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Alegre-Del Rey EJ, Fénix-Caballero S, Díaz-Navarro J. [Controversies about the mechanism of postcoital levonorgestrel: evidences according to the decrease of pregnancies]. Farm Hosp 2017; 41:696-697. [PMID: 29112497 DOI: 10.7399/fh.10811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Affiliation(s)
| | | | - Jorge Díaz-Navarro
- Servicio de Farmacia, Hospital Universitario Puerto Real, Puerto Real, Cádiz.
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Ulipristal and postcoital contraception. Prescrire Int 2010; 19:265-6; author reply 266. [PMID: 21284364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Aubény E. [Emergency contraception]. Rev Prat 2008; 58:50-53. [PMID: 18326361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Emergency contraception is indicated when no birth control is used or in case of contraception failure. To day, two methods of emergency contraception are available. The hormonal method consists in taking a tablet of levonorgestrel 1.5 mg (NorLevo), as soon as possible following the contraceptive failure since its efficiency decreases rapidly as time goes by. No contraindication is associated with this contraceptive; however, it cannot be used as a regular contraception method since it is not 100% efficient (from 95.5 to 89% according to the authors). Apparently, this contraceptive acts by delaying ovulation. Mechanical contraceptives, such as intra-uterine devices, are extremely efficient (99.5%) and can be used up to 5 days after the estimated ovulation date. However, surveys conducted by the Inserm have revealed that in France, women are not aware of or lack of knowledge about emergency contraception and have many misconceptions. Moreover, many of them do not use emergency contraception since they do not feel concerned by the risk of pregnancy following contraception failure.
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Affiliation(s)
- Elisabeth Aubény
- Association Française pour la Contraception, cabinet médical, 37 bis rue Ponthieu, 75008 Paris.
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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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Abstract
AIMS To evaluate differences in the time taken to access progestogen-only emergency hormonal contraception (EHC) by young women from family planning (FP) or community pharmacy settings. METHODS An observational study of 203 women requesting EHC from FP clinics and community pharmacies in South-west Kent Primary Care Trust (PCT) from December 2002 to October 2003. RESULTS Access to EHC from community pharmacy was significantly faster than from FP clinics (16 h vs. 41 h, P<0.001). Older teenagers tended to seek EHC more quickly and were more likely to have had a contraceptive failure rather than have used no contraception at all. CONCLUSION The results provide further support for pharmacist involvement in the supply of EHC.
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Affiliation(s)
| | - Kay Marshall
- School of Pharmacy, University of BradfordBradford, UK
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Stanford JB, Mikolajczyk RT. Emergency contraception. Pediatrics 2006; 117:1448; author reply 1450. [PMID: 16585350 DOI: 10.1542/peds.2005-2491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Bissell P, Savage I, Anderson C. A qualitative study of pharmacists' perspectives on the supply of emergency hormonal contraception via patient group direction in the UK. Contraception 2006; 73:265-70. [PMID: 16472568 DOI: 10.1016/j.contraception.2005.07.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2003] [Revised: 07/19/2005] [Accepted: 07/20/2005] [Indexed: 10/25/2022]
Abstract
AIM To investigate pharmacists' views and experiences of supplying emergency hormonal contraception (EHC) via a group prescribing protocol in community pharmacies in the UK. DESIGN Qualitative study using depth interviews. SETTING Community pharmacists in Manchester, Salford and Trafford (Greater Manchester), and Lambeth, Southwark and Lewisham (London) Health Action Zones in the UK. PARTICIPANTS Forty-four community pharmacists supplying EHC in Manchester, Salford and Trafford, and Lambeth, Southwark and Lewisham (London). RESULTS Pharmacists were broadly very positive about their experiences supplying EHC via the group prescribing protocol. Pharmacists identified many benefits of the EHC schemes for clients, in particular, improved access to EHC at no cost to clients. The confidential nature of the scheme was also seen as an advantage as was the scope for referral to other service providers. Pharmacists also believed that the scheme had benefits for the profession in terms of enhanced professional standing. However, their concerns included the extent of repeated use of EHC, the possible impact on contraceptive behaviors and sexually transmitted infections and its impact on male coercive sexual behavior. CONCLUSIONS Although pharmacy supply of EHC may improve access for some clients and is perceived as a popular service, research into the implications of the schemes as identified in this study need to be conducted.
