October 2015

More teens report having used emergency contraception than ever before, according to the National Center for Health Statistics. Since 2002, the rate of use jumped nearly three-fold; in 2002, only 8% of sexually active female teens reported having used EC at least once. Compare that figure with the 14% reporting EC use at least one time in 2006-2010 and the 22% reporting use in 2011-2013.[1] These findings were based on interviews with about 2,000 teens ages 15 to 19.

Interestingly, although the use of EC rose, the use of most other contraceptive methods such as condoms and pills remained stable over that time. Likewise, the percentage (45%) of female (and male) teens saying that they were sexually active also remained stable.

Why the uptick in EC use? Commentators mention increased awareness and increased accessibility. In 2014, the FDA approved unrestricted over-the-counter access to all one-dose LNG EC products. That means women faced no additional step in having to visit a clinician in order to obtain a prescription. James Trussell thinks that teens’ reported ever-use of EC is probably limited primarily to LNG-containing pills, rather than the other options: the copper-IUD or ulipristal acetate

Under scrutiny is whether the LNG EC provides any effective protection to women at higher weights. In late 2013, European labels on NorLevo (1.5 mg LNG), at the manufacturer’s request, warned that efficacy was reduced in women weight 75 kg or more and was not effective in women weighing 80 kg.[2] However, a year later, European authorities reversed the decision, saying the data were not robust enough after all to require the warning on the label.[3] In 2015, the data that were used to support the original European label change were published; statistical modeling based on two pooled randomized controlled trials, suggested a steep increase in pregnancy rates: “The estimated pregnancy rate increased significantly from 1.4% [95% confidence interval (CI): 0.5%-3.0%] among the group of women weighing 65-75kg to 6.4% (95% CI: 3.1%-11.5%) and 5.7% (95% CI: 2.9%-10.0%) in the 75-85kg and >85kg groups, respectively.”[4]

To date, the U.S. Food and Drug Administration (FDA) does not require label warnings related to efficacy and the weight of the user. So at this time, said Trussell, there is no consensus on the question. However, with millions of women (the average American woman weighs 166 pounds [75.3 kg]) at body weights that could make LNG EC less effective or ineffective, the question pertains to many clients who will need to make choices about contraceptive protection after unprotected sexual intercourse.

What makes LNG EC so attractive is the absence of age or point-of-sale restrictions. Women can purchase their pills from stores and pharmacies, needing no prescription; brands currently available include Plan B One-Step, Take Action, Aftera, Next Choice One Dose and My Way. AfterPill is sold online only, directly to consumers.

However, the most effective EC options are the copper IUD—the most effective and the only long-lasting option—and UPA.  These are excellent options, too, for women whose bodyweights may be associated with decreased efficacy with LNG EC. (Because these methods both require interacting with a healthcare provider–the IUD must be inserted by a trainer clinician, and UPA is prescription-only– their use may be limited.) What about those teens (and other women) at higher body weights who don’t want to use the IUD or UPA or who are not within the 5 days of protected sex? The American Society for Emergency Contraception advises that they should “still consider taking levonorgestrel ECPs, balancing this decision against factors such as price. Health care providers and pharmacists should never deny access to LNG ECPs because of a woman’s weight.”[5]

Adapted from: Advocates for Youth (http://www.advocatesforyouth.org/emergency-contraception-home )

—Deborah Kowal, MA, PA, President, Contraceptive Technology Communications, Inc.

—Kelly Cleland, MPA, MPH, Office of Population Research, Princeton University and American Society for Emergency Contraception