The American College of

Obstetricians and Gynecologists

WOMEN’S HEALTH CARE PHYSICIANS

P RACTICE BULLET IN
clinical management guidelines for obstetrician – gynecologists

Number 152, September 2015 (Replaces Practice Bulletin Number 112, May 2010)
(Reaffirmed 2018)

Emergency Contraception
Emergency contraception, also known as postcoital contraception, is therapy used to prevent pregnancy after an
unprotected or inadequately protected act of sexual intercourse. Common indications for emergency contraception
include contraceptive failure (eg, condom breakage or missed doses of oral contraceptives) and failure to use any form
of contraception (1–3). Although oral emergency contraception was first described in the medical literature in the
1960s, the U.S. Food and Drug Administration (FDA) approved the first dedicated product for emergency contracep-
tion in 1998. Since then, several new products have been introduced. Methods of emergency contraception include oral
administration of combined estrogen–progestin, progestin only, or selective progesterone receptor modulators and
insertion of a copper intrauterine device (IUD). Many women are unaware of the existence of emergency contracep-
tion, misunderstand its use and safety, or do not use it when a need arises (4–6). The purpose of this Practice Bulletin
is to review the evidence for the efficacy and safety of available methods of emergency contraception and to increase
awareness of these methods among obstetrician–gynecologists and other gynecologic providers.

Background of 1.5 mg of levonorgestrel (Table 1). This product can

be purchased over the counter and is available without
age restriction as of 2013. The product using two levo-
Regimens
norgestrel doses of 0.75 mg has fallen out of use in favor
Research on the postcoital use of contraceptive steroids of the simpler one-dose regimen, which is at least as
began in the 1960s. The first oral regimen, which used a effective as the two-dose product (9, 10). The levonor-
widely available brand of combined estrogen–progestin gestrel regimen is labeled for use for up to 72 hours after
oral contraceptive pills, was published in 1974 (7). unprotected sex but is best used as soon as possible after
Research on progestin-only regimens for occasional unprotected sex (10–14) (Table 1).
postcoital use by women having infrequent sexual inter- A second dedicated emergency contraceptive, a pill
course also began at approximately the same time (8). containing 30 mg of ulipristal acetate, was approved by
Data regarding the use of IUDs as emergency contra- the FDA in 2010 and requires a prescription. This selec-
ceptives were initially published in the 1970s and, more tive progesterone receptor modulator, or antiprogestin,
recently, selective progesterone receptor modulators were has demonstrated effectiveness up to 120 hours after
introduced. unprotected sex (14) (Table 1).
The most commonly used oral emergency contra- Combined estrogen–progestin emergency contracep-
ceptive regimen is the progestin-only pill, which consists tive regimens are no longer sold as a dedicated product.

Committee on Practice Bulletins—Gynecology. This Practice Bulletin was developed by the Committee on Practice Bulletins–Gynecology with the
assistance of Elizabeth Raymond, MD; Archana Pradhan, MD; and Lisa Keder, MD, MPH. The information is designed to aid practitioners in making deci-
sions about appropriate obstetric and gynecologic care. These guidelines should not be construed as dictating an exclusive course of treatment or procedure.
Variations in practice may be warranted based on the needs of the individual patient, resources, and limitations unique to the institution or type of practice.
Table 1. Available Methods of Emergency Contraception ^

Timing of Use After FDA Labeled

Unprotected Sexual for Use as Emergency
Regimen Formulation Intercourse* Access Contraception

Selective progesterone 1 tablet, containing 30 mg Up to 5 days Requires a prescription Yes

receptor modulator of ulipristal acetate
Progestin only 1 tablet, containing 1.5 mg Up to 3 days Available over the counter Yes
of levonorgestrel without age restriction
2 tablets, each containing Up to 3 days Available over the counter Yes
0.75 mg of levonorgestrel to those 17 years and older
with photo identification
Combined progestin– A variety of formulations can Up to 5 days Requires a prescription No‡
estrogen pills be used†
Copper IUD§ N/A Up to 5 days Requires office visit and No‡
insertion by a clinician

Abbreviations: FDA, U.S. Food and Drug Administration; IUD, intrauterine device; N/A, not applicable.
*Emergency contraception is best used as soon as possible after unprotected sex.
†
A variety of formulations of combined oral contraceptives can be used for emergency contraception. For a list of appropriate formulations, see http://ec.princeton.
edu/questions/dose.html#dose.
‡
Although these methods are not FDA labeled for use as emergency contraception, they have been found to be safe and effective when used for emergency contracep-
tion and can be used off-label for this indication.
The copper IUD is the most effective method of emergency contraception.
§