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Affiliation(s)
- Paul Bissell
- Centre for Pharmacy, Health and Society, School of Pharmacy, University of Nottingham, NG72RD, UK.
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Soon JA, Levine M, Osmond BL, Ensom MHH, Fielding DW. Effects of making emergency contraception available without a physician's prescription: a population-based study. CMAJ 2005; 172:878-83. [PMID: 15795408 PMCID: PMC554872 DOI: 10.1503/cmaj.045019] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Timely access to emergency contraception has the potential to reduce the number of unwanted pregnancies and subsequent abortions. A public health policy initiative in British Columbia beginning in December 2000 allowed pharmacists to provide emergency contraceptives (ECs) without a prescription. We sought to determine changes in EC use after the policy was introduced and to analyze EC use with data generated by the policy. METHODS All Ovral, Preven and Plan B EC prescriptions from Jan. 1, 1996, to Dec. 31, 2003, were identified through the BC PharmaNet and Medical Services Plan administrative databases and the data analyzed to determine changes between 1996 and 2002. Changes over time were determined in the frequency of EC provision, choice of EC agent, frequency of EC use by age group, repeat use and geographic distribution of EC prescription for the pre- and post-policy periods. Anonymized patient-specific data from treatment consent forms were used to describe the reason for EC use, interval between unprotected intercourse and EC prescription, proportion prescribed for immediate or future use, referrals for regular birth control and STD screening and concomitant antiemetic use. Consent data also provided the time in the menstrual cycle that the EC was requested. RESULTS The number of EC prescriptions increased from a pre-policy mean of 8805 (99% confidence interval 7823-9787) in the years 1996 to 2000 to a post-policy total in 2002 of 17 794. Physicians prescribed the levonorgestrel regimen (Plan B) less frequently than did pharmacists. The frequency of EC use was highest among women aged 20-24 years across all study years, and all age groups demonstrated a post-policy increase in use. On average, 2.1% of the women received an EC 3 or more times a year over the period of the study. More women in urban regions received ECs than women in more rural areas of the province. Analysis of pharmacist treatment consent forms used in 2001 and 2002 showed that 56.2% of women receiving an EC reported using a method of birth control that had failed, 55.7% of pharmacist-provided ECs were obtained within 24 hours after unprotected intercourse, 1.1% of ECs were obtained for future use, antiemetics were provided to 57.7% of women receiving the Yuzpe regimen (Ovral, Preven) and to 20.5% of women receiving levonorgestrel, and women tended to seek ECs when unprotected intercourse occurred at the time of highest risk of pregnancy in their menstrual cycle. Women in greatest financial need obtained ECs more frequently from physicians than from pharmacists. INTERPRETATION The policy change that granted pharmacists authority to provide ECs to women without a physician's prescription did not simply expand EC availability but was associated with an overall increase in EC use in the province.
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Affiliation(s)
- Judith A Soon
- School of Pharmacy, University of Washington, Seattle, Wash, USA. [corrected]
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Abstract
Emergency contraception (EC) consists of either 1.5 mg of levonorgestrel (LNG) in one or two doses, or a combination of LNG with ethinylestradiol, administered for up to 5 days after unprotected intercourse. Clinical studies indicate that LNG alone is more effective and has less side effects. Its effectiveness decreases the longer after coitus it is taken. EC is indicated when there is non-compliance or accidents with the use of regular methods of contraception, or when women have had voluntary or imposed unprotected intercourse. The ethics of providing EC has been questioned by some, arguing that it acts by preventing implantation. Scientific evidence does not support this concept, but shows that EC acts mostly before fertilization. Placing obstacles to the access of EC is unethical as it transgresses the ethical principles of autonomy, non-maleficence beneficence and justice. Far from inducing abortions, EC reduces unwanted pregnancies and prevents abortion.
