A randomized trial to compare 24 h versus 12 h double dose regimen of levonorgestrel for emergency contraception

Ngai, Suk Wai; Fan, Susan; Li, Shiqin; Liu, Cheng; Ding, Jiannan; Jing, Xiaoping; Ng, Ernest Hung Yu; Ho, Pak Chung

doi:10.1093/humrep/deh583

Cited by 77 publications

(12 citation statements)

References 11 publications

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“…The present study demonstrated a failure rate of 0.68%, which was less than or equal to previous reports on EC (Table 1) [6,7,10-14]. This confirms that 1.5 mg of levonorgestrel in a single dose is a highly effective method of EC in preventing unintended pregnancy for patients of SA.…”

Section: Discussionsupporting

confidence: 76%

Effectiveness of emergency contraception in women after sexual assault

Choi

Kim

Hwang

et al. 2013

Clin Exp Reprod Med

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

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Section: Discussionsupporting

confidence: 76%

Effectiveness of emergency contraception in women after sexual assault

Choi

Kim

Hwang

et al. 2013

Clin Exp Reprod Med

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“…Combined oral contraceptive pills in larger doses were used as emergency contraception (EC) in the United States for nearly twenty years before dedicated EC pills became available in the late 1990s. EC pills are a time-sensitive treatment; although some evidence shows that they can work for up to 120 hours (Dada, Godfrey, Piaggio, von Hertzen, & Nigerian Network Reprod Hlth Res &, 2010; Fine et al, 2010; Glasier et al, 2010; Ngai, Fan, Li, Cheng, & Ding, 2004; von Hertzen et al, 2002), EC pills should be taken as soon as possible because they work by inhibiting ovulation (Gemzell-Danielsson, Berger, & Lalitkumar, 2013). It is often difficult for women to know precisely where they are in their cycle, and if ovulation is imminent, a woman may not have 120 hours to wait.…”

Section: Introductionmentioning

confidence: 99%

Access to Emergency Contraception in the Over-the-Counter Era

Cleland

Bass

Doci

et al. 2016

Women's Health Issues

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Introduction After years of complex regulatory changes, levonorgestrel emergency contraception (LNG EC) is now approved for unrestricted sale in the US. Timely access to EC pills is critical because they are more likely to work the sooner they are taken. This study assesses whether LNG EC is sold in accordance with current Food and Drug Administration regulations. Methods We distributed an online questionnaire through an EC-focused listserv for reproductive health professionals, asking data collectors to visit local stores and document product names, price, over-the-counter (OTC) shelf availability, and misinformation about age restrictions. We used Chi-square analysis to assess bivariate associations and t-tests and Wilcoxon rank-sum tests to determine differences in means. Results We collected information about 220 stores. The majority (65%) stocked EC on OTC shelves, although only 22% of these displayed it without a locked security enclosure. Chain pharmacies were more likely to shelf-stock EC than independent pharmacies (77% vs 5%; p=0.000), but variation existed among stores within the same chain. Among stores that were asked, 40% incorrectly reported an age restriction for non-prescription purchase of LNG EC, while 95% correctly reported that men can buy LNG EC. The average price of branded and generic LNG EC was $49.64 and $40.05, respectively. Conclusion Changes in the regulatory status of LNG EC have resulted in widespread confusion about how EC can be sold, and its high price contributes to access barriers. Retailers should ensure that consumers can access LNG EC quickly and easily by stocking the product on OTC shelves and educating staff about current regulations.

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“…A different study compared the efficacy of two doses of 0.75 mg levonorgestrel among 2071 Chinese women, given at either a 12 or 24 h interval, with the treatment period extended to 120 h after unprotected coitus [32]. The crude pregnancy rate was 2.0% in the 12 h group and 1.9% in the 24 h group.…”

Section: Resultsmentioning

confidence: 99%

A systematic review of effectiveness and safety of different regimens of levonorgestrel oral tablets for emergency contraception

et al. 2014

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BackgroundUnintended 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.MethodsRandomized, 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.ResultsEvery 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.ConclusionsThe 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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A randomized trial to compare 24 h versus 12 h double dose regimen of levonorgestrel for emergency contraception

Abstract: Two doses of 0.75 mg levonorgestrel given either 24 or 12 h apart are effective for emergency contraception up to 120 h after unprotected intercourse. Further research to investigative more effective methods of emergency contraception is warranted.

Cited by 77 publications

References 11 publications

Effectiveness of emergency contraception in women after sexual assault

Effectiveness of emergency contraception in women after sexual assault

Access to Emergency Contraception in the Over-the-Counter Era

A systematic review of effectiveness and safety of different regimens of levonorgestrel oral tablets for emergency contraception

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