However, they can be formulated from a variety of stand- of a fertilized egg (24, 27, 29–35). The copper IUD pre-
ard oral contraceptives (http://ec.princeton.edu/questions/ vents fertilization by affecting sperm viability and func-
dose.html#dose) (15). tion. It also may affect the oocyte and endometrium (36).
The copper IUD also can be used for emergency Emergency contraception sometimes is confused
contraception, although the FDA has not labeled it with medical abortion (37). Medical abortion is used to
for this indication. The IUD is highly effective if terminate an existing pregnancy, whereas emergency
placed within 5 days of sexual intercourse and in some contraception is effective only before a pregnancy is
studies was used as many as 10 days later (16–18). established. Emergency contraception can prevent preg-
The levonorgestrel-containing IUDs are currently being nancy after sexual intercourse and is ineffective after
investigated for use as emergency contraception. implantation. Studies of high-dose oral contraceptives
indicate that hormonal emergency contraception confers
Method of Action no risk to an established pregnancy or harm to a develop-
No single mechanism of action has been established for ing embryo (38).
emergency contraception; rather, the mode of action var-
ies according to the day of the menstrual cycle on which Adverse Effects
sexual intercourse occurs, the time in the menstrual No deaths or serious complications have been causally
cycle that the emergency contraceptive is administered, linked to emergency contraceptive pills (39). Short-term
and the type of emergency contraceptive (19–22). adverse effects include the following:
Ulipristal acetate and the levonorgestrel-only regimen
have been shown to inhibit or delay ovulation (23–29). • Nausea and headache––Ulipristal acetate and levo-
Levonorgestrel delays follicular development when norgestrel products have similar adverse effect
administered before the level of luteinizing hormone profiles. The most frequently reported adverse
increases. Ulipristal acetate inhibits follicular rupture effects are headache (19%) and nausea (12%) (14).
even after the level of luteinizing hormone has started The combined estrogen–progestin regimen has a
to increase. Review of the evidence suggests that emer- significantly higher rate of nausea than the ulipristal
gency contraception is unlikely to prevent implantation acetate and levonorgestrel regimens (40).

