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Hernández-Silva G, Vega CC, Barrera D, Hernández-Pando R, García-Uribe PÁ, Chirinos M, Larrea F. Gene Expression Changes in the Ovary Mediate Non-Anovulatory Mechanisms of Contraception with Levonorgestrel. Arch Med Res 2023; 54:102892. [PMID: 37804815 DOI: 10.1016/j.arcmed.2023.102892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/06/2023] [Accepted: 09/20/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Emergency contraception with levonorgestrel (LNG) is a viable option to prevent unintended pregnancies. Although the efficacy of LNG as an anovulatory agent decreases as treatment approaches ovulation, it still provides some contraceptive benefits. AIM To better understand the contraceptive mechanisms of LNG in ovulatory subjects. METHODS We conducted a study on Wistar rats that received a single dose of LNG (0.01 or 0.05 mg/kg) on the morning of proestrus before ovulation and evaluated its effects on ovarian gene expression, ovulation, and implantation. RESULTS Our findings showed changes in the expression of genes involved in follicular development and oocyte quality. Pregnancy rates - as an indicator of ovulation - and embryo implantation were significantly lower than those in the control group. CONCLUSIONS This study suggests that LNG alters regulatory factors in the ovary that are essential for the development of competent fertilizable oocytes, highlighting the non-anovulatory mechanisms by which levonorgestrel may regulate fertility and suggesting that it could be a novel observation that contributes to the understanding of emergency contraception in humans.
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Affiliation(s)
- Gabriela Hernández-Silva
- Reproductive Biology Department Dr. Carlos Gual Castro, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Claudia Cecilia Vega
- Reproductive Biology Department Dr. Carlos Gual Castro, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - David Barrera
- Reproductive Biology Department Dr. Carlos Gual Castro, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Rogelio Hernández-Pando
- Experimental Pathology Lab, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Pablo Ángel García-Uribe
- Reproductive Biology Department Dr. Carlos Gual Castro, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Mayel Chirinos
- Reproductive Biology Department Dr. Carlos Gual Castro, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Fernando Larrea
- Reproductive Biology Department Dr. Carlos Gual Castro, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
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Rabadia JP, Desai TR, Thite VS. Plumeria acuminata: A Systematic in vivo Evaluation for Its Anti-ovulatory and Anti-Implantation Features. CURRENT DRUG THERAPY 2022. [DOI: 10.2174/1574885517666220426101516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Fertility control becomes necessary for under-developed and developing nations for the betterment of the economy, environment, and society. Plant Plumeria acuminata, “Temple tree or Frangipani”, of the Apocynaceae family has exhibited several activities similar to contraceptive medicine and is widely distributed in India.
Objective:
Present investigation aimed to study the anti-ovulatory and anti-implantation activities of ethanolic extract from P. acuminata leaves and roots in Wistar rats.
Methods:
Ethanolic extracts of P. acuminata leaves and roots were subjected to qualitative phytochemical analysis and acute toxicity test. Immature female rats were used to explore anti-ovulatory characteristics administering HCG as a standard ovulation-inducing drug. Mated females were used for exploring anti-implantation characteristics. Levonorgestrel and Ethinylestradiol were administered as standard anti-implantation drugs. Morphological, hematological, hormonal, and histological examinations were performed.
Results:
LD50 value i.e., 2000 mg/kg from acute toxicity test resulted in the selection of 100, 200, and 400 mg/kg dose values for both leaf and root extracts. Treatment with these brought ~2-54%, ~5-48%, and ~1-68% changes respectively in the hormonal, growth factors’ and cytokines’ profile. Ovarian histology revealed restricted follicle maturation and ovulation whereas uterine histology unveiled a ~5-28% decrease in the endometrium thickness making it unreceptive for implantation after treatment with PAL and PAR extracts.
Conclusion:
Anti-ovulatory and anti-implantation results obtained here can be attributed to the presence of plumericin, sterol as well as triterpene groups of phytochemicals from ethanolic extracts of leaves and roots, making them potent contestants for studies on future contraceptive medicines.
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Affiliation(s)
- Jay P Rabadia
- Department of Pharmacology, School of Pharmacy, R K University, Rajkot, Gujarat, India. 360020
- Sun Pharmaceutical Industries Limited, Vadodara, Gujarat, India. 390020
| | - Tushar R Desai
- Department of Pharmacology, School of Pharmacy, R K University, Rajkot, Gujarat, India. 360020
| | - Vihang S Thite
- Sun Pharmaceutical Industries Limited, Vadodara, Gujarat, India. 390020
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Effect of levonorgestrel emergency contraception on implantation and fertility: a review. Contraception 2022; 109:8-18. [DOI: 10.1016/j.contraception.2022.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 01/09/2022] [Accepted: 01/11/2022] [Indexed: 12/30/2022]
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Gómez-Elías MD, May M, Munuce MJ, Bahamondes L, Cuasnicú PS, Cohen DJ. A single post-ovulatory dose of ulipristal acetate impairs post-fertilization events in mice. Mol Hum Reprod 2019; 25:257-264. [PMID: 30824928 DOI: 10.1093/molehr/gaz013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/30/2019] [Accepted: 02/26/2019] [Indexed: 02/06/2023] Open
Abstract
Ulipristal acetate (UPA) is a selective progesterone receptor modulator used for emergency contraception that has proven to be highly effective in preventing pregnancy when taken up to 120 h after unprotected sexual intercourse. Even though it may act mainly by delaying or inhibiting ovulation, additional effects of UPA on post-fertilization events cannot be excluded. Therefore, the aim of this study was to determine whether a single post-ovulatory dose of UPA could prevent pregnancy using the mouse as a pre-clinical model. Mated females received a single dose of UPA (40 mg/kg) on Day E1.5 or E2.5 (E0.5: copulatory plug detection) and post-fertilization events were evaluated. Our studies revealed that UPA administration produced a significant decrease in the number of conceptuses compared to control. Moreover, UPA-treated females exhibited a lower number of early implantation sites on Day E5.5, despite normal in vivo embryo development and transport to the uterus at E3.5. Administration of UPA produced histological and functional alterations in the uterine horns, i.e., a dyssynchronous growth between endometrial glands and stroma, with non-physiological combination of both fractions compared to controls, and a completely impaired ability to respond to an artificial decidualization stimulus. Altogether, our results show that the administration of a single post-ovulatory dose of UPA impairs mouse pregnancy probably due to an effect on embryo-uterine interaction, supporting additional effects of the drug on post-fertilization events. Although these studies cannot be performed with human samples, our results with the mouse model provide new insights into the mechanism of action of UPA as an emergency contraception method.
