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After completing this case study, the reader should be able to:

  • Describe the advantages and disadvantages of the various options for emergency contraception.

  • Describe the efficacy of each emergency contraception method and factors that may influence the efficacy.

  • Discuss the possible adverse effects and contraindications of the various forms of emergency contraceptives, including both oral and nonoral options.

  • Educate patient regarding the use of emergency contraception and adherence to contraceptive regimen.


Chief Complaint

“I forgot to restart my birth control pill pack. I have gone 9 days without a ‘real’ pill. I’m not ready to be pregnant yet!”


Olivia Furtel is a 19-year-old woman who presents to the family medicine clinic in a panic. She states that she typically throws out the last week of pills in her pack, “since they are not ‘real’ pills anyway,” and she forgot to start her new oral contraceptive pack on time. She had intercourse with her husband 2 days ago and wants to know what she should do to avoid pregnancy.


Seasonal allergies


Mother, age 47, with type 2 diabetes. Father, age 45, with hypertension. Maternal grandmother, age 69, with COPD.


Denies smoking

Enjoys an occasional glass of wine

Married × 1 year—mutually monogamous relationship


Cetirizine 10 mg PO once daily × 5 years

Ethinyl estradiol 20 mcg/ levonorgestrel 0.1 mg (Aviane) 1 tablet PO once daily × 2 years




Patient is a nulligravida woman whose menstrual periods are regular with the use of the combined oral contraceptive (OC). She denies any breakthrough bleeding or spotting with routine use. She is tolerating the OC well.



WDWN woman appearing anxious


BP 106/70 mm Hg, P 60 bpm, RR 13, T 37°C; Wt 53.5 kg, Ht 5′5″, BMI 19.6 kg/m2


Normal; intact; warm and dry


Deferred; she had a complete examination 3 months ago that was normal


3 months ago

Negative Pap smear

1 year ...

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