Levonorgestrel Emergency Contraception Research Articles

Effect of body weight and BMI on the efficacy of levonorgestrel emergency contraception

ObjectivesTo further evaluate the effect of weight and body mass index (BMI) on the efficacy of levonorgestrel emergency contraception. MethodsData from two large, multicenter, randomized controlled trials designed to assess emergency contraceptive efficacy were pooled to evaluate the effect of weight and BMI on pregnancy rates among women who received levonorgestrel. Descriptive methods (comparison of means and distributions according to pregnancy status and pregnancy rates across weight and BMI categories) as well as cubic spline modeling were used to describe the relationship between pregnancy risk and weight/BMI. ResultsThe analysis population comprised 1731 women, among whom 38 pregnancies were reported. Women for whom levonorgestrel was not effective in preventing pregnancy had a significantly higher mean body weight and BMI than women who did not become pregnant (76.7 vs. 66.4kg, p<.0001; 28.1 vs. 24.6kg/m2, p<.0001). 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. Statistical modeling demonstrated a steep increase in pregnancy risk starting from a weight near 70–75kg to reach a risk of pregnancy of 6% or greater around 80kg. Similar results were obtained for statistical modeling of BMI as well as when the two studies were analyzed individually. ConclusionsAll analyses showed a significant drop in the efficacy of levonorgestrel emergency contraception with increasing body weight, with pregnancy risk in the higher weight categories similar to expected rates in the absence of contraception. Like body weight, increasing BMI was highly correlated with increased pregnancy risk.

All Can Still End Well After Plan B Failure

When used within 5 days of unprotected intercourse, levonorgestrel emergency contraception (EC) pills markedly lower a woman's chance of becoming pregnant. However, pregnancies occasionally occur despite use of EC. To assess the development of 195 offspring born after failure of levonorgestrel EC, Chinese researchers …

Knowledge and practices of ulipristal acetate among faculty and residents at an academic medical center

Objectives: We describe knowledge and practices regarding ulipristal acetate (UPA) among physicians at the University of California, Davis Medical Center. UPA may be more effective than levonorgestrel emergency contraception (EC), but knowledge and practices regarding UPA use for EC in an academic institution have not been described.

Pharmacy availability of ulipristal acetate emergency contraception: an audit study

Objectives: The potential of emergency contraception (EC) to reduce unplanned pregnancy has not yet been realized. Ulipristal acetate EC has equal or greater efficacy than levonorgestrel EC and is effective for a longer window of time, yet is not prescribed nearly as often. Additionally, pharmacists vary in both their training on EC and their comfort in discussing its use. We performed a cross-sectional audit study to examine pharmacy availability and staff knowledge of both forms of EC in western Massachusetts pharmacies.

Physical and mental development of children after levonorgestrel emergency contraception exposure: a follow-up prospective cohort study.

Levonorgestrel (LNG), a dedicated emergency contraception (EC) product, has been available over-the-counter in China for more than 14 yr. Although LNG-EC is considered to have no effects on the developing fetus if the contraceptive fails and pregnancy occurs, there have been a few studies specifically examining this issue. The purpose of this study was to compare the physical and mental development of children born after LNG-EC failure with that of a cohort of children born to mothers with no history of exposure to LNG or any teratogenic substances. A group of 195 children who were exposed to LNG-EC during their mothers' conception cycle (study group) were matched to a group of 214 children without exposure to LNG (control group). The physical and mental development of the children were evaluated and compared over a 2-yr period. There were four congenital malformations in the study group and three in the control group (2.1% vs. 1.4%, respectively, P > 0.05). Over the 2-yr follow-up period, there were no statistically significant differences between the two groups with respect to children's weight, height, head circumference, and intelligence scores, and the values of all parameters of both groups were similar to those of the national standards. In summary, LNG-EC has no effect on the physical growth, mental development, or occurrence of birth defects in children born from pregnancies in which EC failed.

Use of ulipristal acetate and levonorgestrel for emergency contraception: a follow-up study

ObjectivesPreviously we showed that increasing the choice of emergency contraception (EC) guided by medical eligibility did not result in wholesale large-scale usage of ulipristal acetate (UPA). This further 12-month study...