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Affiliation(s)
- A Faúndes
- Department of Gynecology and Obstetrics, Universidade Estadual de Campinas, Campinas, SP, Brazil.
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Hamel R, Panicola MR. Low risks of moral certitude: response to Msgr. Mulligan. Ethics Medics 2003; 28:2-4. [PMID: 16208828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Ron Hamel
- Catholic Health Association, St. Louis, MO, USA
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Mulligan JJ. Peace of conscience for rape victims: ovulation testing and emergency contraception. Ethics Medics 2003; 28:1-2. [PMID: 16208827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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Hamel R. Rape and emergency contraception: a reply to Rev. Kevin McMahon. Ethics Medics 2003; 28:1-2. [PMID: 16206467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Ron Hamel
- The Catholic Health Association, St. Louis, MO, USA
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McMahon KT. Why fear ovulation testing? A response to Ron Hamel. Ethics Medics 2003; 28:3-4. [PMID: 16206469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Kevin T McMahon
- Saint Charles Borromeo Seminary, Overbrook, Wynnewood, PA, USA
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Abstract
There are little or no data on the risk of ectopic pregnancy following levonorgestrel treatment as an emergency contraception. We encountered three cases of ectopic pregnancy following the use of levonorgestrel administered peri- or postovulation. Here we report these cases and discuss the clinical and epidemiologic implications of this association. Health providers should be alert to the possibility of an ectopic pregnancy in women who become pregnant or complain of lower abdominal pain after taking levonorgestrel.
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Affiliation(s)
- Galit Sheffer-Mimouni
- Department of Obstetrics and Gynecology, The Lis Maternity Hospital, Sackler School of Medicine, Tel-Aviv University, 6 Weizman Street, Tel Aviv 6427, Israel.
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Abstract
The introduction of widespread nonprescription delivery of hormonal emergency contraception (EC) calls for development of innovative tools to provide information to and gather feedback from EC users. Individuals seeking confidential information on sexual health and contraception are increasingly turning to the Internet as the resource of choice. This study employed analytical software and manual content analysis to examine the use of a website dedicated to an EC product (www.norlevo.com) over the course of 2 years. Frequency of visits to and pageviews of the site increased consistently over the 2-year time period, and the bulk of the visitors to the site were EC users seeking responses to frequently asked questions. The most common concern raised by users was the occurrence of spotting and menstrual bleeding following EC use. This analysis reveals that within the context of nonprescription access to hormonal EC, a website can constitute a potent educational tool for health professionals and EC users and provide a valuable source of post-marketing feedback on product use.
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Affiliation(s)
- Erin Gainer
- Laboratoire HRA Pharma, 19 rue Frédérick Lemaître, 75020 Paris, France.
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Hansen CCT, Svare EI, Petersen RH, Bock JE. [Who are the users of emergency contraception?]. Ugeskr Laeger 2002; 164:5003-5. [PMID: 12422390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
INTRODUCTION A user profile is necessary in order to direct future campaigns for emergency contraception (EC). MATERIAL AND METHODS Over a three-month period, 423 women with prescriptions for EC were consecutively entered in the study, which was carried out in four inner-city pharmacies in Copenhagen, Denmark. RESULTS The median age was 24 years (range 13-50 years). Most women (73%) were first-time users of EC. The reason for the current need for EC was most often condom failure (54%) or non-use of any contraceptive method (41%). Only six women (1.4%) reported non-use of contraception because of their knowledge of EC and only four women (0.9%) reported EC as the usual method of contraception. Knowledge about EC more often came from family or friends (51%) and advertising (47%), than from general practitioners (26%) or through sex education in schools (3%). Altogether 282 women (69%) received EC from a doctor in the medical emergency service or a casualty ward. DISCUSSION Overall, EC is used as recommended. Its availability does not seem to reduce the use of safer contraceptive methods. The mandatory sex education in school should include information on EC.
