What is the safest initial order for a female adult?

Emergency Contraception is the Safest Initial Order for Adult Females

For adult females, emergency contraception with levonorgestrel (Plan B) is the safest initial order, as it effectively prevents unintended pregnancy with minimal side effects and no contraindications for most women. 1

Evidence-Based Rationale

Emergency contraception is a critical intervention for preventing unintended pregnancy after unprotected intercourse. The 2013 CDC Selected Practice Recommendations for Contraceptive Use provides clear guidance on this matter:

Levonorgestrel Emergency Contraceptive Pills (ECPs)

• Highly effective when administered within 120 hours (5 days) of unprotected sexual intercourse
• Causes less nausea and vomiting than combined estrogen-progestin ECPs
• Can be started immediately with any regular contraceptive method afterward
• No routine medical screening tests are required before use 1

Dosing and Administration

• Single dose of 1.5 mg levonorgestrel
• Can be taken at any time in the menstrual cycle
• No contraindications for most women
• Does not affect future fertility 1, 2

Safety Profile Comparison

When considering safety for adult females, emergency contraception with levonorgestrel has several advantages over other potential orders:

1. Compared to combined hormonal contraceptives: Levonorgestrel ECPs have fewer contraindications and less risk of serious adverse events like thromboembolism 1, 2

2. Compared to ulipristal acetate: Levonorgestrel has a longer history of use with established safety data and fewer drug interactions 1

3. Compared to antiemetics like ondansetron: While ondansetron is safe for nausea/vomiting 3, it doesn't address the critical reproductive health need of preventing unintended pregnancy

4. Compared to aspirin: Aspirin carries bleeding risks and is only recommended for specific cardiovascular risk groups 1

Important Considerations

• Timing: Effectiveness decreases with time, so earlier administration is better
• Weight considerations: May be less effective in women with BMI >30 kg/m² 1
• Follow-up: Regular contraception can be started immediately after use 1
• STI protection: Does not protect against sexually transmitted infections 2

Algorithm for Use

1. Confirm no contraindications (virtually none for levonorgestrel)
2. Administer single 1.5 mg dose as soon as possible after unprotected intercourse
3. Provide instructions about possible side effects (mild nausea, irregular bleeding)
4. Discuss initiation of regular contraception method immediately after use
5. Consider follow-up pregnancy test if no withdrawal bleeding within 3 weeks 1

Common Pitfalls to Avoid

• Delaying administration: Efficacy decreases with time
• Missing the opportunity: Advance provision of ECPs increases likelihood of use when needed 1
• Failing to address ongoing contraception: Regular contraception can be started immediately after ECP use 1, 2
• Not considering special populations: Adolescents should have the same access to emergency contraception as adult women 1

Emergency contraception with levonorgestrel represents the safest initial order for adult females, balancing high efficacy with minimal side effects and virtually no contraindications, making it appropriate for nearly all women.