Reply

Abstract

To the EditorsWe would like to thank Drs Raymond and Taylor for their thoughtful commentary on the use of emergency contraception. We agree that the published results about the relationship between timing of treatment after unprotected intercourse and treatment effectiveness are conflicting. To our knowledge, only 2 trials have shown a better effectiveness rate associated with a shorter delay in consultation. Many studies have shown no relationship regarding the delay of administration; in some studies, a lack of power could explain these results. The primary concern of our study was not to compare the relative efficacy of emergency contraception for the group of women who consulted us within 72 hours after unprotected intercourse with that for the group of women who consulted us 72 to 120 hours after unprotected intercourse. We would have needed a larger sample. The number of pregnancies observed in our study was compared with the number of pregnancies that would have occurred without treatment according to probability tables. Our message to women is clear: they should not wait after unprotected intercourse and should seek the treatment as soon as possible. There is another study in the United States and United Kingdom that will either confirm or refute our results. Till then, the only relevant message that can be drawn from these results is that if a woman who, for any reason, has not requested emergency contraception on time (before 72 hours elapsed), clinicians should be active in proposing either an intrauterine device, which is very effective, or hormonal treatment. This last choice is better than just waiting for the pregnancy test results. The women recruited in our research study who had unprotected intercourse more than 72 hours earlier did not consult us for emergency contraception. They sought medical attention for other reasons, such as screening for sexually transmitted diseases or long-term contraception. Therefore, clinicians should be active in questioning women about their risk-taking behavior (pregnancy and sexually transmitted diseases) and inform them about the choices that are available. 6/8/118848 To the EditorsWe would like to thank Drs Raymond and Taylor for their thoughtful commentary on the use of emergency contraception. We agree that the published results about the relationship between timing of treatment after unprotected intercourse and treatment effectiveness are conflicting. To our knowledge, only 2 trials have shown a better effectiveness rate associated with a shorter delay in consultation. Many studies have shown no relationship regarding the delay of administration; in some studies, a lack of power could explain these results. The primary concern of our study was not to compare the relative efficacy of emergency contraception for the group of women who consulted us within 72 hours after unprotected intercourse with that for the group of women who consulted us 72 to 120 hours after unprotected intercourse. We would have needed a larger sample. The number of pregnancies observed in our study was compared with the number of pregnancies that would have occurred without treatment according to probability tables. Our message to women is clear: they should not wait after unprotected intercourse and should seek the treatment as soon as possible. There is another study in the United States and United Kingdom that will either confirm or refute our results. Till then, the only relevant message that can be drawn from these results is that if a woman who, for any reason, has not requested emergency contraception on time (before 72 hours elapsed), clinicians should be active in proposing either an intrauterine device, which is very effective, or hormonal treatment. This last choice is better than just waiting for the pregnancy test results. The women recruited in our research study who had unprotected intercourse more than 72 hours earlier did not consult us for emergency contraception. They sought medical attention for other reasons, such as screening for sexually transmitted diseases or long-term contraception. Therefore, clinicians should be active in questioning women about their risk-taking behavior (pregnancy and sexually transmitted diseases) and inform them about the choices that are available. 6/8/118848 We would like to thank Drs Raymond and Taylor for their thoughtful commentary on the use of emergency contraception. We agree that the published results about the relationship between timing of treatment after unprotected intercourse and treatment effectiveness are conflicting. To our knowledge, only 2 trials have shown a better effectiveness rate associated with a shorter delay in consultation. Many studies have shown no relationship regarding the delay of administration; in some studies, a lack of power could explain these results. The primary concern of our study was not to compare the relative efficacy of emergency contraception for the group of women who consulted us within 72 hours after unprotected intercourse with that for the group of women who consulted us 72 to 120 hours after unprotected intercourse. We would have needed a larger sample. The number of pregnancies observed in our study was compared with the number of pregnancies that would have occurred without treatment according to probability tables. Our message to women is clear: they should not wait after unprotected intercourse and should seek the treatment as soon as possible. There is another study in the United States and United Kingdom that will either confirm or refute our results. Till then, the only relevant message that can be drawn from these results is that if a woman who, for any reason, has not requested emergency contraception on time (before 72 hours elapsed), clinicians should be active in proposing either an intrauterine device, which is very effective, or hormonal treatment. This last choice is better than just waiting for the pregnancy test results. The women recruited in our research study who had unprotected intercourse more than 72 hours earlier did not consult us for emergency contraception. They sought medical attention for other reasons, such as screening for sexually transmitted diseases or long-term contraception. Therefore, clinicians should be active in questioning women about their risk-taking behavior (pregnancy and sexually transmitted diseases) and inform them about the choices that are available. 6/8/118848