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Abstract
OBJECTIVE To investigate the knowledge, experiences and attitudes towards emergency contraceptive pills (ECP) among women presenting for induced abortion. DESIGN Survey by self-administered waiting room questionnaires. SETTING Three large hospitals in the cities of Uppsala, Västerås and Orebro in Sweden. POPULATION 591 Swedish-speaking women consecutively attending the clinics for an induced abortion during a four-month period in 2000. RESULTS The response rate was 88% (n = 518). As many as 43% had a history of one or more previous abortions and 43% were daily smokers. Four out of five women, 83%, were aware of ECP, but only 15 women used it to prevent this pregnancy. Fewer, 38%, knew the recommended timeframes for use and 54% had knowledge of the mode of action. The two most common sources of information about ECP were media and friends. One out of five, 22%, had previously used the method, and at the time of conception, 55% would have taken ECP if it had been available at home, and 52% were positive to having ECP available over the counter. CONCLUSIONS Emergency contraception is well known but is still underused. Lack of awareness of pregnancy risk may be one limiting factor for its use. Making ECP available over the counter may be an important measure towards better availability. Information strategies to the public are needed before ECP will be a widely used back-up method.
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Affiliation(s)
- Gunilla Aneblom
- Department of Public Health and Caring Sciences, University of Uppsala, Sweden
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Almodóvar CG, Fernández Pacheco L. [Emergency contraception. Information for patients]. Aten Primaria 2002; 29:124-5. [PMID: 11844433 PMCID: PMC7681707 DOI: 10.1016/s0212-6567(02)70520-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Webb AM. Emergency contraception: mostly successes, but still some threats. J Fam Plann Reprod Health Care 2001; 27:183-5. [PMID: 12457463 DOI: 10.1783/147118901101195588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Espinós JJ, Rodríguez-Espinosa J, Senosiain R, Aura M, Vanrell C, Gispert M, Vega C, Calaf J. The role of matching menstrual data with hormonal measurements in evaluating effectiveness of postcoital contraception. Contraception 1999; 60:243-7. [PMID: 10640171 DOI: 10.1016/s0010-7824(99)00090-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The effectiveness of postcoital contraception can only be estimated. The most commonly used method of calculation compares the expected pregnancy rate in the exposed population to the resultant pregnancies after treatment. Estimation of the fertile period and the day of ovulation are critical to calculate the expected pregnancies. The aim of this study was to improve the accuracy of calculations by evaluating the hormonal status on the day of contraceptive treatment. A total of 483 consecutive women requesting postcoital contraception was included in a prospective observational trial. A blood sample was obtained at the moment of consultation to measure serum luteinizing hormone, estradiol, and progesterone concentrations. An ethinylestradiol-levonorgestrel combination (100 micrograms/500 mg for two doses, 12 h apart) was then prescribed. The fertile period was estimated according to previous hormonal studies in the normal cycling population. Of 483 women, 64 (13.25%) women were excluded because they presented irregular menstrual cycles and 37 (7.6%) women were lost to follow-up. Two pregnancies occurred in the remaining 382 women. Following Wilcox's and Trussell's methods, 21.1 and 17.75 pregnancies should be expected, yielding an overall treatment effectiveness of 90.52% (95% confidence interval [CI] 62.58%-97.6%) and 88.73% (95% CI 55.93%-97.12%), respectively. Hormonal data were available in 356 women; 303 of whom presented with regular cycles. Hormonal information in this group restricted the number of exposed cases to 88 women. Of the women included in Trussell's method of analysis, only 51 (51.5%; p < 0.05) were at risk using hormonal data. Fifty-six percent (95% CI 34.9%-75.6%) of women with luteinizing hormone levels > 20 IU/L were not between days-1 and +1 of the cycle. Hormonal studies suggest that methods based on pregnancy risk calculated by cycle day do not faithfully reflect the real exposure.