2 Practice Bulletin No. 152

 • Irregular bleeding––After emergency contracep- cian if emergency contraception is needed. All but one
tive pill use, the menstrual period usually occurs of these trials showed no difference between the groups
within 1 week of the expected time (41). Some regarding self-reported frequency of either unprotected
patients experience irregular bleeding or spotting sexual intercourse or use of contraception (56).
in the week or month after treatment; one trial of Surveys have documented that a large number of
the levonorgestrel-only regimen found that 16% women are unaware of the existence of emergency con-
of women reported nonmenstrual bleeding in the traception or have insufficient knowledge to allow them
first week after use (10). If emergency contracep- to use it effectively (57–62). In a recent survey of ado-
tion is taken earlier in the cycle, it is more likely lescents who received care at urban emergency depart-
that a woman will experience bleeding before the ments, only 64% had heard of emergency contraception
expected menses (42). Irregular bleeding associ- (63). Other research has indicated that women who are
ated with emergency contraception resolves without poor, foreign born, or who are not high school gradu-
treatment. ates are less likely to have knowledge of emergency
• Other adverse effects––Some patients have reported contraception (47, 64). In a 2007 study, few women who
experiencing other short-term adverse effects with received information about emergency contraception
oral regimens, such as breast tenderness, abdominal remembered discussing it 12 months later (65). In addi-
pain, dizziness, and fatigue (43). tion, many obstetrician–gynecologists and other gyne-
cologic providers are poorly informed about this method
Copper IUD insertion carries a risk of uterine perfora- of contraception (66–68). In a 2008 U.S. survey, almost
tion of approximately 1/1,000, is associated with uterine one in five practitioners were reluctant to provide educa-
cramping, and may cause increased duration of men- tion on the subject of emergency contraception to sexu-
strual flow or dysmenorrhea (44). ally active adolescents (69). Three studies that evaluated
females who were sexually assaulted and received care
Effects on Pregnancy at emergency departments indicated that only 21–50% of
No studies have specifically investigated adverse effects eligible women received emergency contraception (70–
of exposure to emergency contraceptive pills during 72). A survey of emergency medicine residents found
early pregnancy. However, numerous studies of the tera- that 71% reported that they always offered emergency
togenic risk of conception during daily use of oral con- contraception after sexual assault, but only 19% always
traceptives (including older, higher-dose preparations) offered it after consensual, unprotected sex. More stud-
have found no increase in risk to either the pregnant ies to evaluate barriers to use in specific populations are
woman or the developing fetus (45). needed so that appropriate policy interventions can be
Existing data indicate that use of levonorgestrel implemented (73, 74).
emergency contraception does not increase the chance Availability of levonorgestrel emergency contracep-
that a subsequent pregnancy will be ectopic. Emergency tion has improved since it was approved for over-the-
contraception, like all other contraceptives, actually counter use. A study of 1,087 pharmacies in Philadelphia,
reduces the absolute risk of ectopic pregnancy by pre- Boston, and Atlanta found that even when availability
venting pregnancy overall (46). was limited to behind-the-counter status (ie, being avail-
able without a prescription, but only after consultation
Barriers to Use with a pharmacist), the percentage of pharmacies unable
Women seeking emergency contraception typically are to provide Plan B within 24 hours decreased from 23%
younger than 25 years, have never been pregnant, and in 2005 to 8% in 2007 (75). However, previously docu-
have used some form of contraception in the past (1, 47, mented barriers such as limited access to emergency
48). Numerous studies have shown that making emer- contraception through pharmacies, student health cen-
gency contraception more available does not encourage ters, urgent care centers, and other sources remain (74,
risky sexual behavior or increase the risk of unintended 76). Despite the fact that the single-dose 1.5-mg levo-
pregnancy (49). Several published randomized trials norgestrel regimen is now available over the counter for
have evaluated the policy of providing emergency con- individuals of all ages, a recent evaluation of telephone
traception to women at the time of a routine gynecologic calls made to pharmacies by females posing as adoles-
visit so that they will have the medication immediately cents requesting emergency contraception revealed that
available if a contraceptive mishap occurs (2, 50–56). significant barriers remain for adolescents seeking this
These trials compared this policy of advance provision product (77). Consequently, obstetrician–gynecologists
with a policy of instructing women to contact a clini- and other gynecologic providers need to pay particular

Practice Bul­le­tin No. 152 3

attention to barriers for emergency contraception use in decreasing efficacy with time after unprotected sex and is
this at-risk population. labeled for use up to 72 hours (10–14). However, studies
have shown it is still moderately effective when the first
dose is taken up to 5 days after sexual intercourse (10,
Clinical Considerations and 79–84). Insertion of a copper IUD should be performed
as soon as possible after unprotected or inadequately pro-
Recommendations tected sexual intercourse. It is effective when placed up to
5 days after sexual intercourse and, in some studies, was
Who are candidates for emergency
used up to 10 days afterward without failure (18).
contraception?
Emergency contraception should be offered or made How effective is emergency contraception in
available to women who have had unprotected or inad- preventing pregnancy?
equately protected sexual intercourse and who do not
desire pregnancy. The Centers for Disease Control and For emergency contraception, efficacy can be defined
Prevention’s U.S. Medical Eligibility Criteria for Con- in one of two ways: the first is the proportion of women
traceptive Use, 2010 include no conditions in which becoming pregnant after use of the method. The second
the risks of emergency contraception use outweigh the is the number of pregnancies observed after treatment
benefits (78). These criteria specifically note that women divided by the estimated number of pregnancies that
with previous ectopic pregnancy, cardiovascular disease, would occur without treatment. When this proportion
migraines, or liver disease and women who are breast- is subtracted from one, the resulting statistic is the
feeding may use emergency contraception. Therefore, any “prevented fraction,” which represents the estimated
emergency contraceptive regimen may be made available percentage of cases averted by the treatment. Reported
to women with contraindications to the use of conven- figures on the efficacy of emergency contraception vary
tional oral contraceptive preparations. Reproductive-aged considerably and are imprecise.
women who are victims of sexual assault always should The copper IUD was evaluated in a multicenter trial
be offered emergency contraception. among women who requested emergency contracep-
tion up to 5 days after unprotected sex. Among 1,893
What screening procedures are needed women, there were no pregnancies within the first month
before provision of emergency contraception? (17). A systematic review of the published literature
regarding the use of IUDs as emergency contraception
No clinical examination or pregnancy testing is neces-
identified 42 studies over a 35-year time frame (16).
sary before provision or prescription of emergency con-
The pregnancy rates reported were between 0% and 2%,
traception. Emergency contraception should be offered
of which the aforementioned study was the largest (17).
or made available any time unprotected or inadequately
The second largest study, which involved 1,013 women,
protected sexual intercourse occurs and the patient is
had one pregnancy for a rate of 0.1% (16, 85).
concerned that she is at risk of an unwanted pregnancy.
The oral regimens also have been evaluated thor-
Emergency contraception should not be withheld or
oughly. Studies have found that ulipristal acetate is
delayed in order to test for pregnancy, nor should it be
more effective than the levonorgestrel-only regimen and
denied because the unprotected coital act may not have
maintains its efficacy for up to 5 days. A meta-analysis
occurred on a fertile day of the menstrual cycle.
of comparative efficacy trials found a lower pregnancy
rate among users of ulipristal acetate (1.4%) compared
When should emergency contraception be
with users of the levonorgestrel-only regimen (2.2%)
initiated?
(14). Phase III studies had an overall pregnancy rate of
Treatment with emergency contraception should be 1.9% for women who used ulipristal acetate (86). Six
initiated as soon as possible after unprotected or inad- studies comprising a total of more than 8,000 women
equately protected sexual intercourse to maximize effi- who used the levonorgestrel-only regimen calculated
cacy. Emergency contraceptive pills or the copper IUD prevention rates ranging from 60% to 94% (9–11, 41,
should be made available to patients who request it up 87, 88). Similarly, eight studies including a total of
to 5 days after unprotected or inadequately protected more than 3,800 women who used the combined
sexual intercourse. estrogen–progestin regimen yielded prevention rates
Ulipristal acetate’s effectiveness is maintained for ranging from 56% to 89%; a meta-analysis of pooled
5 days after sexual intercourse (14). Levonorgestrel has data from these studies concluded that the combined