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Affiliation(s)
- Matías D Gómez-Elías
- Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
| | - María May
- Instituto de Investigaciones Farmacológicas (ININFA-UBA-CONICET), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - María José Munuce
- Laboratory of Reproductive Medicine, Biochemical Chemistry Area, School of Biochemical and Pharmaceutical Sciences, National University of Rosario, Rosario, Argentina
| | - Luis Bahamondes
- Department of Obstetrics and Gynaecology, School of Medicine, University of Campinas (UNICAMP), Campinas, Brazil
| | - Patricia S Cuasnicú
- Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
| | - Débora J Cohen
- Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
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Wynn LL, Foster AM. Muftis in the Matrix. JOURNAL OF MIDDLE EAST WOMENS STUDIES 2018. [DOI: 10.1215/15525864-7025413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract
English- and Arabic-language cyberfatwas on emergency contraception (EC) illuminate current debates around sexuality in the global Muslim community. In websites with fatwas about EC, there are significant differences in the way that English- and Arabic-language fatwa websites discuss this reproductive health technology. During the study period of 2016–17, English-language sites were more likely to rule that EC was not religiously acceptable, whereas no Arabic-language online fatwas declared the technology forbidden to Muslims. In contrast, Arabic questions to online fatwa sites were more concerned about whether EC would facilitate illicit sex and the health risks of contraceptives. Only English-language sites discussed the morality of pharmacists providing EC. These websites and fatwas reveal different visions of Muslims’ relationships with technology, science, and scientific experts. They also suggest the influence of non-Islamic religious constituencies on Muslim interpretations of reproductive health technologies.
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Moral Certitude in the Use of Levonorgestrel for the Treatment of Sexual Assault Survivors. PHILOSOPHY AND MEDICINE 2017. [DOI: 10.1007/978-3-319-55766-3_15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Schneider AP, Kubat C, Zainer CM. Appreciation for Analysis of how Levonorgestrel Works and Reservations with the use of Meloxicam as Emergency Contraception. Linacre Q 2016; 83:52-68. [DOI: 10.1080/00243639.2016.1145894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
This paper is a response to Dr. Kathleen Raviele's recent article on her critical analysis of the use of levonorgestrel given to women postsexual assault and her suggestion that the use of Meloxicam may be an ethical alternative.
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Affiliation(s)
| | - Christopher Kubat
- Catholic Social Services of Southern Nebraska, Lincoln, Nebraska, USA
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8
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Abstract
Emergency contraception, also known as postcoital contraception, is therapy used to prevent pregnancy after an unprotected or inadequately protected act of sexual intercourse. Common indications for emergency contraception include contraceptive failure (eg, condom breakage or missed doses of oral contraceptives) and failure to use any form of contraception (). Although oral emergency contraception was first described in the medical literature in the 1960s, the U.S. Food and Drug Administration (FDA) approved the first dedicated product for emergency contraception in 1998. Since then, several new products have been introduced. Methods of emergency contraception include oral administration of combined estrogen-progestin, progestin only, or selective progesterone receptor modulators and insertion of a copper intrauterine device (IUD). Many women are unaware of the existence of emergency contraception, misunderstand its use and safety, or do not use it when a need arises (). The purpose of this Practice Bulletin is to review the evidence for the efficacy and safety of available methods of emergency contraception and to increase awareness of these methods among obstetrician-gynecologists and other gynecologic providers.
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Faúndes A, Osis MJ, Sousa MH, Duarte GA, Miranda L, Oliveira W. Physicians' information to patients and prescription of the emergency contraceptive pill according to their personal experience of using the method and perception of its mechanism of action. EUR J CONTRACEP REPR 2015; 21:176-82. [PMID: 26572173 DOI: 10.3109/13625187.2015.1111325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate the association between physicians' understanding of the mechanism of action of the emergency contraceptive pill (ECP), their personal use of it, and their practice in informing their patients about the method and in prescribing it. METHODS The study was carried out in a sample of 3337 obstetrician-gynaecologists who responded to a mailed questionnaire. Bivariate analysis was used to test the association between physicians' personal use of the ECP, their understanding of its mechanism of action, and their practice in informing their patients about the method and in prescribing it. Multiple Poisson regression analysis was carried out to identify variables independently associated with the two dependent variables. RESULTS Multiple regression analysis showed that the percentage of physicians who had informed their patients about the ECP was significantly lower among those who had needed it themselves but had not used it and among those living in the northeast of Brazil. A significantly higher percentage of female than male physicians had provided information on the ECP. The percentage of physicians who had prescribed the ECP was significantly lower among those who had needed it themselves but had not used it and among those who believed that it caused a mini-abortion. The proportion of physicians who had ever-prescribed the ECP was greater among those who worked exclusively in private practice and among those who worked in a state capital. CONCLUSIONS The misconception that emergency contraception could cause a mini-abortion was associated with its denial to potential users, while physicians' personal experience of needing to use it favoured the likelihood of their informing potential users about it and prescribing it.
