Emergency contraception use and counseling after changes in United States prescription status

Kavanaugh, Megan L.; Williams, Sanithia L.; Schwarz, Eleanor Bimla

doi:10.1016/j.fertnstert.2011.03.011

Cited by 25 publications

(16 citation statements)

References 23 publications

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“…Healthcare providers are not consistently providing information, although women view them as reliable sources of information [8,[13][14][15]. Women in this study were more concerned with living with the consequences of an unintended pregnancy; many cited "family values" as a motivating factor to avoiding pregnancy.…”

Section: Discussionmentioning

confidence: 76%

“…Many women are not well informed regarding indication, timing, side effects and efficacy; many cannot differentiate EC from RU-486 (mifepristone), the medication used to induce an abortion [8,9,14]. Other studies have noted that healthcare providers have not informed women of EC as a contraceptive option, even after its availability OTC [15,16]. Many women report learning about EC from the media or from friends [13].…”

Section: Introductionintroductionmentioning

confidence: 99%

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Female college students' experiences with and perceptions of over-the-counter emergency contraception in the United States

Hickey

White

2015

Sexual & Reproductive Healthcare

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Section: Discussionmentioning

confidence: 76%

Section: Introductionintroductionmentioning

confidence: 99%

Female college students' experiences with and perceptions of over-the-counter emergency contraception in the United States

Hickey

White

2015

Sexual & Reproductive Healthcare

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“…The leading form of EC, known as Plan B One Step® or Next Choice®, is available over-the-counter in the U.S. to adults and following a recent court decision (2013), is available to adolescents as well. The use of EC among reproductive-age women has doubled from 2006 to 2008 [3] and is likely to continue increasing with this recent legislative change. Unfortunately, the levonorgestrel (LNG)-based method appears to be significantly less effective in obese women, failing 4 times as often as in non-obese women [4].…”

Section: Introductionmentioning

confidence: 99%

Impact of obesity on the pharmacokinetics of levonorgestrel-based emergency contraception: single and double dosing

et al. 2016

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Objective To determine if differences exist in the pharmacokinetics (PK) of levonorgestrel-based emergency contraception (LNG-EC) in obese and normal body mass index (BMI) users and test whether doubling the dose of LNG-EC in obese women increases total and free (active) LNG serum concentrations. Study design Healthy, reproductive-age women with obese and normal BMIs received 1.5 mg LNG orally (ECx1) and then in a subsequent menstrual cycle, the obese group also received 3mg LNG (ECx2). Dosing occurred during the follicular phase. Total and free LNG PK parameters were obtained via serum samples through an indwelling catheter at 0, 0.5, 1, 1.5, 2, and 2.5 hours. The primary outcome was the difference in total and free LNG concentration maximum (Cmax) between ECx1 and ECx2 in the obese group. Results A total of 10 women enrolled and completed the study (normal BMI = 5, median 22.8 kg/m2, range 20.8–23.7; obese BMI = 5, 39.5 kg/m2, range 35.9–46.7). The total LNG Cmax for obese subjects following ECx1 (5.57±2.48 ng/mL) was significantly lower than the level observed in normal BMI women (10.30±2.47, p=0.027). Notably, ECx2 increased the Cmax significantly (10.52±2.76, p=0.002); approximating the level in normal BMI subjects receiving ECx1. Free LNG Cmax followed a similar pattern. Conclusion Obesity adversely impacts both the total and free Cmax levels of LNG EC and this likely explains its lack of efficacy in obese women. Doubling the dose appears to correct the obesity-related PK changes but additional research is needed to determine if this also improves EC effectiveness in obese women. Implications This study demonstrates that obesity interferes with the pharmacokinetics of LNG EC, and that doubling the dose may be an effective strategy to improve its efficacy in obese women.

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“…In the United States, four EC methods are available: the copper intrauterine device (IUD), levonorgestrel 1.5 mg (LNG, a progestin-only pill), ulipristal acetate 30 mg (UPA, an anti-progestin pill), and the Yuzpe method (oral contraceptives taken in various combinations). Although major medical associations [1–5] recommend counseling women at risk of unintended pregnancy about EC, a 2011 study found that only 3% of women received such counseling in the past year [6]. Often, providers rely on patients to initiate discussions about EC [7].…”

Section: Introductionmentioning

confidence: 99%

Emergency contraception: A multispecialty survey of clinician knowledge and practices

et al. 2016

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Objectives To assess knowledge and provision of emergency contraception (EC), particularly the most effective methods. Study Design A web-based survey was distributed to a cross-sectional convenience sample of healthcare providers across specialties treating reproductive-aged women. The survey was sent to 3,260 practicing physicians and advanced practice clinicians in 14 academic centers between February 2013 and April 2014. We analyzed responses by provider specialty using multivariable logistic regression. Results The final sample included 1,684 providers (response rate = 51.7%). Ninety-five percent of the respondents had heard of levonorgestrel (LNG) EC. Among reproductive health specialists, 81% provide levonorgestrel EC in their practice, although only half (52%) had heard of ulipristal acetate (UPA) and very few provide it (14%). The majority in family medicine (69%) and emergency medicine (74%) provide levonorgestrel, in contrast to 42% of internists and 55% of pediatricians. However, the more effective methods (UPA and copper IUD) were little known and rarely provided outside of reproductive health specialties; 18% of internists and 14% of emergency medicine providers had heard of UPA and 4% provide it. Only 22% of emergency providers and 32% of pediatricians had heard of the copper IUD used as EC. Among reproductive health specialists, only 36% provide copper IUD as EC in their practice. Specialty, provider type and proportion of women of reproductive age in the practice were related to knowledge and provision of some forms of EC. Conclusions Awareness and provision of the most effective EC methods, UPA and the copper IUD (which are provider-dependent), are substantially lower than for LNG EC, especially among providers who do not focus on reproductive health. Implications In our sample of 1,684 healthcare providers from diverse specialties who treat reproductive-aged women, knowledge and provision of the most effective forms of emergency contraception (ulipristal acetate and the copper IUD) are far lower than for levonorgestrel EC. Women should be offered the full range of EC methods.

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Emergency contraception use and counseling after changes in United States prescription status

Cited by 25 publications

References 23 publications

Female college students' experiences with and perceptions of over-the-counter emergency contraception in the United States

Female college students' experiences with and perceptions of over-the-counter emergency contraception in the United States

Impact of obesity on the pharmacokinetics of levonorgestrel-based emergency contraception: single and double dosing

Emergency contraception: A multispecialty survey of clinician knowledge and practices

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