Postcoital contraception

A 22- year-old female who requests a postcoital contraceptive after being raped would best be treated with which of the following ... 

Postcoital contraception can be defined as the use of a drug or device to prevent pregnancy soon after intercourse. It has been estimated that the use of emergency contraception in the USA has prevented over 2 million unwanted pregnancies. 

Mifepristone, an antagonist at progesterone and glucocorticoid receptors, has a luteolytic effect and is effective as a postcoital contraceptive. When combined with a prostaglandin it is also an effective abortifacient. 

Notelovitz M. Estrogens and postcoital contraception. Female Patient 1981 6(7) 36-8. 

Haspels AA, Van Santen MR. Postcoital contraception. Pediatr Adolesc Gynecol 1984 2 63. 

Glasier A, Thong KJ, Dewar M, Mackie M, Baird DT. Postcoital contraception with mifepristone. Lancet 1991 337(8754) 1414-5. 

Sanchez-Guerra M, Valle N, Blanco LA, Combarros O, Pascual J. Brain infarction after postcoital contraception in a migraine patient. J Neurol 2002 249 774. 

Postcoital contraception may be successful up to 72 hours after a single act of unprotected intercourse. A common technique is to take one tablet of levonoegestrel 750 micrograms (Levonelle 2) as soon as possible after intercourse and then a second tablet 12 hours (but not more than 16 hours) later. With this regimen, vomiting is rare but if it occurs within 3 hours of either dose, another table should be taken immediately. It is available over the coimter, i.e. off prescription, in the UK from trained pharmacists. 

Glasier A1997 Emergency postcoital contraception. New England Journal of Medicine 337 1058-1064... 

The varied clinical uses of estrogens include menstrual disorders, alleviation of menopause, associated symptoms (replacement therapy), osteoporosis, postmenopausal breast cancer and prostatic cancer and hypertrophy, lactation suppression, postcoital contraceptives, oral contraceptives (combined with progestins), estrogen deficiencies unrelated to the menopause, ovarian failure, and hypogenitalism. 

POSTCOITAL OR EMERGENCY CONTRACEPTIVES The FDA has approved two preparations for postcoital contraception. PLAN-B is two doses of the minipiU (0.75 mg levonorgestrel per pdl) separated by 12 hours PLAN-B will soon be available without a prescription for women 18 years old and older, preven is two 2-pill doses of a high-dose oral contraceptive (0.25 mg of levonorgestrel and 0.05 mg of ethinyl estradiol per pUl) separated by 12 hours. The FDA also has declared other products with the same or very similar composition safe and effective for use as emergency contraceptive piUs. 

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