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Affiliation(s)
- Aníbal Faúndes
- a Department of Obstetrics and Gynaecology , University of Campinas (UNICAMP) , Campinas , SP , Brazil ;,b Centre of Research on Reproductive Health of Campinas (CEMICAMP) , Campinas , SP , Brazil
| | - Maria José Osis
- a Department of Obstetrics and Gynaecology , University of Campinas (UNICAMP) , Campinas , SP , Brazil ;,b Centre of Research on Reproductive Health of Campinas (CEMICAMP) , Campinas , SP , Brazil
| | - Maria Helena Sousa
- b Centre of Research on Reproductive Health of Campinas (CEMICAMP) , Campinas , SP , Brazil
| | - Graciana Alves Duarte
- b Centre of Research on Reproductive Health of Campinas (CEMICAMP) , Campinas , SP , Brazil
| | - Laura Miranda
- b Centre of Research on Reproductive Health of Campinas (CEMICAMP) , Campinas , SP , Brazil
| | - William Oliveira
- a Department of Obstetrics and Gynaecology , University of Campinas (UNICAMP) , Campinas , SP , Brazil ;,b Centre of Research on Reproductive Health of Campinas (CEMICAMP) , Campinas , SP , Brazil
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Zhao W, Zhu Q, Yan M, Li C, Yuan J, Qin G, Zhang J. Levonorgestrel decreases cilia beat frequency of human fallopian tubes and rat oviducts without changing morphological structure. Clin Exp Pharmacol Physiol 2015; 42:171-8. [PMID: 25399777 PMCID: PMC6680194 DOI: 10.1111/1440-1681.12337] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 10/25/2014] [Accepted: 11/05/2014] [Indexed: 12/30/2022]
Abstract
Levonorgestrel, a derivative of progesterone, effectively protects women against unwanted pregnancy as an emergency contraceptive. Previous studies have not been successful in determining the mechanism by which levonorgestrel acts. In the present study we analysed cilia beat action and cilia morphology following levonorgestrel exposure in vitro and in vivo using both light and electron microscopy. There was a significant decrease in the ciliary beat frequency (CBF) of human fallopian tubes between mucosal explants bathed in 5 μmol/L levonorgestrel and those bathed in medium alone (P < 0.05). There was a tendency for CBF to decrease more in the ampulla than in isthmus, but there were no differences between the proliferative and secretory phases. In rat oviducts, levonorgestrel produced a similar reduction in CBF (~ 10%) compared with the saline control group (P < 0.05). Histological and ultrastructural analysis demonstrated no changes in the percentage of ciliated cells or in the classic '9 + 2' structure of cilia following levonorgestrel treatment in either system. Thus, levonorgestrel reduces CBF without damaging cilia morphology. Decreases in CBF may indicate a pathological role for levonorgestrel in the transportation of the ovum and zygote in the fallopian tube.
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Affiliation(s)
- Weihong Zhao
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital/School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Carvajal A, Sáinz M, Velasco V, García Ortega P, Treceño C, Martín Arias LH, Pellón M, García Sevillano L. Emergency contraceptive pill safety profile. Comparison of the results of a follow-up study to those coming from spontaneous reporting. Pharmacoepidemiol Drug Saf 2014; 24:93-7. [PMID: 25408302 DOI: 10.1002/pds.3725] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 08/02/2014] [Accepted: 09/22/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND The emergency contraceptive pill (ECP) containing levonorgestrel is dispensed without a prescription in Spain since 2009. An easy access could diminish unwanted pregnancies; however, there is a risk of misuse and, in any case, of developing some adverse events. The aim of the present study is to further learn the adverse effects of this ECP. METHODS An ad hoc follow-up study was carried out in three community pharmacies in a city of Central Spain; the sample was composed of those women asking for the ECP; they were interviewed by telephone after at least a month since the last menses. We completed the safety profile obtained with that coming from spontaneous reporting in Spain. RESULTS Out of 139 women surveyed, 113 developed any adverse event--two considered as severe; the most frequently reported events were menstrual disturbances, which accounted for 21% of all events. Through spontaneous reporting, 36 cases of whatever adverse events related to levonorgestrel as ECP were identified. Twenty-five cases were considered as severe. Both types of reaction and severity were significantly different in the follow-up study and in the spontaneous reporting. Some of the reactions identified, such as miscarriage, febrile neutropenia, and porphyria, are not included in the Summary of Product Characteristics. CONCLUSIONS Levonorgestrel as an ECP is mostly safe. Attention should be paid to some severe events and particularly to those risk factors for them to appear. Combining spontaneous reporting with an ad hoc follow-up study, the whole safety profile of a given medication can be obtained.
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Affiliation(s)
- Alfonso Carvajal
- Centro de Estudios sobre la Seguridad de los Medicamentos (CESME), Universidad de Valladolid, Valladolid, Spain
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Shohel M, Rahman MM, Zaman A, Uddin MMN, Al-Amin MM, Reza HM. A systematic review of effectiveness and safety of different regimens of levonorgestrel oral tablets for emergency contraception. BMC Womens Health 2014; 14:54. [PMID: 24708837 PMCID: PMC3977662 DOI: 10.1186/1472-6874-14-54] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 03/30/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Unintended pregnancy is a complex phenomenon which raise to take an emergency decision. Low contraceptive prevalence and high user failure rates are the leading causes of this unexpected situation. High user failure rates suggest the vital role of emergency contraception to prevent unplanned pregnancy. Levonorgestrel - a commonly used progestin for emergency contraception. However, little is known about its pharmacokinetics and optimal dose for use. Hence, there is a need to conduct a systematic review of the available evidences. METHODS Randomized, double-blind trials were sought, evaluating healthy women with regular menstrual cycles, who requested emergency contraception within 72 h of unprotected coitus, to one of three regimens: 1.5 mg single dose levonorgestrel, two doses of 0.75 mg levonorgestrel given 12 h apart or two doses of 0.75 mg levonorgestrel given 24 h apart. The primary outcome was unintended pregnancy; other outcomes were side-effects and timing of next menstruation. RESULTS Every trial under consideration successfully established the contraceptive effectiveness of levonorgestrel for preventing unintended pregnancy. Moreover, a single dose of levonorgestrel 1.5 mg for emergency contraception supports its safety and efficacy profile. If two doses of levonorgestrel 0.75 mg are intended for administration, the second dose can positively be taken 12-24 h after the first dose without compromising its contraceptive efficacy. The main side effect was frequent menstrual irregularities. No serious adverse events were reported. CONCLUSIONS The review shows that, emergency contraceptive regimen of single-dose levonorgestrel is not inferior in efficacy to the two-dose regimen. All the regimens studied were very efficacious for emergency contraception and prevented a high proportion of pregnancies if taken within 72 h of unprotected coitus. Single levonorgestrel dose (1.5 mg) can substitute two 0.75 mg doses 12 or 24 h apart. With either regimen, the earlier the treatment is given, the more effective it seems to be.
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Affiliation(s)
- Mohammad Shohel
- Department of Pharmaceutical Sciences, North South University, Dhaka 1229, Bangladesh
| | | | - Asif Zaman
- Department of Pharmaceutical Sciences, North South University, Dhaka 1229, Bangladesh
| | | | - Md Mamun Al-Amin
- Department of Pharmaceutical Sciences, North South University, Dhaka 1229, Bangladesh
| | - Hasan Mahmud Reza
- Department of Pharmaceutical Sciences, North South University, Dhaka 1229, Bangladesh
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Anderson DC, Sullivan DM. Plan B and the German Catholic bishops. Ann Pharmacother 2013; 47:1079-80. [PMID: 23737514 DOI: 10.1345/aph.1s157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
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.
