EMERGENCY CONTRACEPTION

by Cynthia Chong MD

This is an on-line exercise.  Click on the two recommended
articles and read them.  Then read the case and answer the questions. 
Click through to the answers.

Recommended Articles

1.  Emergency
Contraception, Westhoff, Carolyn.  New England Journal of
Medicine, Vol. 349, No. 19 pp.1830-35.

2.. Emergency
Postcoital Contraception, Wertheimer, Randy Ellen.  American Family
Physician 2000;62:2287-92.

Practice Case

A 17-year-old college freshman presents to student health
services for a GYN evaluation.  She
has no significant past medical history, takes no medications but appears very
anxious and requests a GYN examination and pregnancy test. 
Her last menstrual period was two weeks ago. 
She had attended a fraternity party two nights ago where she was pressed
into using alcohol and other recreational drugs and became intoxicated. 
She was told today that male partygoers took advantage of her
helplessness and sexually assaulted her, but she has no clear recollection of
these events.  She had never been
sexually active in the past.  She
very tearfully tells you she does not want to be pregnant and is afraid that
that may have happened. She is
mortified that her parents and schoolmates will find out and brand her a tramp.

Question #1
Of what value would the GYN examination and pregnancy test serve?   Answer

Question #2
What therapeutic options are there?    Answer

Question #3
Are there any untoward effects?     Answer

Question #4
Do parents or college officials need to be notified?    Answer

Question #5
What follow-up should be scheduled?    Answer

Question #6
Should emergency contraception be available over-the-counter?   Answer

Other References

1. Randomised
controlled trial of levonorgestrel versus the Yuzpe
regimen of combined oral
contraceptives for emergency contraception.
Task Force on Postovulatory Methods of
Fertility Regulation, The Lancet • Vol 352 •
August 8, 1998, 425-33.

2. Timing
of emergency contraception with levonorgestrel or the Yuzpe regimen. G
Piaggio et al.  The Lancet • Vol 353 • February 27, 1999
p.721.

3. Comparison
of three single doses of mifepristone as emergency
contraception: a randomised trial. 
Task Force on Postovulatory Methods of Fertility Regulation. The
Lancet • Vol 353 • February 27, 1999 697-702.

4. Low
dose mifepristone and two regimens of levonorgestrel for emergency
contraception: a WHO multicentre randomised trial. Helena
von Hertzen et al, The Lancet 2002; 360: 1803–10.