We've come a long way... or have we?

Emergency contraception (EC) has come a long way since the days when Family Planning clinics and other services provided cut-up sections of pink oral contraceptive pill strips and a dose or two of an antiemetic in tiny sealed plastic bags to women who were lucky enough to know about this option. When evidence demonstrated the superiority of the progestogen-only regimen in 1998 1 , these plastic bags were then loaded with 50 minipills – many more pills to swallow but less nausea and vomiting for these women 'in the know'. However, despite current 'over the counter' (OTC) availability of a dedicated product and clear evidence on its safety and efficacy, it is probably underutilised and poorly understood by many in the community and by some health professionals. EC is defined as a medication or device used to prevent pregnancy after unprotected intercourse (including sexual assault) or after a recognised contraceptive failure. It has alternatively been called postcoital contraception or 'the morning after pill'. These terms are confusing and imply that EC pills can only be taken immediately, which is incorrect. They can be used, while with decreasing efficacy, for up to five days post intercourse. There are no evidence-based absolute contraindications to hormonal EC except established pregnancy (due to a lack of efficacy rather than specific adverse outcomes) and allergy. Side effects are uncommon with the progestogen-only regimen and hormonal EC can be used more than once in a cycle if required. It will not provide protection for the rest of the cycle, so ongoing contraception should be addressed from the time of administration. 2 What is used in Australia? The oldest method of hormonal EC, the 'Yuzpe' method (named after the Canadian who described it), was introduced in 1974 and consisted of two doses of 100mcg of ethinyl estradiol and 500mcg of levonorgestrel, given 12 hours apart. Only a few countries ever licensed this method, but it was widely used off-label, including in Australia. It is associated with side effects, particularly nausea and vomiting, due to the high estrogen dose and was therefore usually administered with prophylactic antiemetics. The progestogen method, using levonorgestrel (LNG), was found to be both more effective and associated with less side effects in a WHO study. 1 LNG is administered in two doses of 0.75g 12 hours apart, or a single dose of 1.5mg is equally effective for EC. 3 until 2002, there was …