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Affiliation(s)
- Douglas C Anderson
- Department of Pharmacy Practice, School of Pharmacy, Cedarville University, Cedarville, OH, USA.
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Gemzell-Danielsson K, Berger C, P.G.L. L. Emergency contraception — mechanisms of action. Contraception 2013; 87:300-8. [DOI: 10.1016/j.contraception.2012.08.021] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Accepted: 08/20/2012] [Indexed: 12/30/2022]
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Abstract
There have been numerous attempts to control fertility after unprotected sexual intercourse (UPSI). From very bizarre methods like the vaginal application of Coca Cola to the more serious attempts using calcium antagonists influencing fertility parameters in sperm to hormonal methods or intrauterine devices. So far, hormonal methods preventing or delaying ovulation have proved to be the most popular starting with the combination of ethinyl estradiol and levonorgestrel (LNG), known as the Yuzpe regimen. The first dose had to be taken within 72 hours of UPSI, a second one 12 hours later. Later on, LNG alone, at first in a regimen similar to the Yuzpe method (2 × 0.75 mg 12 hours apart) showed to be more successful, eventually resulting in the development of a 1.5 mg LNG pill that combined good efficacy with a high ease of use. Several efficacious and easy to use methods for emergency contraception (EC) are available on the market today with the most widely spread being LNG in a single dose of 1.5 mg (given as one tablet of 1.5 mg or 2 tablets of 0.75 mg each) for administration up to 3 days (according to WHO up to 5 days) after UPSI. Its limitations are the non-optimal efficacy which is decreasing the later the drug is taken and the fact that it is only approved for up to 72 hours after UPSI. This regimen has no effect on the endometrium, corpus luteum function and implantation, is not abortive and don't harm the fetus if accidentally taken in early pregnancy. It has no impact on the rate of ectopic pregnancies. It has become the standard method used up to this day in most countries. Since the mid 1970s copper IUDs have been used for EC, which show a high efficacy. Their disadvantages lie in the fact that EC is considered an off label use for most IUDs (not for the GynFix copper IUD in the European Union) and that they might not be acceptable for every patient. Furthermore IUD-insertion is an invasive procedure and it is required trained providers and sterilized facilities. Mifepristone in the dosages of 10 or 25 mg is used with good results as an emergency contraceptive in China for up to 120 hours after UPSI, but has never received any significant consideration in Western countries. While high doses of mifepristone has an effect on endometrial receptivity and will inhibit ovulation if given in the follicular phase and prevent implantation if given in the early luteal phase, low doses such as 10 mg has no impact on the endometrium. Mifepristone does not increase the rate of ectopic pregnancies. The most recent development is the approval of the selective progesterone receptor modulator ulipristal acetate (UPA) in the dosage of 30 mg for EC up to 5 days after UPSI, combining the safe and easy application of the single dose LNG pill with an even higher efficacy. It has shown to be more efficacious than LNG and can be used for up to 120 hours after UPSI; the difference in efficacy is highest for 0-24 hours, followed by 0-72 hours following UPSI. No VTE has been reported following UPA-administration or any progesterone receptor modulator. No effect on endometrium, corpus luteum function and implantation has been observed with doses used for EC. Independent of the substance it should be noted that, if there is a choice, the intake of an oral emergency contraceptive pill should happen as soon as possible after the risk situation. A pre-existing pregnancy must be excluded. Possible contraindications and drug interactions must be considered according to the individual special product informations.
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Affiliation(s)
- Kristina Gemzell-Danielsson
- Department of Woman and Child Health, Karolinska Institutet, WHO-centre, Karolinska University Hospital, Stockholm, Sweden
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Koyama A, Hagopian L, Linden J. Emerging options for emergency contraception. CLINICAL MEDICINE INSIGHTS. REPRODUCTIVE HEALTH 2013; 7:23-35. [PMID: 24453516 PMCID: PMC3888080 DOI: 10.4137/cmrh.s8145] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Emergency post-coital contraception (EC) is an effective method of preventing pregnancy when used appropriately. EC has been available since the 1970s, and its availability and use have become widespread. Options for EC are broad and include the copper intrauterine device (IUD) and emergency contraceptive pills such as levonorgestrel, ulipristal acetate, combined oral contraceptive pills (Yuzpe method), and less commonly, mifepristone. Some options are available over-the-counter, while others require provider prescription or placement. There are no absolute contraindications to the use of emergency contraceptive pills, with the exception of ulipristal acetate and mifepristone. This article reviews the mechanisms of action, efficacy, safety, side effects, clinical considerations, and patient preferences with respect to EC usage. The decision of which regimen to use is influenced by local availability, cost, and patient preference.
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Affiliation(s)
- Atsuko Koyama
- Department of Pediatric Emergency Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Laura Hagopian
- Department of Emergency Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Judith Linden
- Department of Emergency Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
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Zhao M, Liu M, Li D, Wan X, Hinds LA, Wang Y, Zhang Z. Anti-fertility effect of levonorgestrel and quinestrol in Brandt's voles (Lasiopodomys brandtii). Integr Zool 2012; 2:260-8. [PMID: 21396043 DOI: 10.1111/j.1749-4877.2007.00059.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The combination of levonorgestrel and quinestrol (EP-1) has been shown to have anti-fertility effects on several wild rodents, but the mechanism underlying these effects is poorly understood. We investigated the effects of EP-1 and each of its components, levonorgestrel (P) and quinestrol (E), on the fertility of Brandt's voles (Lasiopodomys brandtii) by using a gastric gavage method. The doses for EP-1, E and P were 1, 0.34 and 0.66 mg/kg body weight, respectively. Male voles (n = 98) were treated daily for 5 or 14 days, then the testes and epididymides were collected, weighed and examined histologically at 30 (D30), 60 (D60) or 90 (D90) days after the end of treatment. Four males were allowed to mate with normal females at D90. Female voles (n = 75) were treated for 3 days and a further 3 days after a 7-day interval. The uteri and ovaries were weighed and examined histologically at 15 (D15), 30 (D30) or 75 (D75) days after the end of treatment. Each of three females were mated with fertile males at D30 and D75, respectively. Our results indicated that quinestrol (E) significantly decreased the sperm numbers in the testes as well as the weight of the testes and epididymides, with both of these tissues showing obvious structural abnormalities, and significantly reduced the litter size and the pup weight for females mated with males of the E treatment group. For female voles, treatment with E, P or EP-1 resulted in no marked influence on the fertility status. These data indicate that quinestrol (E) alone has a significant anti-fertility effect on male Brandt's voles, but is ineffective in combination with levonorgestrel (P).