4 Practice Bulletin No. 152

estrogen–progestin regimen prevents at least 74% of Is emergency contraception safe if used
expected pregnancies (89). repeatedly?
Two studies have examined the efficacy of the
levonorgestrel-only regimen compared with the com- Data are not available on the safety of current regimens
bined estrogen–progestin regimen. The first study found of emergency contraception if used frequently over a
no statistically significant difference in pregnancy long period. However, oral emergency contraception
rates between the levonorgestrel-only regimen and the may be used more than once, even within the same
combined regimen (2.4% versus 2.7%, respectively) menstrual cycle. Information about other forms of con-
(11). However, a second larger trial reported that the traception and counseling about how to avoid future con-
levonorgestrel-only regimen was significantly more traceptive failures should be made available to women
effective for preventing pregnancy than the combined who use emergency contraception, especially those who
regimen (85% versus 57% of pregnancies prevented, use it repeatedly.
respectively) (41). Estimates based on combined data Hormonal emergency contraception is less effective
from these two studies show a reduced relative risk of for long-term contraception than most other available
pregnancy (relative risk, 0.51; 95% confidence interval, methods. In addition, continued use of hormonal emer-
0.31– 0.83) with the levonorgestrel-only regimen (90). gency contraception would result in exposure to higher
The levonorgestrel-only regimen for emergency contra- total levels of hormones than would ongoing use of
ception is more effective than the combined hormonal either combined or progestin-only oral contraceptives,
and frequent use also would result in more adverse
regimen and is associated with less nausea and vomit-
effects, including menstrual irregularities. Therefore,
ing (40). Therefore, the levonorgestrel-only regimen is
emergency contraception should not be used as a long-
preferred to the combined estrogen–progestin regimen.
term contraceptive.
Body weight influences the effectiveness of oral
emergency contraception. Levonorgestrel emergency
What clinical follow-up is needed after use of
contraception may be less effective in women who are
emergency contraception?
overweight (body mass index [BMI] 25–29.9 kg/m2)
or obese (BMI of 30 kg/m2 or greater) (91, 92). Addi- No scheduled follow-up is required after use of emer-
tionally, some research suggests that ulipristal acetate gency contraception. However, clinical evaluation is
has lower effectiveness among obese women (86). The indicated for women who have used emergency contra-
efficacy of the copper IUD is not affected by body ception if menses are delayed by a week or more after
weight (16, 93). Therefore, consideration should be the expected time or if lower abdominal pain or persis-
given to use of a copper IUD as an alternative to oral tent irregular bleeding develops. The woman should be
emergency contraception in obese women. However, advised that if her menstrual period is delayed by a week
oral emergency contraception should not be withheld or more, she should have a pregnancy test and seek clini-
from women who are overweight or obese because no cal evaluation. Clinical evaluation also is indicated for
research to date has been powered adequately to evalu- women who have used emergency contraception if lower
ate a threshold weight at which it would be ineffective. abdominal pain or persistent irregular bleeding develops
To maximize effectiveness, women should be edu- because these symptoms could indicate a spontaneous
cated about the availability of emergency contraception pregnancy loss or an ectopic pregnancy. Women should
in advance of need. Multiple randomized controlled be referred as needed for the provision of ongoing con-
trials have failed to demonstrate a reduction in unin- traception, sexually transmitted infection testing, and
tended pregnancy or abortion with increased access to well-woman care.
emergency contraception (94). These data highlight
the importance of counseling patients about the appro- When should regular contraception be
priate use of emergency contraception as an episodic initiated or resumed after use of emergency
intervention rather than an effective long-term method. contraception?
Information regarding effective long-term contraceptive Treatment with emergency contraception may not pro-
methods should be made available whenever a woman tect against pregnancy in subsequent coital acts (10)
requests emergency contraception, and consideration unless the copper IUD is the method chosen. In fact,
should be given to the use of the copper IUD, which because emergency contraception may work by delay-
is highly effective as an emergency contraceptive and ing ovulation, women who have taken emergency con-
an ongoing contraceptive. Use of highly effective long- traceptive pills are at risk of becoming pregnant later in
acting reversible methods should be encouraged. the same menstrual cycle. Women should begin using

