Commentary

The review by Cheng et al concludes that levonorgestrel or mifepristone are more effective and better tolerated than the traditionally used Yuzpe method. Mifepristone, however, remains controversial because of its identity as the “abortion” pill. It is also associated with delayed onset of menses. The thorough search of specialised databases, inclusion of studies in any language, consultation with experts, and sound methodological quality of most of the individual studies gives strength to the authors’ conclusions. A levonorgestrel regimen of 1.5 mg, as a single or divided dose, is the treatment of choice when available, although it may be more costly than the Yuzpe method.

The clinical safety and effectiveness of emergency contraception is well established. The challenge for clinicians is to promote the appropriate use of this underused contraceptive option. Few women report having ever used emergency contraception.^1,2 It is likely that wider use could prevent many unwanted pregnancies and prevent abortions. Some countries are initiating changes that will make emergency contraception available through pharmacists without prescription. Over-the-counter sales will dramatically increase access and should be supported by healthcare professionals. Clinicians might also consider providing women or couples with an advance dose of emergency contraception for use after unprotected intercourse. Although this approach is controversial, adolescents provided with an advance dose do not have more unprotected sex and actually increase their use of condoms or oral contraceptives.³

The take home message is that emergency contraception is safe and effective, and access to this important contraceptive option should be expanded.