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Affiliation(s)
- Meirong Zhao
- State Key Laboratory of Integrated Management of Pest Insects and Rodents, Institute of Zoology, Chinese Academy of Sciences, Beijing, China State Key Laboratory of Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China CSIRO Entomology, Canberra, Australian Capital Territory, Australia
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Lv X, Shi D. Combined effects of levonorgestrel and quinestrol on reproductive hormone levels and receptor expression in females of the Mongolian gerbil (Meriones unguiculatus). Zoolog Sci 2012; 29:37-42. [PMID: 22233494 DOI: 10.2108/zsj.29.37] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The effects of treatment with a combination of levonorgestrel and quinestrol (EP-1; ratio of 2:1) on reproductive hormone levels and the expression of their receptors in female Mongolian gerbils were examined. We show that serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) decreased, whereas serum estradiol (E2) and progesterone (P4) increased after EP-1 treatment. EP1 down-regulated mRNA expression of the follicle-stimulating hormone receptor (FSHR) and the estrogen receptor (ER) βin the ovary. EP-1 up-regulated the mRNA expression of the luteinizing hormone receptor (LHR) and the progesterone receptor (PR) in the ovary as well as ERα and PR in the uterus of Mongolian gerbils. The effects were time-dependent and dose-dependent. EP-1 had no obvious effects on ERα mRNA expression in the ovary. The current study demonstrates that the effect of EP-1 on the expression of ER subtypes is tissue-specific in Mongolian gerbils. EP-1 disrupted the reproductive endocrinology of the Mongolian gerbil. These findings suggest that the effects of EP-1 on reproductive hormone levels and their receptor expression in Mongolian gerbils may be the result of synergistic actions of levonorgestrel and quinestrol, with quinestrol playing the major role.
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Affiliation(s)
- Xiaohui Lv
- College of Agriculture and Biotechnology, China Agricultural University, Beijing 100193, China
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Lv X, Guo Y, Shi D. Effects of quinestrol on reproductive hormone expression, secretion, and receptor levels in female Mongolian gerbils (Meriones unguiculatus). Theriogenology 2012; 77:1223-31. [DOI: 10.1016/j.theriogenology.2011.10.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 10/23/2011] [Accepted: 10/23/2011] [Indexed: 10/14/2022]
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Contraceptive efficacy of emergency contraception with levonorgestrel given before or after ovulation. Contraception 2011; 84:486-92. [DOI: 10.1016/j.contraception.2011.03.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Revised: 03/07/2011] [Accepted: 03/09/2011] [Indexed: 12/30/2022]
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Mozzanega B, Cosmi E. How do levonorgestrel-only emergency contraceptive pills prevent pregnancy? Some considerations. Gynecol Endocrinol 2011; 27:439-42. [PMID: 20670097 DOI: 10.3109/09513590.2010.501885] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Controversial opinions exist about the possible mechanisms throughout emergency contraception prevents pregnancy. Recently, the International Federation of Gynaecology and Obstetrics and the International Consortium for Emergency Contraception released a Joint Statement declaring that 'inhibition or delay of ovulation should be their primary and possibly only mechanism of action'. They still added that 'Review of the evidence suggests that LNG-ECPs cannot prevent implantation'. Concerning levonorgestrel-only emergency contraceptive pills effects on ovulation, the Statement based on seven reference papers which considered a total of only 142 patients, divided into still different subgroups. Basing on their same references we got quite different conclusions.
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Affiliation(s)
- Bruno Mozzanega
- Department of Gynecological and Human Reproductive Sciences, University of Padua, Italy.
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LV XH, SHI DZ. Effects of Levonorgestrel on Reproductive Hormone Levels and Their Receptor Expression in Mongolian Gerbils (Meriones unguiculatus). Exp Anim 2011; 60:363-71. [DOI: 10.1538/expanim.60.363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Xiao-Hui LV
- College of Agriculture and Biotechnology, China Agricultural University
| | - Da-Zhao SHI
- College of Agriculture and Biotechnology, China Agricultural University
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Gemzell-Danielsson K. Mechanism of action of emergency contraception. Contraception 2010; 82:404-9. [DOI: 10.1016/j.contraception.2010.05.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2010] [Accepted: 05/03/2010] [Indexed: 12/30/2022]
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Gemzell-Danielsson K, Meng CX. Emergency contraception: potential role of ulipristal acetate. Int J Womens Health 2010; 2:53-61. [PMID: 21072297 PMCID: PMC2971744 DOI: 10.2147/ijwh.s5865] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Indexed: 12/30/2022] Open
Abstract
Unintended pregnancy is a global reproductive health problem. Emergency contraception (EC) provides women with a safe means of preventing unwanted pregnancies after having unprotected intercourse. While 1.5 mg of levonorgestrel (LNG) as a single dose or in 2 doses with 12 hours apart is the currently gold standard EC regimen, a single dose of 30 mg ulipristal acetate (UPA) has recently been proposed for EC use up to 120 hours of unprotected intercourse with similar side effect profiles as LNG. The main mechanism of action of both LNG and UPA for EC is delaying or inhibiting ovulation. However, the 'window of effect' for LNG EC seems to be rather narrow, beginning after selection of the dominant follicular and ending when luteinizing hormone peak begins to rise, whereas UPA appears to have a direct inhibitory effect on follicular rupture which allows it to be also effective even when administered shortly before ovulation, a time period when use of LNG is no longer effective. These experimental findings are in line with results from a series of clinical trials conducted recently which demonstrate that UPA seems to have higher EC efficacy compared to LNG. This review summarizes some of the data available on UPA used after unprotected intercourse with the purpose to provide evidence that UPA, a new type of second-generation progesterone receptor modulator, represents a new evolutionary step in EC treatment.
