What emergency contraceptive pill options are available for a nulligravid (nulligravida) adolescent with a recent menstrual period and a negative pregnancy test?

From the Guidelines

I would recommend providing the patient with emergency contraception in the form of levonorgestrel 1.5 mg as a single oral dose, which should be taken as soon as possible. This medication, commonly known as Plan B One-Step, is available over-the-counter without age restrictions and is most effective when taken within 72 hours after unprotected intercourse, though it can be used up to 120 hours afterward 1. The patient should be informed that her next menstrual period might be early or delayed by a few days, and she should take a pregnancy test if her period is more than a week late. Common side effects include nausea, headache, fatigue, and breast tenderness.

Key Considerations

• As a minor seeking contraceptive services, the patient has a right to confidentiality in most states, and parental notification is not required.
• Levonorgestrel works primarily by preventing or delaying ovulation, and it may also alter the endometrium to prevent implantation 1.
• It's essential to discuss ongoing contraception options and safe sex practices, including condom use for STI prevention.
• The patient should also be offered STI testing given the unprotected intercourse.

Alternative Options

• Although levonorgestrel is the recommended option, ulipristal acetate may be considered, especially for patients who weigh more than 165 pounds, as it may have greater effectiveness than oral levonorgestrel at the end of the 5-day window of use 1.
• The copper IUD can also be considered as an emergency contraceptive option, which can be inserted within 5 days of the first act of unprotected sexual intercourse 1.

From the FDA Drug Label

Levonorgestrel tablet is emergency contraception that helps prevent pregnancy after birth control failure or unprotected sex. The sooner you take emergency contraception, the better it works You should use levonorgestrel tablet within 72 hours (3 days) after you have had unprotected sex.

The patient can take levonorgestrel tablet as emergency contraception since she had unprotected sex last night and is within the 72-hour window.

• The patient should take the tablet as soon as possible to increase its effectiveness.
• The patient's age and menstrual history do not contraindicate the use of levonorgestrel tablet.
• The patient should be informed that levonorgestrel tablet is not a regular birth control method and will not protect her from future pregnancies or sexually transmitted diseases.
• The patient should also be informed about potential side effects, such as changes in her period, nausea, or abdominal pain, and instructed to seek medical attention if her period is more than a week late or if she experiences severe abdominal pain 2.

From the Research

Emergency Contraception Options

• The patient has several emergency contraception options, including levonorgestrel-only pills, combined estrogen and progestin pills, and the copper intrauterine device 3.
• Ulipristal acetate (UPA) is the most effective oral option for emergency contraception, but it requires a prescription 4.
• The copper intrauterine device (IUD) is the most effective method of emergency contraception, but it requires a timely visit with a trained clinician 4, 5.

Accessibility and Age Restrictions

• In the United States, levonorgestrel-containing emergency contraceptive pills are available without prescription to women and men without age restrictions 4.
• However, the patient is 16 years old, and according to the study published in 2010, levonorgestrel-only EC is available to women ≥17 years of age without a prescription 3.
• It is not specified in the provided studies whether a 16-year-old can obtain emergency contraception without parental notification.

Effectiveness and Usage

• Emergency contraception reduces the risk of pregnancy by 60 to 94% when used within 120 hours after unprotected sexual intercourse 3.
• The effectiveness of emergency contraceptive pills may be lower in overweight or obese women, and such women should be offered a copper IUD or ulipristal instead of levonorgestrel pills 4, 6.
• Women who are counseled by their clinician about emergency contraception are more likely to use it in the following 12 months 3.