Practice Bul­le­tin No. 152 5

barrier contraceptives to prevent pregnancy (eg, condoms,
diaphragms, and spermicides) immediately after using
Summary of
emergency contraception. The U.S. Selected Practice Recommendations and
Recommendations for Contraceptive Use, 2013 advise
that any regular contraceptive method can be started
Conclusions
immediately after the use of ulipristal acetate emergency
The following conclusions are based on good and
contraception, but the woman should abstain from sexual
consistent scientific evidence (Level A):
intercourse or use a barrier method of contraception for
14 days or until her next menses, whichever comes first Ulipristal acetate is more effective than the levo-
(95). However, subsequent to the publication of the U.S. norgestrel-only regimen and maintains its efficacy
Selected Practice Recommendations for Contraceptive for up to 5 days.
Use, 2013, the FDA changed the ulipristal acetate
labeling to include a new warning about its use with The levonorgestrel-only regimen for emergency
hormonal contraceptives and a recommendation to delay contraception is more effective than the combined
initiating hormonal contraception until no sooner than hormonal regimen and is associated with less nau-
5 days after intake of ulipristal acetate (96). This label- sea and vomiting.
ing change was based on data from two pharmacody- Insertion of a copper IUD is the most effective
namic studies (96). Although these studies suggest that method of emergency contraception.
coadministration of ulipristal acetate and progestins may
reduce the contraceptive effect of either product, there The following recommendations are based on lim-
have been no clinical studies demonstrating an increased ited or inconsistent scientific evidence (Level B):
rate of pregnancy. Any regular contraceptive method can
be started immediately after the use of levonorgestrel or No clinical examination or pregnancy testing is nec-
combined estrogen–progestin emergency contraception, essary before provision or prescription of emer-
but the woman should abstain from sexual intercourse or gency contraception.
use barrier contraception for 7 days (95).
Treatment with emergency contraception should be
initiated as soon as possible after unprotected or
When is an intrauterine device appropriate inadequately protected sexual intercourse to maxi-
for emergency contraception? mize efficacy.
Insertion of a copper IUD is the most effective method Emergency contraceptive pills or the copper IUD
of emergency contraception. The copper IUD is appro- should be made available to patients who request it
priate for use as emergency contraception in women who up to 5 days after unprotected or inadequately pro-
meet standard criteria for an IUD and who desire long- tected sexual intercourse.
acting contraception. Obese women may have higher
failure rates with the use of levonorgestrel and ulipristal Body weight influences the effectiveness of oral
emergency contraception than women of normal body emergency contraception. The efficacy of the cop-
weight (86, 91, 92). The efficacy of the copper IUD for per IUD is not affected by body weight. Therefore,
contraception is not affected by body weight (16, 93). consideration should be given to use of a copper
Therefore, consideration should be given to the use of IUD as an alternative to oral emergency contracep-
the copper IUD for emergency contraception among tion in obese women. However, oral emergency
obese women. contraception should not be withheld from women
Another advantage of using the copper IUD for who are overweight or obese.
emergency contraception is that it can be retained for
continued long-term contraception. One study found The following recommendations are based primar-
the continuation rate after insertion for emergency con- ily on consensus and expert opinion (Level C):
traception was 94.3% for parous women and 88.2% for
nulliparous women (17). Another study demonstrated a Any emergency contraceptive regimen may be made
available to women with contraindications to the use
much lower cumulative pregnancy rate within the fol-
of conventional oral contraceptive preparations.
lowing year among women who selected the IUD over
levonorgestrel as emergency contraception (97). No ran- To maximize effectiveness, women should be edu-
domized controlled trials have compared IUD insertion cated about the availability of emergency contracep-
with oral regimens for emergency contraception. tion in advance of need.

