taking ECPs. For indirect evidence, we considered studies that reported pharmacokinetic (PK) data for ECP use among women with certain medical conditions or characteristics and studies that reported safety outcomes among healthy women taking ECPs. Five studies provided direct evidence; of these five studies, four examined LNG or Yuzpe use among pregnant or breastfeeding women, and one reported risk of ectopic pregnancy among women repeatedly using LNG ECPs. Poor pregnancy outcomes were rare among pregnant women who used LNG or Yuzpe ECPs during the conception cycle or early pregnancy. Breastfeeding outcomes did not differ between women exposed to LNG ECP and those unexposed, and there was no increased risk of ectopic pregnancy versus intrauterine pregnancy after repeated use of LNG ECPs compared with nonuse. Forty-five studies provided indirect evidence. One PK study demonstrated that LNG passes into breastmilk but in minimal quantities. In addition, nine studies examined pregnancy outcomes following ECP failure among healthy women, and 35 articles reported adverse events. Studies suggest that serious adverse events are rare among women taking any of these ECP formulations.
Evidence on safety of ECPs among women with characteristics or medical conditions listed within WHO and CDC family planning guidance is limited. However, both direct and indirect evidence for our study question did not suggest any special safety concerns for the use of ECPs among women with particular medical conditions or personal characteristics, such as pregnancy, lactation or frequent ECP use.
Hormonal Contraception
2015, Williams Textbook of Endocrinology
"i'll see what i can do": What adolescents experience when requesting emergency contraception
2014, Journal of Adolescent Health
To understand the experiences of adolescent females when they try to obtain emergency contraception (EC) from pharmacies.
Female callers, posing as 17-year-old adolescents, used standardized scripts to telephone 943 pharmacies in five United States cities. Two investigators independently coded qualitative data from these calls. Codes were discussed and a thematic analysis was conducted. Investigator, expert, and informant triangulation were used to ensure data credibility.
Four major themes emerged. First, ethical terms (personal or religious) were used to explain institutional pharmacy policies on EC availability. Second, there was confusion about the dispensing regulations regarding EC, given recent changes in United States policies. Third, pharmacy staff often introduced false barriers to EC access. In some cases, pharmacy staff used these barriers as justification for refusing to dispense EC; however, in other cases, pharmacy staff helped the adolescents overcome these false barriers. Finally, the degree of confidentiality in providing EC was unpredictable, with some pharmacies guaranteeing strict confidentiality and others explicitly telling adolescents, incorrectly, that their parents had to be informed.
Adolescents requesting EC from pharmacies are often explained pharmacy policies in ethics-laden terms, and confidentiality is not always guaranteed. They are told of false barriers to EC access, and there is confusion concerning the evolving policies regarding EC dispensing. It is important for clinicians, pharmacy staff and others to be aware of these experiences as they work to help improve adolescents' access to EC.
Assessing the extent of provision of comprehensive medical care management for female sexual assault patients in US hospital emergency departments
2013, International Journal of Gynecology and Obstetrics
To describe medical services provided to sexual assault patients in US emergency departments and to identify the percentage of hospitals always providing the 10 elements of comprehensive medical care management (CMCM).
A cross-sectional study was conducted in a national sample of US hospitals. A 26-item telephone survey assessed provision of services to sexual assault survivors in accordance with CMCM. Management included acute medical care comprising history and physical examination; acute and long-term rape crisis counseling; STI testing and prophylaxis; emergency contraception counseling and provision; and HIV testing and prophylaxis. The primary outcome was extent of provision of these elements.
Overall, 582 emergency departments responded to the survey. The following components of CMCM were provided: acute medical care (582 [100.0%]); rape crisis counseling (234 [40.2%]); STI management (448 [77.0%]); emergency contraception (351 [60.3%]); and HIV management (380 [65.3%]). Only 101 (17.4%) hospitals provided all 10 elements of CMCM.
Less than one-fifth of US hospitals provide comprehensive services to sexual assault patients. A national program incorporating clinical guidelines, checklists, and funding for sexual assault forensic/nurse examiner programs could improve the standard of care provided in emergency departments—the primary point of contact for acute care of sexual assault survivors.

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^☆: Supported by the FMOQ (Féderation des Médicins Omnipraticiens du Québec).

^☆☆: Reprint requests: Isabel Rodrigues, MD, Department of Family Medicine, University of Montreal, Local Center for Community Services, 1351 des Laurentides, Laval, Quebec, Canada H7M 2Y2.

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American Journal of Obstetrics and Gynecology

Abstract

Section snippets

Study group

Results

Comment

Acknowledgements

References (12)

Ethinylestradiol and dl –norgestrel as a postcoital contraceptive

Fertil Steril

Hormonal postcoital contraception with an ethinyl estradiol–norgestrel combination and two danazol regimens

Eur J Obstet Gynecol Reprod Biol

The postcoital IUD as an effective continuing contraceptive method

Contraception

The morning-after pill: how long after?

Am J Obstet Gynecol

New estimates of the effectiveness of the Yuzpe regimen of emergency contraception

Contraception

OCs provide emergency contraception option

Network

Cited by (148)

Contraception d'urgence

Acute Sexual Assault in the Pediatric and Adolescent Population

Safety data for levonorgestrel, ulipristal acetate and Yuzpe regimens for emergency contraception

Hormonal Contraception

"i'll see what i can do": What adolescents experience when requesting emergency contraception

Assessing the extent of provision of comprehensive medical care management for female sexual assault patients in US hospital emergency departments

GynecologyEffectiveness of emergency contraceptive pills between 72 and 120 hours after unprotected sexual intercourse☆,☆☆

Abstract

Section snippets

Study group

Results

Comment

Acknowledgements

Fertil Steril

Eur J Obstet Gynecol Reprod Biol

Contraception

Am J Obstet Gynecol

Contraception

OCs provide emergency contraception option

Network

Gynecology
Effectiveness of emergency contraceptive pills between 72 and 120 hours after unprotected sexual intercourse☆,☆☆