Question #2

Emergency contraception and HIV prophylaxis should be offered.  Emergency contraception options include
estrogen/progestin combination regimen (Yupze method), progestin alone (Plan B),
mifepristone (RU-486), or copper IUD insertion would be effective.  The estrogen/progestin combinations,
progestin alone or mifepristone are best administered within 72 hours.  There is some evidence that there may be
efficacy up to 120 hours.  However, only
IUD insertion is recommended for up to 120 hours.  These methods work by preventing ovulation, preventing
implantation, or causing regression of the corpus luteum and are not considered
equivalent to therapeutic abortion.

The Yupze method requires 100 micrograms ethinyl estradiol and 0.5 mg
of levonorgestrel taken twice 12 hours apart. Preven is a prepackaged
estrogen/progestin.  Standard birth
control pills can also be used with dosing adjustments.  This methods is felt to be about 80%
effective.

Levonorgestrel alone is more efficacious.  It can be taken as a 0.75 mg 12 hours apart or 1.5 mg once.  This is felt to be about 85% effective.  Plan B, containing 2 0.75 mg levonorgestrel
tablets, has been marketed for this purpose.

High dose estrogens, 5 mg of ethinyl estradiol daily for five days has
similar efficacy to the Yupze regimen.

Mifepristone, an antiprogestin, works by preventing ovulation and
implantation.  600 mg once works 100% of
the time if given within 72 hours. 
Doses as low as 10 mg have been equally efficacious.  Mifepristone appears to be efficacious even
up to 120 hours.

A copper IUD can be inserted within 120 hours.  The IUD will disrupt implantation.  It will also provide ongoing contraception
after the initial situation.

Other situations where emergency contraceptives should be considered
include intercourse where there was failure of the primary form of
contraception.  Examples are broken
condoms, missed oral contraceptives, lack of contraceptives, missed or late
injection of injectable contraceptives, dislodging of diaphragm or cervical
cap, and failure of coitus interruptus.