Abstract
Emergency hormonal contraceptives play an important role in preventing unplanned pregnancies in South Africa. In this review, we discuss the levonorgestrel emergency contraceptive, the combined estrogen and progestin regimen (also known as the Yuzpe method) and the use of Ulipristal acetate. The levonorgestrel and the combined estrogen, progestin regimen are available in South Africa. The specific mechanisms of action of each of these emergency hormonal contraceptives will be discussed as well as their efficacy, the side effects associated with each of these preparations and the drug interactions. Levonorgestrel can be used as a single dose (1.5 mg) instead of two doses (0.75 mg) 12 hours apart. Levonorgestrel is very effective, with fewer adverse effects than the combined estrogen and progestogen administration. Levonorgestrel and the Yuzpe method have demonstrated good efficacy when utilised within 72 hours after unprotected intercourse or contraceptive failure. These emergency hormonal contraceptives should not be used as regular contraception. It is essential that all health professionals and educators inform women of reproductive age about the risks and common side effects of emergency hormonal contraceptives.
Highlights
Despite the recent advances in modern hormonal contraceptive developments, ill-timed and unintended pregnancies continue to be a concern worldwide
Co-administration of levonorgestrel with HIV protease inhibitors or with nonnucleoside reverse transcriptase inhibitors has shown to produce significant changes in the plasma levels of levonorgestrel.25The metabolism of ulipristal acetate involves cytochrome p450 CYP 3A4 so the co-administration of CYP 3A4 enzyme inducers is not recommended.[26]
Emergency hormonal contraceptives are effective in preventing unplanned pregnancies and should be initiated as soon as possible following unprotected sexual intercourse or contraceptive failure
Summary
Despite the recent advances in modern hormonal contraceptive developments, ill-timed and unintended pregnancies continue to be a concern worldwide. The unintended pregnancy rate fell 16% (90% UI 5–24), from 77 (74–88) per 1000 women aged 15–44 years to 65 (62–76). The decline in developing regions coincided with a declining unintended birth rate. In 2010–14, 55% of unintended pregnancies ended in abortion in developing regions.[1] Abortion in many African countries is risky and unsafe, resulting in almost 9% of all maternal deaths. This is where the importance of emergency hormonal contraceptives plays a significant role in preventing unwanted pregnancies. Emergency hormonal contraceptives (EC) are safe methods that can be used to prevent unwanted pregnancies if they are used within an exact time period.[2,3]
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