Pharmacy-based interventions for initiating effective contraception following the use of emergency contraception: a pilot study

ObjectivesIn Scotland most women get emergency contraception (EC) from pharmacies. Pharmacists currently cannot provide effective ongoing contraception after EC. In this pilot study, we aimed to determine the feasibility of a larger study designed to ascertain if pharmacy-based interventions can increase the uptake of effective contraception after EC. Study designThis is a pilot study of women presenting for levonorgestrel EC to community pharmacies in Edinburgh, UK, in 2012. Pharmacies were cluster randomized to provide either standard care or one of two interventions: (a) one packet of progestogen-only pills (POPs), giving women 1 month to arrange ongoing contraception; (b) invitation to present the empty EC packet to a family planning clinic (FPC) for contraceptive advice (rapid access). ResultsOne hundred sixty-eight women were recruited from 11 pharmacies to POP (n=56), rapid access (n=58) and standard care (N=54) groups, respectively. Telephone follow-up was conducted successfully in 102 women (61%) 6–8 weeks later to determine current contraceptive use. In the POP arm, 35/39 (90%) women used the pills provided, and 9/28 women (32%) in the rapid access arm attended the FPC. The proportion of women using effective contraception at follow-up was significantly greater in both POP [56% (22/39), p=<0.001] and rapid access [52% (13/25), p=0.006] groups compared to standard care [16% (5/31)]. The relative probability of a woman using an effective method of contraception versus barrier/no method, after use of EC, was 3.13 [95% confidence interval (CI), 1.90–5.13] in the POP group and 2.57 (95% CI, 1.55–4.27) in the rapid access group. ConclusionsThis promising pilot study suggests that simple pharmacy-based interventions may increase the uptake of effective contraception after EC. A larger study is required to provide further validation of these findings. Implications statementFor women obtaining EC from a pharmacy, simple interventions such as supplying 1 month of a POP, or offering rapid access to a FPC, hold promise as strategies to increase the uptake of effective contraception after EC.

Single-Dose 1.5 mg Levonorgestrel Emergency Contraceptive Safety in Young Women (Various Age Groups)

INTRODUCTION: A recent over-the-counter simulation study (Raine TR Ricciotti N Sokoloff A Brown BA Hummel A Harper CC. An over-the-counter simulation study of a single-tablet emergency contraceptive in young females. Obstet Gynecol 2012;119:772-9.) of a single-dose emergency contraceptive demonstrated young womens ability to appropriately select and correctly use the emergency contraceptive. This post hoc analysis examined the safety of the emergency contraceptive in various age subgroups. METHODS: This was a noncomparative case-series study of a single-dose 1.5 mg levonorgestrel emergency contraceptive. Eligible women were 11-17 years of age and presented to study sites requesting emergency contraception. Safety information (side effects and any medical problems) was collected by telephone or return clinic visit at approximately 1 4 and 8 weeks after the date the emergency contraceptive was dispensed. Safety data were retrospectively assessed in the following age subgroups: 13-14 15-16 and 17 years. RESULTS: There were 299 women included in the safety analysis (11-12 year olds n=0; 13 year olds n=2; 14 year olds n=30; 15 year olds n=87; 16 year olds n=123; 17 year olds n=57). The incidence of treatment-emergent adverse events were 13% (4/32) in 13-14 year olds 16% (34/210) in 15-16 year olds and 12% (7/57) in 17 year olds. The emergency contraceptive was well tolerated in all age subgroups. The most commonly reported treatment-emergent adverse event(s) in each age subgroup was as follows: in 13-14 year olds vaginal bleeding (6% [2/32]); in 15-16 year olds nausea and headache (each 3% [6/210]); in 17 year olds nausea and vulvovaginal mycotic infection (each 4% [2/57]). CONCLUSION: This post hoc analysis found a single-dose 1.5 mg levonorgestrel emergency contraceptive to be safe and well tolerated in young women of various ages ranging from 13 to 17 year olds.

Экстренная контрацепция на современном этапе: дискуссии экспертов и практика

Emergency contraception with levonorgestrel for the practicing obstetricians-ginecologist is a well-known method of contraception. The modern science has analyzed the safety issues of its use, and recently has changed the understanding of the method mechanism of action, and also gave the answer to the particular question about the relationship of the patient` weight with the effectiveness of the levonorgestrel Emergency Contraception method.

