UMEM Educational Pearls

Title: A Quick Guide to Emergency Contraception

Posted: 4/13/2025 by Jennifer Wang, MD (Updated: 4/15/2025)
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Emergency contraception comes in multiple forms, all of which have their own side effects and best case use scenarios that emergency medicine providers should be aware of to offer the best counseling.

Levonorgestrel (Brand Names: Plan B, Julie), progestin only
1. Up to 3 days, 97-98% effective
2. One pill 1.5mg
3. Decreased efficacy in BMI > 25
4. Side effects: N/v, abdominal pain, cramping, bleeding
Ulipristal (Brand Names: Ella), selective progesterone receptor modulator
1. Up to 5 days, 98% effective
2. One pill 30mg
3. Effective in BMI > 25
4. Side effects: N/v, abdominal pain, spotting, delayed menses
Combined Oral Contraceptives
1. Up to 3 days, 96-97% effective
2. Combine pills to a total of 100 ?g ethinyl estradiol/0.5 mg levonorgestrel once and then again 12 hours later
  1. Known as the “Yuzpe” method
3. Side effects: N/v, abdominal pain, cramping/bleeding
Copper IUD
1. Up to 5 days, 98-99% effective
2. Inserted by OBGYN/family medicine
3. Side effects: Vaginal bleeding, cramping

Consider your patient before advising - if their BMI is > 25, consider ulipristal. If they want the most effective method, that'll be a copper IUD - but make sure they can get an appointment within 5 days of the unprotected intercourse! If they cannot afford ulipristal or levonorgestrel (which can both be $50 without insurance), but they already have OCPs, combining OCPs to the total noted above can be a method of emergency contraception that is still very effective.

References

Mazer-Amirshahi M, Ye P. Emergency contraception in the emergency department. Am J Emerg Med. 2023;63:102-105. doi:10.1016/j.ajem.2022.10.034

Rudzinski P, Lopuszynska I, Pazik D, et al. Emergency contraception - A review. Eur J Obstet Gynecol Reprod Biol. 2023;291:213-218. doi:10.1016/j.ejogrb.2023.10.035