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Affiliation(s)
- J J Espinós
- Department of Obstetrics and Gynecology, Universitat Autonoma, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
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Affiliation(s)
- A M Wearn
- Department of Primary Care and General Practice, The Medical School, University of Birmingham, U.K.
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Mazza D. The perimenopause and contraception. Aust Fam Physician 1999; 28:1045-6. [PMID: 10592583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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Serru F. [Postcoital contraception]. Rev Infirm 1999:10-1. [PMID: 10723419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Cheng L. [Current status and development of emergency contraception]. Zhonghua Fu Chan Ke Za Zhi 1999; 34:325-6. [PMID: 11360605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
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Abstract
The purpose of this study was to provide revised estimates of the effectiveness of the Yuzpe method of emergency contraception. Through a literature search, we identified eight studies that present the number of women treated and outcome of treatment by cycle day of unprotected intercourse relative to expected day of ovulation. Using five sets of external estimates of conception probabilities by cycle day of intercourse among women not using contraception, we assessed the effectiveness of the Yuzpe regimen. The 45 estimates of effectiveness, based on eight separate studies and the eight studies combined and five different sets of conception probabilities by cycle day, ranged from a low of 56.4% to a high of 89.3%. Our preferred point estimate is that the Yuzpe regimen reduces the risk of pregnancy by 74.1%, with a 95% confidence interval extending from 62.9% to 79.2%. True effectiveness is likely to be > 74% because treatment failures (observed pregnancies) include women who were already pregnant when treated and women who became pregnant after being treated.
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Affiliation(s)
- J Trussell
- Office of Population Research, Princeton University, NJ 08544, USA.
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Abstract
This review discusses the available data reporting the efficacy of emergency contraceptive treatment with the Yuzpe regimen (0.2 mg of ethinyl oestradiol in combination with either 2.0 mg of norgestrel or 1.0 mg of levonorgestrel) and evaluates the true effectiveness in preventing pregnancy. A literature review was completed for reports including women treated with the Yuzpe using a MEDLINE search for articles published since 1970 and by reviewing the secondary reference lists of these manuscripts. Expected pregnancy rates for each study population were calculated using published conception rate estimates. Seven published studies provided adequate data to assess accurately efficacy of the Yuzpe regimen in preventing pregnancy after unprotected intercourse. Of 2871 women treated, 54 (1.9%, 95% confidence intervals (CI) 1.4-2.4) became pregnant. By calculating the expected pregnancy rates using two different methodologies, the Yuzpe regimen decreased the observed number of pregnancies by 70.0% (95% CI 63.3-76.7) and 77.2% (95% CI 71.5-82.8). Emergency contraception with the Yuzpe regimen is an effective form of contraception to prevent unwanted pregnancy after unprotected intercourse.
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Affiliation(s)
- M D Creinin
- University of Pittsburgh School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Women's Hospital, USA
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Nelson AL. Adolescent contraception. West J Med 1996; 165:374-6. [PMID: 9000861 PMCID: PMC1303878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Sánchez-Borrego R, Balasch J. Ethinyl oestradiol plus dl-norgestrel or levonorgestrel in the Yuzpe method for post-coital contraception: results of an observational study. Hum Reprod 1996; 11:2449-53. [PMID: 8981131 DOI: 10.1093/oxfordjournals.humrep.a019135] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
This observational study compares the efficacy and incidence of side-effects between dl-norgestrel (2 mg) and levonorgestrel (1 mg) associated with ethinyl oestradiol (200 micrograms) given in two doses 12 h apart for emergency post-coital contraception. A total of 117 consecutive women were given dl-norgestrel in combination with the oestrogen (dl-norgestrel group) while 423 consecutive subjects received the combination ethinyl oestradiol/levonorgestrel (levonorgestrel group). Overall, four (0.8%) pregnancies occurred in the 540 treated women, one (0.9%) in the dl-norgestrel group and three (0.7%) in the levonorgestrel group. In addition to this similar high contraceptive efficacy between both study groups, women in the levonorgestrel group had a significantly lower incidence of side-effects (23.5%) and better timing of the next menstruation after treatment (75% had bleeding on time) than those in the dl-norgestrel group (corresponding figures were 50.5 and 62.6% respectively). It is concluded that levonorgestrel should be used in preference to dl-norgestrel for post-coital contraception in the Yuzpe regimen.