Assessment of Family Planning Services at Community Pharmacies in San Diego, California

Levonorgestrel emergency contraception and other contraceptive methods are available over-the-counter (OTC); however youth continue to face a number of barriers in accessing healthcare services, including lack of knowledge of the method, fear of loss of privacy, difficulties in finding a provider, and cost. A descriptive, nonexperimental, cross-sectional study of a sample of 112 community pharmacies in San Diego, California was conducted between December 2009 and January 2010 to assess community pharmacy practices related to the availability and accessibility of family planning health pharmacy services and products, particularly to youth. A majority (n = 79/112, 70.5%) of the pharmacies carried a wide selection of male condoms; however, the other OTC nonhormonal contraceptive products were either not available or available with limited selection. A majority of the pharmacies sold emergency contraception (n = 88/111, 78.6%). Most patient counseling areas consisted of either a public or a semi-private area. A majority of the pharmacy sites did not provide materials or services targeting youth. Significant gaps exist in providing family planning products and services in the majority of community pharmacies in San Diego, California. Education and outreach efforts are needed to promote provision of products and services, particularly to the adolescent population.

Plan B and the German Catholic Bishops

Germany's Catholic bishops recently ruled that levonorgestrel emergency contraception (EC) was acceptable for prevention of pregnancy in the case of rape. The ruling represents a significant change in Catholic doctrine that has been opposed to most forms of birth control. In their ruling the bishops cited a lack of evidence that levonorgestrel EC acts as an abortifacient. This case serves as a reminder of the need for bioethics to be based on current scientific literature as well as articles of faith and morals.

Expressions of candidate molecules in the human fallopian tube and chorionic villi of tubal pregnancy exposed to levonorgestrel emergency contraception

BackgroundCases of ectopic pregnancy (EP) following levonorgestrel (LNG) emergency contraception (EC) failure were reported, however, the effects of LNG on tubal microenvironment or chorionic villi in EP have not yet been documented.MethodsFifty-five women with tubal pregnancy were divided into two groups according to whether LNG-EC was administrated during the cycle of conception. The serum concentrations of beta-hCG, E2 and P were measured. The mRNA and protein expressions of estrogen and progesterone receptors, leukemia inhibitory factor, vascular endothelial growth factor, inducible nitric oxide synthase, and endocannabinoid receptor - CB1 in the ectopic implantation site and chorionic villi were examined.ResultsCompared to those unexposed to LNG-EC, women with tubal pregnancy exposed to LNG-EC during the cycle of conception had no statistically significances in the serum concentrations of beta-hCG, E2 P, nor in the pathological types of tubal pregnancy or the expressions of ER-alpha, PR, LIF, VEGF, iNOS and CB1.ConclusionsThe expressions of candidate molecules in the fallopian tube and chorionic villi were not altered by exposure to LNG-EC. A routine therapy with no additional intervention might thus be applied to tubal pregnancy exposed to LNG-EC.

Can We Identify Women at Risk of Pregnancy Despite Using Emergency Contraception? Data From Randomized Trials of Ulipristal Acetate and Levonorgestrel

Levonorgestrel (LNG) is the most widely used emergency contraceptive. It is effective when given orally up to 72 hours after intercourse and prevents at least 50% of pregnancies that would have occurred without its use. Insertion of a copper intrauterine device (IUD) is more effective for emergency contraception (EC) than LNG. Some organizations recommend the IUD as the agent of choice for EC, especially for women who have intercourse midcycle when the pregnancy risk is greatest. Ulipristal acetate (UPA), a selective progesterone receptor modulator, is nearly twice as effective as LNG for EC and longer acting; it can be used up to 120 hours after intercourse. Ulipristal acetate has been marketed in Europe since 2009 and is now available on prescription in the United States. The decision of some women whether to use EC is based on the timing of intercourse; if they have intercourse at a time in the cycle when they believe they are at low risk, they do not use EC. However, the timing of intercourse before using EC is unreliable and does not protect against pregnancy. A number of potential risk factors increase the risk of pregnancy and the likelihood of failure of a less effective method of EC. To identify risk factors that could explain a higher risk of EC failures, data were analyzed from a meta-analysis of 2 randomized controlled trials that compared the efficacy of UPA with LNG. Risk factors examined with both methods were body mass index (BMI), the timing of intercourse before using EC, and further acts of intercourse after treatment. Compared with women with a normal BMI (<25 kg/m2), the risk of pregnancy was more than 3 times greater (odds ratio [OR], 3.60; 95% confidence interval [CI], 1.96–6.53; P < 0.0001) for obese women (BMI >30 kg/m2) regardless of which method of EC was used. Among obese women, however, the risk of pregnancy was greater with use of LNG (OR, 4.41; 95% CI, 2.05–9.44; P = 0.0002) than with use of UPA (OR, 2.62; 95% CI, 0.89–7.00; not statistically significant). Risk of pregnancy was related to the cycle day of intercourse for both LNG and UPA. The likelihood of pregnancy with both methods was increased 4-fold among women who had intercourse the day before estimated day of ovulation (OR, 4.42; 95% CI, 2.33–8.20; P = 0.0001) compared with women who had sex outside the fertile window. With both methods, unprotected intercourse after using EC was associated with a substantially higher risk of pregnancy compared with those who did not (OR, 4.64; 95% CI, 2.22–8.96; P = 0.0002). These findings suggest that women who have intercourse around the time of ovulation should use a copper IUD. Use of UPA or the IUD is more effective for overweight or obese women than LNG. Effective contraception is advisable immediately after use of EC.

