Answering questions on emergency contraception

What is your approach when it comes to repeat doses of the levonorgestrel-only emergency contraceptive pill (ECP), Plan B (Women’s Capital Corp., Washington, DC)? Comments on this question are offered by the following Contraceptive Technology Update Editorial Advisory Board members: Robert Hatcher, MD, MPH, professor of gynecology and obstetrics at Emory University School of Medicine in Atlanta and senior author of Contraceptive Technology; Michael Rosenberg, MD, MPH, clinical professor of obstetrics and gynecology and adjunct professor of epidemiology at the University of North Carolina at Chapel Hill and president of Health Decisions, a private research firm specializing in reproductive health; James Trussell, PhD, professor of economics and public affairs and director of the Office of Population Research at Princeton University; and Susan Wysocki, RNC, NP, president and chief executive officer of the Washington, DC-based National Association of Nurse Practitioners in Women’s Health.

Question: A woman received Plan B for unprotected coitus that occurred within the prior 72 hours. She returned the following day requesting it again as she had another act of unprotected coitus. The provider did not give Plan B again, thinking that the woman still had protection. The provider now is asking how long a woman would have protection. Should she have given Plan B a second time within 24 hours?

Hatcher: There is no harm in giving her a second dose of Plan B (two tablets at once) on the second day. This case reminds us of two important truths about using Plan B:

1. There is almost no woman wanting treatment with Plan B who should be turned down. If she asks for it, give her Plan B. (Editor’s note: The labeling for Plan B lists only three prescribing precautions: pregnancy, hypersensitivity to any component of the product, and undiagnosed abnormal bleeding.)1

2. As soon as a woman takes Plan B, she must use contraception for the rest of that cycle and thereafter.

Rosenberg: This is an emerging area of practice, and this situation has not been studied. However, it seems prudent in this circumstance to go ahead and provide another dose of Plan B. Many physicians now are providing the two pills at the same time, and under that scenario, a second dose of two pills would be given after the second act of unprotected coitus.

Trussell: We get asked this question frequently at the Emergency Contraception web site (www.not-2-late.com), but unfortunately, there are no data to provide an answer.

Biologically, it would make sense that ECPs taken five minutes before unprotected intercourse would be just as effective as ECPs taken five minutes after intercourse. But it is not possible to know to pick the time X such that if intercourse occurs more than X hours after ECPs are taken, then the regimen should be repeated. That is the reason why many protocols simply state that ECPs do not protect against pregnancy from intercourse subsequent to treatment.

Reference

1. Hatcher RA, Nelson AL, Zieman M, et al. A Pocket Guide to Managing Contraception. Tiger, GA: Bridging the Gap Foundation; 2001.