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New birth control options. Int J Fertil Menopausal Stud 1996; 41:445. [PMID: 8934249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Abstract
OBJECTIVES The objectives of the study were to assess the suitability of a service for provision of emergency hormonal contraception by nurses. METHODS Retrospective analysis was carried out of data obtained from the case records of 500 consecutive women who attended ABACUS (a city center-based family planning clinic in Liverpool, UK) for emergency contraception during the 7th and 9th months of the first year (1994) of the service. Similar data were collected for 100 consecutive women during 1 month of the third year (June 1996). The number of women who received emergency hormonal contraception was noted. In particular, details pertaining to the reasons for referral to the doctor and the trend of referrals were noted. RESULTS The results indicate that during the first year the nurses independently issued emergency hormonal contraception to 37% of the women. They referred the remaining 63% to the medical staff. One-third of referrals were for ongoing contraception, especially oral contraception. Another third of referrals appeared to be due to 'nurse anxiety', as no medical or other cause was found for these referrals. During the third year, nurses dispensed emergency hormonal contraception to 64% of women. Among the remaining 36% of women who were referred to the doctor, 19% needed hormonal contraception. Referral reflecting 'nurse anxiety' significantly declined (1%) compared to the first year of service. CONCLUSIONS Ongoing contraception, particularly initiation of oral contraception, was one of the main reasons for referral during the first year. Referral due to 'nurse anxiety' significantly declined with continued experience and may have reflected initial anxiety and the learning curve. With increased experience over the first 2 years, the outcome of this service showed encouraging improvement. The nurses now dispense emergency hormonal contraception to a majority of women.
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Affiliation(s)
- R R Jarvis
- Bolton Centre for Sexual Health, Bolton General Hospital, UK
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Brown HP. Emergency contraception, a method whose time has come: an update. Tex Med 1996; 92:61-63. [PMID: 8775852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Unplanned pregnancy is a major public health problem in the United States. Emergency contraception has the potential to significantly decrease the incidence. The Yuzpe regimen is highly effective but woefully underutilized. Mechanisms of action of hormonal emergency contraception will be discussed as well as appropriate indications for use, patient counseling issues, and future methods.
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Affiliation(s)
- H P Brown
- Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, TX 78284-7836, USA
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Cardy GC. Failed emergency contraception. Br J Gen Pract 1994; 44:428. [PMID: 8790665 PMCID: PMC1239004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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de Melo NR, Pinotti J. [Advances in hormonal contraception]. Adv Contracept 1994; 10 Suppl 1:33-9. [PMID: 7839870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
MESH Headings
- Contraception/trends
- Contraceptive Agents, Female/administration & dosage
- Contraceptive Agents, Female/adverse effects
- Contraceptive Agents, Female/classification
- Contraceptive Devices, Female
- Contraceptives, Oral, Hormonal
- Contraceptives, Postcoital, Hormonal
- Delayed-Action Preparations
- Drug Implants
- Drug Utilization
- Female
- Gonadal Steroid Hormones/administration & dosage
- Gonadal Steroid Hormones/adverse effects
- Gonadotropin-Releasing Hormone/agonists
- Humans
- Injections, Intramuscular
- Intrauterine Devices, Medicated
- Progestins/antagonists & inhibitors
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Affiliation(s)
- N R de Melo
- Gynecology Department, Hospital das Clinicas, University of Sao Paolo, Brazil
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Sundaram K, Kumar N, Bardin CW. 7 alpha-Methyl-19-nortestosterone: an ideal androgen for replacement therapy. Recent Prog Horm Res 1994; 49:373-6. [PMID: 8146434 DOI: 10.1016/b978-0-12-571149-4.50027-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
MENT is a synthetic androgen which cannot be 5 alpha-reduced. Therefore, relative to T, its stimulatory action on the prostate is lower than that on the muscle and pituitary. Like T, MENT undergoes enzymatic aromatization to an estrogen. We conclude that the use of MENT instead of T for androgen replacement therapy could have health-promoting effects by reducing the occurrence of prostate disease.