Access to Levonorgestrel Emergency Contraception: Science versus Federal Politics

Past US FDA decisions about emergency contraception (EC) have been subject to undue political influence, and last year's barring of over-the-counter access to Plan B One-Step(®) for those under the age of 17 years is no exception. The US Department of Health and Human Services cited insufficient data on EC use for females aged 11-12 years. These youngest adolescents, however, rarely need EC: data from California (USA) show that in 2009, fewer than one in 10,000 females under the age of 13 years received EC. Maintaining barriers to safe and effective EC is not medically necessary and conflicts with national goals to decrease teenage and unintended pregnancies.

Over‐the‐Counter Access to Emergency Contraception without Age Restriction: An Opinion of the Women's Health Practice and Research Network of the American College of Clinical Pharmacy

Family planning remains a high priority area for the United States, with goals to increase the proportion of pregnancies that are intended, reduce pregnancy rates among adolescents, and increase contraceptive use prioritized in the Healthy People 2020 objectives. Contraception intended for use after unprotected intercourse, known as emergency contraception, remains underutilized. Levonorgestrel is one method of oral emergency contraception, which prevents fertilization and does not disrupt an already established pregnancy; thus, timing of administration is critical. Despite data demonstrating safety and efficacy, evidence‐based decision making has been overshadowed by politically charged actions involving levonorgestrel emergency contraception for over a decade. The Women's Health Practice and Research Network of the American College of Clinical Pharmacy supports expanded access to levonorgestrel emergency contraception and removal of barriers such as age restrictions on the nonprescription drug product. Pharmacists remain a key provider of emergency contraceptive services and can help ensure timely access. In states where direct pharmacy access to emergency contraception is available, pharmacists are encouraged to participate. Education, research, and advocacy are other important responsibilities for pharmacists in this arena.

Effectiveness of emergency contraception in women after sexual assault

ObjectiveTo assess the effectiveness of emergency single-dose levonorgestrel contraception in preventing unintended pregnancies among woman who visited the emergency department (ED) due to sexual assault (SA).MethodsWe conducted a retrospective chart review in a university hospital in South Korea. Cases from November 10, 2006 to November 9, 2009 were enrolled. Information from the initial visit to the ED and subsequent follow-up visits to the gynecology outpatient clinic was collected.ResultsIn total, 1,179 women visited the ED due to SA. Among them, 416 patients had a gynecological examination and 302 patients who received emergency contraception (EC) (1.5 mg single-dose levonorgestrel) at the ED due to SA were enrolled. Ten patients did not return for follow-up examinations. In follow-up visits at the outpatient clinic, two pregnancies were confirmed, which showed the failure rate of the EC to be 0.68%.ConclusionSingle-dose levonorgestrel EC is extremely effective at preventing pregnancy among victims of SA.

