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Update on Emergency Contraception

(Published March 2011)

Clinical Consultation

Even with progestin-only emergency contraception pills (ECPs) available over-the-counter for those aged 17 years and older, there is still a role for clinicians to counsel patients about emergency contraception and increase awareness and possibly use.

ECP Counseling Points for Clinicians

  • How to obtain them – Progestin-only ECPs are available behind the pharmacy counter or at family planning clinics without a prescription for those 17 and older, sometimes for a reduced cost. Those 16 years old and younger must obtain a prescription for progestin-only ECPs from their clinician or from their pharmacist in pharmacy-access states. Women of all ages need a prescription for ulipristal acetate (UPA) emergency contraception (EC).
  • Why it is a good idea to keep them on hand – Advance provision is recommended so that EC can be taken as soon as possible after unprotected sex.
  • How they work – ECPs most likely prevent pregnancy by stopping or delaying ovulation.
  • They are safe and benefits outweigh risks – ECPs are proven safe for all women.
  • There are more effective long-term and reversible methods of contraception – Women should be counseled on other more effective reversible contraceptive methods.

Case study: Marisa

Marisa is a 22-year-old woman who presents for a primary care visit with a chief complaint of vaginal discharge.

While encouraging future attempts at condom use, health professionals should also remember to:

  • Discuss emergency contraception (EC) as an option if/when condom use is not possible
  • Encourage her to purchase EC today to keep at home just in case
  • Discuss use of a highly-effective reversible form of contraception in addition to condoms

Case study: Heather

Heather is a 25-year-old woman who presents for a primary care visit expressing her desire to start on a birth control pill to prevent pregnancy.

Health professionals should:

  • Discuss EC as an option if/when she takes longer than she expected to pick up a refill Rx, or she misses 2 or more pills
  • Encourage her to purchase EC today to keep at home just in case
  • Clarify that highly-effective reversible options such as IUDs and the implant are typically more effective than an oral contraceptive
  • Encourage condom use to prevent sexually transmitted infections