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Affiliation(s)
- Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden
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Obstetrician-gynecologist physicians' beliefs about emergency contraception: a national survey. Contraception 2010; 82:324-30. [PMID: 20851225 DOI: 10.1016/j.contraception.2010.04.151] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 04/27/2010] [Accepted: 04/29/2010] [Indexed: 12/30/2022]
Abstract
BACKGROUND Although emergency contraception (EC) is available without a prescription, women still rely on doctors' advice about its safety and effectiveness. Yet little is known about doctors' beliefs and practices in this area. STUDY DESIGN We surveyed 1800 US obstetrician-gynecologists. Criterion variables were doctors' beliefs about EC's effects on pregnancy rates, and patients' sexual practices. We also asked which women are offered EC. Predictors were demographic, clinical and religious characteristics. RESULTS Response rate was 66% (1154/1760). Most (89%) believe EC access lowers unintended pregnancy rates. Some believe women use other contraceptives less (27%), initiate sex at younger ages (12%) and have more sexual partners (15%). Half of physicians offer EC to all women (51%), while others offer it never (6%) or only after sexual assault (6%). Physicians critical of EC, males and religious physicians were more likely to offer it never or only after sexual assault (odds ratios 2.1-12). CONCLUSION Gender, religion and divergent beliefs about EC's effects shape physicians' beliefs and practices.
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Noé G, Croxatto HB, Salvatierra AM, Reyes V, Villarroel C, Muñoz C, Morales G, Retamales A. Contraceptive efficacy of emergency contraception with levonorgestrel given before or after ovulation. Contraception 2010; 81:414-20. [DOI: 10.1016/j.contraception.2009.12.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 12/10/2009] [Accepted: 12/16/2009] [Indexed: 12/30/2022]
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Affiliation(s)
- Vivian W Y Leung
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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Tang T, Li P, Luo L, Shi D, Li J, Cao Y. Development and validation of a HPLC method for determination of levonorgestrel and quinestrol in rat plasma. Biomed Chromatogr 2009; 24:706-10. [DOI: 10.1002/bmc.1350] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Nagle CA, Lahoz MM, Porta MM, Torres M, Manzur T, Farinati Z. Suppression of ovulation by a synthetic progestin in the capuchin monkey. J Med Primatol 2009; 38:340-6. [PMID: 19470082 DOI: 10.1111/j.1600-0684.2009.00357.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND From the limited research in New World monkeys it is not clear whether they are as sensitive to the antiovulatory effects of synthetic progestins as noted in human beings. We examined whether levonorgestrel prevented ovulation in the capuchin monkey. METHODS Cebus apella monkeys were treated orally with two doses of 2 mg of levonorgestrel, 8-9 hours apart, in four periovulatory stages assessed by laparoscopy. RESULTS Levonorgestrel-induced luteinization of the follicle prevented oocyte release up to 8 hours before ovulation. Unhealthy oocytes were recovered from 46% of unruptured follicles. Luteal progesterone was reduced by 55%, 35%, and 25% according to when levonorgestrel was given -2, -1, and 0 day from estradiol peak respectively. CONCLUSION The capuchin monkey, a neotropical primate in which progesterone circulates at levels much higher than in Old World primates and human beings, is sensitive to the antiovulatory effects of synthetic progestins.
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Affiliation(s)
- Carlos A Nagle
- Centro de Investigación en Reproducción Humana y Experimental, Instituto Universitario CEMIC, Buenos, Aires, Argentina.
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Black KI. Developments and challenges in emergency contraception. Best Pract Res Clin Obstet Gynaecol 2009; 23:221-31. [DOI: 10.1016/j.bpobgyn.2008.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Accepted: 11/07/2008] [Indexed: 12/30/2022]
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Abstract
Emergency contraception (EC), also known as 'the morning after pill', or post-coital contraception, is a modality of preventing the establishment of a pregnancy after unprotected intercourse. Both a hormonal and an intrauterine form are available. Modern hormonal EC, with low side effects, was first proposed by Yuzpe in 1974. More recently, a new regimen, consisting of levonorgestrel administered alone, was introduced and found in clinical trials to be more effective (if taken as early as possible), and associated with less side effects than the Yuzpe regimen, which it has gradually replaced. The WHO developed another regimen based on the use of the selective progesterone receptor modulator (antiprogestin) mifepristone and conducted trials with different dosages. Intrauterine EC was first proposed by Lippes in 1976. It has the advantage of being applicable for almost a week and the disadvantage of a greater complexity. In addition, this modality is solely interceptive, acting by preventing implantation. Pregnancy rates reported following EC using an intrauterine device with more than 300 mm2 of copper are consistently low (0.1-0.2%).
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Affiliation(s)
- Carlo Bastianelli
- Department of Gynaecologic Sciences, Perinatology and Child Care, University la Sapienza, Rome, Italy.
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Wynn LL, Erdman JN, Foster AM, Trussell J. Harm Reduction or Women's Rights? Debating Access to Emergency Contraceptive Pills in Canada and the United States. Stud Fam Plann 2007; 38:253-67. [PMID: 18284040 DOI: 10.1111/j.1728-4465.2007.00138.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- L L Wynn
- Department of Anthropology, Macquarie University, NSW 2109, Australia.
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Williams A. The morning-after pill. ACTA ACUST UNITED AC 2007; 13:8-36. [PMID: 17847630 DOI: 10.1558/hrge.v13i1.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Anne Williams
- Scottish Council on Human Bioethics, 15 Morningside Road, Edinburgh, Scotland
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Levonorgestrel emergency contraception: a joint analysis of effectiveness and mechanism of action. Fertil Steril 2007; 88:565-71. [DOI: 10.1016/j.fertnstert.2006.11.178] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Revised: 11/30/2006] [Accepted: 11/30/2006] [Indexed: 12/30/2022]
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Emergency contraception under attack in Latin America: response of the medical establishment and civil society. REPRODUCTIVE HEALTH MATTERS 2007; 15:130-8. [PMID: 17512384 DOI: 10.1016/s0968-8080(07)29300-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The concept that it is possible to prevent a pregnancy after coitus is not new, but has gained prominence over the last 10-15 years. It provides a second chance to women who do not want to get pregnant and who, voluntarily or not, have had unprotected intercourse. Emergency contraception has been under strong attack by the Catholic church and anti-choice organisations in Latin America, who claim that the interference with implantation of the fertilised ovum is equivalent to an early abortion. The accumulation of evidence, however, is that the mechanism of action of emergency contraception is to prevent ovulation and that it does not interfere with implantation. This has been ignored by the anti-choice movement. The pattern of opposition to emergency contraception has been the same all over the Latin America region. The medical establishment and civil society, including the International Consortium for Emergency Contraception, have played a key role in defending access to emergency contraception throughout the region. A positive consequence of the public opposition of the Catholic church is that the concept and the method have become better known, and emergency contraception has become widely used. The cases of Peru, Brazil and Chile are described as examples.