Emergency Contraception

ObjectiveTo review current knowledge about emergency contraception (EC), including available options, their modes of action, efficacy, safety, and the effective provision of EC within a practice setting. OptionsThe combined estradiol-levonorgestrel (Yuzpe regimen) and the levonorgestrel-only regimen, as well as post-coital use of copper intrauterine devices, are reviewed. OutcomesEfficacy in terms of reduction in risk of pregnancy, safety, and side effects of methods for EC and the effect of the means of access to EC on its appropriate use and the use of consistent contraception. EvidenceStudies published in English between January 1998 and March 2010 were retrieved though searches of Medline and the Cochrane Database, using appropriate key words (emergency contraception, post-coital contraception, emergency contraceptive pills, post-coital copper IUD). Clinical guidelines and position papers developed by health or family planning organizations were also reviewed. ValuesThe studies reviewed were classified according to criteria described by the Canadian Task Force on Preventive Health Care, and the recommendations for practice were ranked according to this classification (Table 1). Benefits, Harms, and CostsThese guidelines are intended to help reduce unintended pregnancies by increasing awareness and appropriate use of EC. SponsorThe Society of Obstetricians and Gynaecologists of Canada. Summary Statements1.Hormonal emergency contraception may be effective if used up to 5 days after unprotected intercourse. (II-2)2.The earlier hormonal emergency contraception is used, the more effective it is. (II-2)3.A copper IUD can be effective emergency contraception if used within 7 days after intercourse. (II-2)4.Levonorgestrel emergency contraception regimens are more effective and cause fewer side effects than the Yuzpe regimen. (I)5.Levonorgestrel emergency contraception single dose (1.5 mg) and the 2-dose levonorgestrel regimen (0.75 mg 12 hours apart) have similar efficacy with no difference in side effects. (I)6.Of the hormonal emergency contraception regimens available in Canada, levonorgestrel-only is the drug of choice. (I)7.A pregnancy that results from failure of emergency contraception need not be terminated (I) Recommendations1.Emergency contraception should be used as soon as possible after unprotected sexual intercourse. (II-2A)2.Emergency contraception should be offered to women if unprotected intercourse has occurred within the time it is known to be effective (5 days for hormonal methods and up to 7 days for a copper IUD). (II-2B)3.Women should be evaluated for pregnancy if menses have not begun within 21 days following emergency contraception treatment. (III-A)4.During physician visits for periodic health examinations or reproductive health concerns, any woman in the reproductive age group who has not been sterilized may be counselled about emergency contraception in advance with detailed information about how and when to use it. (III-C)

Pregnancy rates 1 year after choosing the copper t380 IUD or oral levonorgestrel for emergency contraception: a prospective observational study

To compare pregnancy rates 1 year after choosing either the Copper T380 IUD or oral levonorgestrel (LNG) for emergency contraception (EC).

Pregnancy rates 1 year after choosing the copper T380 IUD or oral levonorgestrel for emergency contraception: a prospective observational study

Pregnancy rates 1 year after choosing the copper T380 IUD or oral levonorgestrel for emergency contraception: a prospective observational study

Use of Levonorgestrel Emergency Contraception In Utah: Is It More than “Plan B”?

It is important to understand why some women use levonorgestrel emergency contraceptive pills repeatedly, because the method is not intended for repeated use, and current evidence suggests that it is approximately 77% effective at preventing pregnancy. An anonymous patient survey of 1,040 women aged 18-29 purchasing levonorgestrel at Planned Parenthood clinics in Utah was conducted during a 4-6-week period in 2007. Chi-square tests and analyses of variance were used to examine associations between selected characteristics and level of levonorgestrel use. Logistic regression was used to assess characteristics independently associated with repeated use. Twenty-nine percent of participants had used levonorgestrel more than twice in the prior year. Fifty-eight percent believed that levonorgestrel is at least 90% effective in protecting against pregnancy; 16% believed that it is 100% effective. In univariate analyses, lifetime number of partners, currently having multiple partners, substance use at last intercourse and perceived effectiveness of levonorgestrel were positively associated with repeated levonorgestrel use in the previous year. The measure most strongly associated with repeated levonorgestrel use in multivariate analyses was perceived effectiveness: Women who believed that the method is 90-99% or 100% effective in preventing pregnancy had greater odds of repeated use than those who believed it is 75-89% effective (odds ratios, 1.8 each). Women who repeatedly use levonorgestrel may have an inflated perception of its effectiveness. Future research, including qualitative research, may help clarify factors that lead to inflated perceptions of effectiveness.