Yuzpe Method for Emergency Contraception
The Yuzpe method is a less effective, older emergency contraception regimen that involves taking combined oral contraceptives (COCs) containing ethinyl estradiol and levonorgestrel in two doses 12 hours apart within 72 hours of unprotected intercourse, but it has been largely superseded by more effective options like levonorgestrel-only pills, ulipristal acetate, or copper IUD.
Dosing Schedule
The Yuzpe regimen consists of:
- First dose: Combined oral contraceptives taken within 72 hours after unprotected intercourse
- Second dose: Identical dose taken 12 hours after the first dose 1
The regimen uses ordinary combined oral contraceptives containing levonorgestrel and ethinyl estradiol 2. Any combined pill can be used except triphasic formulations 3. Alternative formulations containing norethindrone-ethinyl estradiol work approximately as well as levonorgestrel-ethinyl estradiol combinations 2.
Effectiveness
The Yuzpe method reduces unintended pregnancies by approximately 75% 4. However, it is the least effective of all emergency contraceptive pills 3. Perfect-use failure rates are approximately 2.0-2.9% 2, but efficacy declines significantly after 72 hours and the method does not work beyond this timeframe 3.
Side Effects and Management
The major limitation of the Yuzpe method is its side effect profile:
- Nausea occurs in approximately 50% of users
- Vomiting occurs in approximately 20% of users 2
These side effects can be controlled with antiemetic medication taken prior to the first dose 4. Interestingly, taking the pills with food does not appear to reduce nausea or vomiting 2.
Contraindications and Safety
The Yuzpe method is remarkably safe with few absolute contraindications 5:
- Serious adverse events are rare among women taking this formulation
- Poor pregnancy outcomes are rare among pregnant women who inadvertently used Yuzpe ECPs during the conception cycle or early pregnancy
- The method can be used even if pregnancy is suspected, though it will not terminate an existing pregnancy 5
Superior Alternatives
You should preferentially recommend the following alternatives over the Yuzpe method:
Levonorgestrel-Only Pills (Plan B)
- More effective than Yuzpe with fewer side effects 3
- Approved for use up to 72 hours postcoitus 1
- Available over-the-counter without prescription
- Significantly less nausea and vomiting compared to Yuzpe
Ulipristal Acetate (Ella)
- Approved for up to 120 hours (5 days) postcoitus 1
- More effective than levonorgestrel after 72 hours 6
- More suitable for obese women 3
- Requires prescription 1
Copper IUD
- Most effective emergency contraceptive method 3
- Can be inserted up to 5-7 days after unprotected intercourse 1, 7
- Provides ongoing long-term contraception 3
- Nonhormonal option 1
- Requires trained provider and appropriate infrastructure 3
When to Use Yuzpe Method
The Yuzpe regimen remains useful only in specific circumstances:
- When dedicated emergency contraceptive methods are not available 3
- In resource-limited settings where levonorgestrel or ulipristal are inaccessible
- As it uses readily available combined oral contraceptives that may already be in a patient's possession
Clinical Pitfalls
- Do not assume the Yuzpe method is as effective as newer options—counsel patients about superior alternatives
- Efficacy does not improve when pills are started sooner after intercourse within the 72-hour window 2
- The method should not be considered an alternative to ongoing contraceptive methods 4
- Consider advanced provision of emergency contraception for all patients, particularly ulipristal since it requires prescription 1