Emergency postcoital contraception: SOGC clinical practice guidelines

The Yuzpe 2+2 regimen is recommended for emergency postcoital contraception by the Reproductive Endocrinology and Infertility Committee of the Society of Obstetricians and Gynaecologists of Canada (SOGC). In the Yuzpe 2+2 regimen, two tablets of estradiol and levonorgestrel are taken with an antiemetic; an identical dose is taken 12 hours later. The regimen has a 98% success rate and should be administered within 72 hours of unprotected intercourse. It should be regarded strictly as an emergency measure.
Objective: A major reduction in the number of unwanted pregnancies and pregnancy terminations could be achieved if an effective method of emergency pregnancy interception (postcoital contraception) was readily available to women. This policy statement describes a method which is the Yuzpe 2 + 2 regimen; the use of two tablets of estradiol/levonorgestrel, with an antiemetic, followed by a second identical dose 12 hours later. Opinions: It must be stressed that this is the method of emergency contraception. Treatment should be reserved for those who have been exposed to unprotected coitus within the previous 72 hours only. Outcomes and Benefits: The success rate is 98 percent and is heralded by menstrual bleeding by the 21st day following treatment. For those women who do not qualify for this regimen, or with exposure in the previous seven days, the insertion of a copper intrauterine device (IUD) is highly effective in preventing pregnancy. Contraindications are those of the oral contraceptive pill. Evidence: Clinical trials have supported this statement. Harm and Costs: The rates of mild side effects, headaches, bloating and nausea and/or vomiting have been reduced by the reduction of the steroid dosage and the accompanying antiemetic. Reccomendations: Although the Yuzpe 2+2 method has been widely marketed in Europe and used in North America at physicians' discretion, there is currently no specific approval by the Health Protection Branch (HPB) or the Food and Drug Administration (FDA). However, the SOGC recommends this method to consumers as a highly effective method of emergency contraception. Sponsors: The SOGC is the sponsor of this practice guideline produced by the Reproductive Endocrinology Committee of SOGC and approved by the SOGC Council in June 1996.
Acknowledgement: This article has been reprinted with the permission of the Society of Obstetricians and Gynaecologists of Canada from the February 1997 issue of the Journal SOGC, 19, 167-172. INTRODUCTION [...]