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Trussell J, Guthrie KA. Talking straight about emergency contraception. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2007; 33:139-42. [PMID: 17609063 DOI: 10.1783/147118907781004859] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- James Trussell
- Office of Population Research, Princeton University, Princeton, NY 08544, USA.
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Hansen LB, Saseen JJ, Teal SB. Levonorgestrel-Only Dosing Strategies for Emergency Contraception. Pharmacotherapy 2007; 27:278-84. [PMID: 17253917 DOI: 10.1592/phco.27.2.278] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The United States Food and Drug Administration-approved progestin-only dosing strategy for emergency contraception is levonorgestrel 0.75 mg taken as soon as possible within 72 hours of unprotected intercourse, with a second 0.75-mg dose taken 12 hours later. However, different dosing strategies have been studied and promoted by various organizations. The American College of Obstetricians and Gynecologists recommends a single dose of levonorgestrel 1.5 mg for emergency contraception as one option. As another option, they recommend two doses of levonorgestrel 0.75 mg may be effective when taken 12-24 hours apart. We performed a search of MEDLINE and International Pharmaceutical Abstracts from 1967-2006 to evaluate and describe the existing pharmacokinetic and patient outcome data regarding administration of levonorgestrel as a 1.5-mg single dose or two 0.75-mg doses taken 12 or 24 hours apart. Additional studies were identified from the bibliographies of the selected literature. Several pertinent articles were identified. All of the studies demonstrated that emergency contraception effectively prevented pregnancy. In addition, evidence supports the safety and efficacy of a single dose of levonorgestrel 1.5 mg for emergency contraception. Furthermore, when two doses of levonorgestrel 0.75 mg are administered, the second dose can confidently be taken 12-24 hours after the first without compromising efficacy. Understanding the evidence that supports the different emergency contraception dosing strategies is critical for clinicians, and especially pharmacists, who have interactive roles in dispensing emergency contraception.
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Affiliation(s)
- Laura B Hansen
- Department of Clinical Pharmacy, University of Colorado at Denver and Health Sciences Center, Denver, Colorado 80262-0238, USA
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Brunton J, Beal MW. Current issues in emergency contraception: an overview for providers. J Midwifery Womens Health 2006; 51:457-63. [PMID: 17081936 DOI: 10.1016/j.jmwh.2006.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Emergency contraception has the potential to greatly reduce the number of unintended pregnancies occurring each year in the United States. Emergency contraception is a safe and effective intervention to which all women should have easy access in the event of an act of unprotected intercourse. Methods of emergency contraception include combined hormone oral contraceptive pills, progestin-only oral contraceptive pills, a dedicated progestin-only emergency contraceptive product, and insertion of a copper intrauterine device. Barriers exist to the increased use of emergency contraception, including the prescription-only status of all of the methods and lack of accurate knowledge on the part of health care providers and consumers. This article provides an overview of the clinical management of emergency contraception.
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Novikova N, Weisberg E, Stanczyk FZ, Croxatto HB, Fraser IS. Effectiveness of levonorgestrel emergency contraception given before or after ovulation--a pilot study. Contraception 2006; 75:112-8. [PMID: 17241840 DOI: 10.1016/j.contraception.2006.08.015] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Revised: 08/28/2006] [Accepted: 08/29/2006] [Indexed: 12/30/2022]
Abstract
BACKGROUND Although widely used, the mechanisms of action of the levonorgestrel emergency contraceptive pill (LNG ECP) are still unclear. There are increasing data to indicate that LNG is particularly effective as an ECP by interrupting follicular development and ovulation. An important outstanding question is whether it has any effect on fertilization or implantation. METHOD Ninety-nine women participated; they were recruited at the time they presented with a request for emergency contraception. All women took LNG 1.5 mg in a single dose during the clinic consultation. A blood sample was taken immediately prior to ingestion of the ECP for estimation of serum LH, estradiol and progesterone levels to calculate the day of ovulation. The specimens were analyzed in a single batch. Based on these endocrine data, we estimated the timing of ovulation to be within a +/-24-h period with an accuracy of around 80%. Women were followed up 4-6 weeks later to ascertain pregnancy status. The effectiveness of ECP when taken before and after ovulation was determined. RESULTS Three women became pregnant despite taking the ECP (pregnancy rate, 3.0%). All three women who became pregnant had unprotected intercourse between Days -1 and 0 and took the ECP on Day +2, based on endocrine data. Day 0 was taken as ovulation day. Among 17 women who had intercourse in the fertile period of the cycle and took the ECP after ovulation occurred (on Days +1 to +2), we could have expected three or four pregnancies; three were observed. Among 34 women who had intercourse on Days -5 to -2 of the fertile period and took ECP before or on the day of ovulation, four pregnancies could have been expected, but none were observed. We found major discrepancies between women's self-report of stage of the cycle and the dating calculation based on endocrine data. CONCLUSION These data are supportive of the concept that the LNG ECP has little or no effect on postovulation events but is highly effective when taken before ovulation.
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Affiliation(s)
- Natalia Novikova
- Department of Obstetrics and Gynaecology, University of Sydney, NSW, 2006, Australia
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Trussell J, Jordan B. Mechanism of action of emergency contraceptive pills. Contraception 2006; 74:87-9. [PMID: 16860044 DOI: 10.1016/j.contraception.2006.03.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2006] [Accepted: 03/24/2006] [Indexed: 12/30/2022]
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Abstract
Emergency contraception is the only resource that women can use to avoid becoming pregnant after having sexual intercourse without contraceptive protection. It could be a powerful means to prevent unwanted pregnancies and their devastating consequences for women's health, social wellbeing and life project, and for the unwanted child, if all people had ample access to good quality information, education and services for sexual and reproductive health. In spite of the preventive medicine value of emergency contraception, conservative sectors oppose its availability, appealing to moral values that are not universally shared in pluralistic societies. Excluding the only contraceptive that can be used after intercourse because some consider the mechanism of action to be unacceptable would mean restricting the right of choice of others, and imposing one particular belief or set of values on all members of the community, thus violating the freedom of conscience. Authorities have a moral obligation to protect human rights.
