More treatment options for women requiring emergency contraception

December 05, 2002

Results of an international study in this week's issue of THE LANCET suggest that there are three effective therapeutic options for women requiring emergency contraception after sexual intercourse.

Hormone treatment with a single 10 mg dose of mifepristone, and two 0.75 mg doses of levonorgestrel 12 hours apart are known to be effective for emergency contraception--however there is no evidence to suggest that one treatment may be better than another, or that one dose of levonorgestrel may be as effective as two separate doses.

Helena von Hertzen and colleagues from the World Health Organisation, Geneva, Switzerland, did a randomised trial in 15 family-planning clinics in 10 countries. 4136 healthy women with regular menstrual cycles who requested emergency contraception within five days of unprotected sexual intercourse were randomly assigned to one of three treatment groups: 10 mg single-dose mifepristone; 1.5 mg single-dose levonorgestrel; or two doses of 0.75 mg levonorgestrel given 12 hours apart.

There were no significant differences in pregnancy rates or side-effects between the three groups, with an average pregnancy rate of around 1.6%; most women menstruated within 2 days of the expected date, although women given levonorgestrel menstruated earlier than women given mifepristone.

Helena von Hertzen comments: "Our findings show that the levonorgestrel dose does not need to be split, but that a single dose of 1.5 mg can be used. The use of a single dose simplifies the use of levonorgestrel for emergency contraception without an increase in side-effects. Compared with mifepristone, either of the levonorgestrel regimens has the advantage of being associated with early, rather than late, menses after treatment. With early or on-time menses, women are relieved from anxiety about an unwanted pregnancy sooner, and can begin a regular and effective method of contraception more quickly than if menstruation is delayed. Evidence of higher efficacy with earlier treatment from this trial was weak, suggesting that further research is needed. Even if a declining trend in efficacy with time is verified, the regimens studied still prevent a high proportion of pregnancies even up to 5 days after intercourse."
-end-
Contact: Dr Helena von Hertzen, UNDP/UNFPA/WHO, World Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO 1211 Geneva 27 Switzerland, T) +41 22 791 3373/3462; F) +41 22 791 4171; E) vonhertzenh@who.int

Lancet

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