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Affiliation(s)
- K Sundaram
- Center for Biomedical Research, Population Council, New York, New York 10021
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Webb A. [Risk of an unwanted pregnancy after a single unprotected coitus; observations on the current hormonal postcoital contraceptive methods]. Ned Tijdschr Geneeskd 1993; 137:309-10. [PMID: 8433780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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45
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Haspels AA. [Risk of an unwanted pregnancy following a single unprotected coitus; observations concerning the current hormonal postcoital contraceptive methods]. Ned Tijdschr Geneeskd 1993; 137:308-9. [PMID: 8433779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Morning-after pill creates controversy. Ohio Med 1990; 86:12. [PMID: 2300365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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48
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Fitz R, Grünberger W, Vytiska-Binstorfer E. [Initial experiences with a levonorgestrel-ethinyl estradiol combination for interception]. Geburtshilfe Frauenheilkd 1989; 49:1087-9. [PMID: 2515090 DOI: 10.1055/s-2008-1036294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Several authors have reported on reliable postcoital contraception, using an estrogen/gestagen combination. These studies in more than a hundred women showed, that the unprotected intercourse in less than 50% took place around ovulation. Pregnancy rates from 0.7 to 2.6% were observed. From October 1987 to July 88, 50 women after unprotected intercourse around ovulation were included in our study. From one to 44 hours after intercourse, 0.5 mg levonorgestrel + 0.1 mg ethinylestradiol (Tetragynon) were administered orally. The same dose was repeated 12 hours later. Cervical secretion, LH- and E2 and P-serum levels at the time of the first administration were determined and side effects and bleeding patterns were registered. In one third of the women, we observed slight side effects. The bleeding resulted 5 to 29 days after the first tablet administration. Shortened menstruation cycles were seen more often than prolonged cycles. Bleeding duration was only slightly prolonged. Two pregnancies occurred - both women vomited immediately after the first medication and disregarded the order to visit our department again as quickly as possible. Tetragynon is not appropriate for regular contraception and should only be used in emergency situations.
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Affiliation(s)
- R Fitz
- I. Universitäts-Frauenklinik, Wien
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Bagshaw SN, Edwards D, Tucker AK. Ethinyl oestradiol and D-norgestrel is an effective emergency postcoital contraceptive: a report of its use in 1,200 patients in a family planning clinic. Aust N Z J Obstet Gynaecol 1988; 28:137-40. [PMID: 3228408 DOI: 10.1111/j.1479-828x.1988.tb01643.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We describe a prospective study of 1,200 patients using the Yuzpe regimen of hormonal postcoital contraception. There was an 85% follow-up rate, and of the 1,015 patients followed there were 13 pregnancies, giving a pregnancy rate of 1.3%. The number of expected pregnancies at mid-cycle was reduced by 83%; 12 of the 13 pregnancies went on to abortion. The patients were young: 86% were under 25, and 10% were under 15. The most frequent reason for presentation was that no contraception had been used (57%). All patients received an antiemetic; 57% experienced no side-effects, 28% had some nausea and 9.6% some vomiting. It is concluded that this is a safe form of emergency contraception, which is an effective way of reducing the number of unwanted pregnancies, especially in the very young.
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Affiliation(s)
- S N Bagshaw
- Christchurch Branch, Family Planning Association, New Zealand
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50
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Couzinet B, Schaison G. [Contragestion]. Rev Prat 1987; 37:2285-92. [PMID: 3659795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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