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Pruitt SL, Mullen PD. Response to letters to the editor regarding Contraception or Abortion? Inaccurate Descriptions of Emergency Contraception in Newspaper Articles, 1992–2002. Contraception 2005. [DOI: 10.1016/j.contraception.2005.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Trussell J, Calabretto H. Cost savings from use of emergency contraceptive pills in Australia. Aust N Z J Obstet Gynaecol 2005; 45:308-11. [PMID: 16029298 DOI: 10.1111/j.1479-828x.2005.00417.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Emergency contraception, which prevents pregnancy after unprotected sexual intercourse, has the potential to reduce significantly the incidence of unintended pregnancy and the consequent need for abortion and to reduce medical care costs. AIM To determine the savings generated by use of Postinor-2, the levonorgestrel regimen of emergency hormonal contraception, in Australia. METHODS We modelled the cost savings when women obtain Postinor-2 directly from a pharmacist where cost savings are measured as the cost of pregnancies averted by use of Postinor-2 per dollar spent on Postinor-2. RESULTS Each dollar spent on a single treatment with Postinor-2 saves A$2.27-A$3.81 in direct medical care expenditures on unintended pregnancy depending on assumptions about savings from costs avoided by preventing mistimed births. Postinor-2 is cost-saving even under the least favourable assumption that mistimed births when prevented today occur 2 years later. Results are robust even to large changes in model input parameters. CONCLUSION Emergency contraception is cost saving. More extensive use of emergency contraception could save considerable medical and social costs by reducing unintended pregnancies, which are expensive.
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Affiliation(s)
- James Trussell
- Office of Population Research, Princeton University, Princeton, NJ 08544, USA.
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Munuce MJ, Nascimento JAA, Rosano G, Faúndes A, Saboya-Brito K, Bahamondes L. In vitro effect of levonorgestrel on sperm fertilizing capacity and mouse embryo development. Contraception 2005; 72:71-6. [PMID: 15964296 DOI: 10.1016/j.contraception.2004.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2004] [Revised: 11/24/2004] [Accepted: 12/16/2004] [Indexed: 12/30/2022]
Abstract
The objectives of this study were to assess the expression of alpha-d-mannose binding sites in human spermatozoa, human sperm-oocyte interaction and the development of early stages of mouse embryo in the presence of levonorgestrel (LNG). Semen samples were obtained from 16 normozoospermic men. Spermatozoa were separated by Percoll gradient and incubated overnight for capacitation. The kinetic analysis of the expression of alpha-D-mannose binding sites was determined at 0, 4 and 22 h and in 22 h-capacitated spermatozoa that had been exposed to 1, 10 or 100 ng/mL of LNG or to a control medium for 30 min. Sperm binding sites for alpha-D-mannose were detected using commercial alpha-D-mannosylated bovine serum albumin conjugated with fluorescein isothiocyanate. To evaluate sperm-oocyte interaction, each oocyte was placed in a 100-microL droplet containing one of the three doses of LNG or control medium and inseminated with 1.0 x 10(5) motile spermatozoa/mL, after which the number of bound spermatozoa was evaluated. A total of 157 two-cell embryos recovered from eight mice was pooled and assigned randomly to treatment (1, 10 or 100 ng/mL of LNG) or control groups. There was a significant increase in the expression of specific alpha-d-mannose binding sites (Patterns II and III) during the incubation of spermatozoa under capacitating conditions. In the presence of LNG, results showed that there was no significant difference in the expression of specific alpha-d-mannose binding sites (Patterns II and III) at any LNG concentration tested compared with those spermatozoa in control medium. None of the LNG concentrations were capable of modifying the number of spermatozoa tightly bound to the human zona pellucida. There was no association between the presence or absence of LNG or the different doses of LNG evaluated and mouse embryo development. In conclusion, the hypothesis that in vitro exposure to LNG could interfere with sperm function and could contribute to the mechanism of action of this form of contraception was not confirmed but cannot be ruled out by the results of this study.
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Affiliation(s)
- María José Munuce
- Laboratory of Reproductive Studies, Department of Clinical Biochemistry, School of Biochemical and Pharmaceutical Sciences, Universidad Nacional de Rosario, Rosario 2000, Argentina
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Croxatto H. Reply: Post-coital administration of levonorgestrel and post-fertilization events in the new-world monkey Cebus apella. Hum Reprod 2005. [DOI: 10.1093/humrep/deh729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pruitt SL, Mullen PD. Contraception or abortion? Inaccurate descriptions of emergency contraception in newspaper articles, 1992–2002. Contraception 2005; 71:14-21. [PMID: 15639066 DOI: 10.1016/j.contraception.2004.07.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2004] [Revised: 07/18/2004] [Accepted: 07/19/2004] [Indexed: 11/15/2022]
Abstract
BACKGROUND Media portrayals of emergency contraception (EC) may influence public health policy and the public's acceptance of this reproductive health option. OBJECTIVES We investigated the accuracy of newspaper coverage of EC, 1992-2002. METHODS We conducted a content analysis of a sample of 1077 articles in 113 newspapers discussing both EC and abortion and determined the frequency of confusion between the two. RESULTS Of all articles, 44.5% (n = 479) included at least one instance of confusion between EC and medical abortion. Inaccurate portrayal of the mode of action of EC as medical abortion occurred in 31.8% (n = 343) of articles; 13.1% (n = 141) inappropriately applied terms such as "abortifacient postcoital contraceptives" for EC. CONCLUSIONS Errors were prevalent, persisted over time and may have contributed to incorrect beliefs about a form of contraception that is used infrequently, despite its potential to deter unintended pregnancy and abortion.
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Affiliation(s)
- Sandi L Pruitt
- Department of Health Promotion and Health Education, The University of Texas-Houston Health Science Center School of Public Health, Houston, TX 77030, USA
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