Repeat use of emergency contraception: How frequent is it?

School of Postgraduate Medicine and Health Sciences, University of Exeter, Barrack Road, Exeter, EX2 5AX, UK.
Journal of Family Planning and Reproductive Health Care (Impact Factor: 1.6). 11/2001; 27(4):197-201. DOI: 10.1783/147118901101195759
Source: PubMed


To measure the level of repeat use of emergency contraception (EC) in family planning clinics (FPCs) in North and East Devon.
An audit of repeat use of EC was carried out in seven FPCs, in parallel with a client survey. All women seeking EC in the study period were included (n = 572).
Nearly 70% of women had 'ever' used EC prior to the study visit; over half had previously used EC in the year of the study; a quarter had previously used EC three or more times in the same period. Teenagers were more likely to have previously used EC in the study year, but half of all repeat users were aged 20 and older. Asked why EC was needed today, most women reported current use of regular contraception, but almost a quarter had had unprotected sex, and half reported a condom mishap.
These results show frequent repeat use of EC and do not support recent research based on general practice records, which suggests that repeat use is rare. If EC users use multiple sources of EC, or prefer alternative sources, repeat use of EC will be underestimated if calculated using general practitioner (GP) records alone.

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    ABSTRACT: The objective of this study is to make the public aware of progress, safety, effectiveness of use, acceptance, and over-the-counter availability of emergency contraception (EC). Data were extracted from the literature for the period 2000–2006 via MEDLINE using a keyword, and also from some pre-2000 journals. Randomised trials, reviews, surveys, clinical investigations, and articles relevant to the subject matter are considered in this review. Approximately 85%, 57% and 84% of unintended pregnancy could be prevented by using levonorgestrel, the Yuzpe regimen (levonorgestrel plus ethinylestradiol), and mifepristone, respectively, as EC. Levonorgestrel was more effective than the Yuzpe regimen in preventing pregnancy. A dose of 1.5mg levonorgestrel seemed to have similar effectiveness as that of split doses (0.75mg twice) at 12h apart, and that of a low-dose (10mg) of mifepristone. Nausea and vomiting, dizzy spells and fatigue were less frequent in women using levonorgestrel only than in those receiving the Yuzpe regimen. The mode of action of EC is associated primarily with inhibition of ovulation. EC acts before implantation and hence does not amount to abortion. Teenagers are more likely to be repeat users of EC. Easy access to EC over the counter is likely to increase its use but will widen the chance of misuse or abuse. Both adolescents and health care providers need to be adequately educated and informed about EC to make this method successful. Over the counter supply of EC without prescription but with pharmacists’ counselling may increase reduction of unintended pregnancy and abortion. The controversy surrounding, and opposition to, EC may subside with more awareness and knowledge among the public about its mode of action, safety and effectiveness. Educational programmes on EC and further studies on the psychosocial aspects of its use may resolve hurdles for implementation of ‘advance provision’ or ‘over the counter supply’ of EC in the community.
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