Emergency contraception: time for de‐regulation?

In 1991, around 200,000 pregnancies were terminated in the UK. In a study of 733 women undergoing pregnancy termination in Oxford, over 40% admitted that they were using no contraception at the time they conceived. 528 of the pregnancies were predictable as either no contraception was used or a recognizable contraceptive failure occurred. 80% of these pregnancies might have been prevented by postcoital contraception (PCC), which only 18 women admitted to using. In a recent study of 398 women using the standard combined estrogen-progestogen regime, only 4 conceived, yielding a failure rate of 1%. Calculating the chance of conception for each individual woman based on the timing of intercourse, 23 pregnancies would have been anticipated, and over 80% were prevented by PCC. The IUD is even more effective in women for whom combined estrogen-progestogen is relatively contra-indicated or in those who present beyond 72 hours after intercourse: only 1 pregnancy occurred in 879 postcoital insertions and that pregnancy miscarried spontaneously. Recently, the antiprogesterone mifepristone (RU-486), given as a single dose of 600 mg, proved a safe and highly effective postcoital agent compared with the standard combined estrogen-progestogen regime. No pregnancies occurred in almost 600 women treated within 71 hours of intercourse. In a study, 30% of women did not know about emergency contraception and another 10% did not know where to get it. In a survey commissioned by Schering, over 75% of 1007 women had heard of PCC, but only 10% had an accurate knowledge of its time limits. the only contraindications of PCC are pregnancy and a history of contraindications to estrogen, such as thromboembolism. It is highly unlikely that any woman would suffer severe adverse effects from taking 200 mcg of ethinyl estradiol on one occasion. There is no evidence of any change in clotting factors following the use of the standard regime.