FDA-approved options for emergency or post-coital contraception include the copper IUD, oral levonorgestrel, and oral ulipristal. For ongoing contraception, more people in the United States choose progestin IUDs over copper IUDs, and previous studies show many patients would select a progestin IUD if it were available as emergency contraception.
A new study suggests that progestin IUDs are non-inferior to copper IUDs for emergency contraception. Patients who had intercourse without contraception within the last five days were randomized to receive a copper or progestin IUD. One month after insertion, positive pregnancy test rates were 1 in 317 (0.3%; 95% confidence interval 0.01 to 1.7) in the progestin group and 0 in 321 (0%; 95% confidence interval 0 to 1.1) in the copper group. This between-group difference of 0.3 percentage points (95% CI, -0.9 to 1.8) was below the prespecified noninferiority margin of 2.5%. Secondary analysis suggests no difference in efficacy based on body-mass index. The pregnancy rate is lower in this study than other studies of oral emergency contraceptives (1.4-2.6%), though this study did not compare these options directly.
This study expands our options for emergency contraception. Any conversation about post-coital contraception should include discussion with the patient about efficacy, side effects, and patient experience.
Turok DK, Gero A, Simmons RG, Kaiser JE, Stoddard GJ, Sexsmith CD, Gawron LM, Sanders JN. Levonorgestrel vs. copper intrauterine devices for emergency contraception. N Engl J Med. 2021;384:335-344. doi: 10.1056/NEJMoa2022141.
Turok DK, Sanders JN, Thompson IS, Royer PA, Eggebroten J, Gawron LM. Preference for and efficacy of oral levonorgestrel for emergency contraception with concomitant placement of a levonorgestrel IUD: A prospective cohort study. Contraception. 2016 Jun; 93(6):526-532. doi: 10.1016/j.contraception.2016.01.009.
The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.