6 Practice Bulletin No. 152

 Information regarding effective long-term contra- Princeton University
ceptive methods should be made available when- Emergency contraception website
ever a woman requests emergency contraception. Office of Population Research
Wallace Hall
Oral emergency contraception may be used more Princeton, NJ 08544
than once, even within the same menstrual cycle.
Emergency contraception hotline: 1-888-NOT-2-LATE
Clinical evaluation is indicated for women who http://ec.princeton.edu
have used emergency contraception if menses are
Reproductive Health Technologies Project
delayed by a week or more after the expected time
634 I Street NW, Suite 650
or if lower abdominal pain or persistent irregular
Washington, DC 20006
bleeding develops.
(202) 530-4401
The copper IUD is appropriate for use as emergency http://www.rhtp.org/contraception/emergency
contraception in women who meet standard criteria
for an IUD and who desire long-acting contraception.
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be­tween January 1985–March 2015. The search was
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cles pub­ lished in the English lan­ guage.
of the effectiveness of the Yuzpe regimen of emergency Pri­or­i­ty was given to articles re­port­ing results of orig­i­nal
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located by re­view­ing bib­liographies of identified articles.
91. Kapp N, Abitbol JL, Mathe H, Scherrer B, Guillard When re­li­able research was not available, expert opinions
H, Gainer E, et al. Effect of body weight and BMI on from ob­ste­tri­cian–gynecologists were used.
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[Full Text] ^ to the method outlined by the U.S. Pre­ven­tive Services
Task Force:
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I Evidence obtained from at least one prop­ er­
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trolled ex­per­i­ments also could be regarded as this
94. Trussell J, Schwarz EB, Guthrie K, Raymond E. No such
type of ev­i­dence.
thing as an easy (or EC) fix. Contraception 2008;78:
III Opinions of respected authorities, based on clin­i­cal
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Organization selected practice recommendations for con- recommendations are provided and grad­ed ac­cord­ing to the
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Health, National Center for Chronic Disease Prevention
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and Health Promotion, Centers for Disease Control and
sis­tent sci­en­tif­ic evidence.
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tate tablet: highlights of prescribing information. Level C—Recommendations are based primarily on con­
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/022474s007lbl.pdf. Retrieved May 21, 2015. (Level III)
^ Copyright September 2015 by the American College of Ob­ste­
tri­cians and Gynecologists. All rights reserved. No part of this
97. Turok DK, Jacobson JC, Dermish AI, Simonsen SE, publication may be reproduced, stored in a re­triev­al sys­tem,
Gurtcheff S, McFadden M, et al. Emergency contracep- posted on the Internet, or transmitted, in any form or by any
tion with a copper IUD or oral levonorgestrel: an obser- means, elec­tron­ic, me­chan­i­cal, photocopying, recording, or
vational study of 1-year pregnancy rates. Contraception oth­er­wise, without prior written permission from the publisher.
2014;89:222–8. (Level II-3) [PubMed] [Full Text] ^
Requests for authorization to make photocopies should be
directed to Copyright Clearance Center, 222 Rosewood Drive,
Danvers, MA 01923, (978) 750-8400.
ISSN 1099-3630
The American College of Obstetricians and Gynecologists
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Emergency contraception. Practice Bulletin No. 152. American College
of Obstetricians and Gynecologists. Obstet Gynecol 2015;126:e1–11.

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