Abstract:
1report a randomised single-blind non-inferiority multicentre trial involving an analysis of nearly 2000 women who requested emergency contraception within 5 days of unprotected sexual intercourse. The investigators compared the effi cacy and side-eff ects of levonorgestrel, the widely marketed emergency contraceptive, and ulipristal acetate, a selective progesteronereceptor modulator, recently licensed for emergency contraception in Europe. Both treatments decreased the pregnancy rate: from an expected 5·5% to 1·8% in the ulipristal group and from 5·4% to 2·6% in the levonorgestrel group. High eff ectiveness is an important requirement for an ideal emergency contraceptive and research to improve its effi cacy is most welcome. Along with previous research, 2 today’s study shows thatKeywords:
Ulipristal acetate
Emergency Contraception
Levonorgestrel
Unintended Pregnancy
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This chapter focuses on the non-oral combined hormonal contraceptive options, including the patch and more specifically the vaginal ring, which are underused in the UK and Australia. The clinical effectiveness unit of the faculty of sexual and reproductive healthcare developed a guideline to facilitate appropriate investigation of women presenting with unscheduled bleeding. For women with breakthrough bleeding in association with the use of hormonal contraception, lasting longer than three months, it is important to view the cervix. A pelvic examination should be undertaken to exclude pelvic pathology including ovarian cysts, fibroids and gynaecological cancers. In clinical trials, most users have been satisfied with the combined hormonal ring. The greatest barrier to this method is promoting the vagina as an ideal organ in which to place hormonal contraception and this remains a challenge to all providers of contraception.
Emergency Contraception
Vaginal ring
Hormonal contraception
Guideline
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Unintended pregnancy is a global reproductive health concern. Although emergency contraception is meant to be used after an unprotected intercourse to prevent unwarranted pregnancies, available methods including levonorgestrel 1·5 mg, the currently gold standard EC regimen, is only effective if used as soon as possible after sexual intercourse and before ovulation. Ulipristal acetate (ellaOne in the European Union, ella in the U.S., HRA Pharma), a novel selective progesterone receptor modulator formulated as a 30mg emergency contraceptive tablet with similar side effect profiles as levonorgestrel can prevent pregnancy within 120 hours (5 days) after an unprotected intercourse or contraceptive failure on account of its ability to inhibit or delay ovulation. It has been shown to prevent about 60% of expected pregnancies, which is comparable to that provided by levonorgestrel. Two phase 3 prospective, multicenter controlled clinical trials have already demonstrated the safety and effectiveness of ulipristal, according to the USFDA, whose advisory committee has voted unanimously in favor of approving the new drug application in August 2010. However, the findings from a very recent randomized non-inferiority trial comparing the efficacy and safety of ulipristal acetate with levonorgestrel for emergency contraception, has been questioned by scientists and statistical consultants all around the globe based on the premature and misleading conclusions due to lack of sufficient sample size and safety data along with less accessibility and higher cost of the drug. In the light of the above perspectives, ulipristal acetate although provides women and health-care providers with an effective alternative for emergency contraception extended up to 5 days post-unprotected intercourse or contraceptive failure, further long term evidence is warranted before a change in practice should be entertained.
Ulipristal acetate
Emergency Contraception
Levonorgestrel
Regimen
Unintended Pregnancy
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Despite the widespread availability of highly effective methods of contraception, unintended pregnancy is common. Unplanned pregnancies have been linked to a range of health, social and economic consequences. Emergency contraception reduces risk of pregnancy after unprotected intercourse, and represents an opportunity to decrease number of unplanned pregnancies and abortions. Emergency contraception pills (ECP) prevent pregnancy by delaying or inhibiting ovulation, without interfering with post fertilization events. If pregnancy has already occurred, ECPs will not be effective, therefore ECPs are not abortificants. Ulipristal acetate (17alpha-acetoxy-11beta-(4N-N,N-dymethilaminophenyl)-19-norpregna--4,9-diene-3,20-dione) is the first drug that was specifically developed and licensed for use as an emergency contraceptive. It is an orally active, synthetic, selective progesterone modulator that acts by binding with high affinity to the human progesterone receptor where it has both antagonist and partial agonist effects. It is a new molecular entity and the first compound in a new pharmacological class defined by the pristal stem. Up on the superior clinical efficacy evidence, UPA has been quickly recognized as the most effective emergency contraceptive pill, and recently recommended as the first prescription choice for all women regardless of the age and timing after intercourse. This article provides literature review of UPA and its role in emergency contraception.
Ulipristal acetate
Emergency Contraception
Pill
Unintended Pregnancy
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In the U.S., medical emergency contraception usually consists of levonorgestrel within 72 hours after unprotected intercourse. The selective progestin-receptor modulator ulipristal recently was licensed in Europe for emergency contraception within 120 hours after unprotected intercourse.
To compare the efficacy of these two agents, international investigators (funded by the manufacturer …
Ulipristal acetate
Emergency Contraception
Levonorgestrel
Progestin
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Ulipristal acetate
Emergency Contraception
Levonorgestrel
Pill
Hormonal contraception
Progestin
Intrauterine device
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Emergency contraception is a therapeutic option for women after event of unprotected sexual intercourse. Available postcoital contraception methods include emergency contraceptive pills (ECPs) with and without estrogen, and copper-bearing intrauterine devices. Each method has its own efficacy, safety, and side effect profile. But emergency contraception is not a logical choice for ongoing protection and no any method of ongoing contraception is more effective than conventional contraceptive pills.
Emergency Contraception
Pill
Intrauterine device
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This is an increased window of
treatment opportunity compared to
levonorgestrel, the only other dedicated
oral emergency contraceptive, which
is registered for use within three days
(72 hours) of intercourse. Despite more
than a decade of non-prescription
availability of levonorgestrel,
emergency contraception is currently
underutilised in Australia and
elsewhere in the world
Levonorgestrel
Emergency Contraception
Ulipristal acetate
Window of opportunity
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Emergency Contraception
Ulipristal acetate
Levonorgestrel
Progestin
Contraindication
Hormonal contraception
Intrauterine device
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Atrial by the World Health Organization published in 1998 established “levonorgestrel only” as the gold standard in hormonal emergency contraception.1 Over 80 countries have now approved dedicated emergency contraception products containing progestogen only, that are often available directly from pharmacies. Innovative strategies to improve access are also proliferating, expanding the ranks of those who can supply to nurses and other health workers, and offering supplies to women in advance. More recently, a further WHO trial has encouraged new flexibility in offering emergency contraception.2 Emergency contraception with levonorgestrel can now be given as “one stat” dose. However, women who need emergency contraception also have other needs, and a holistic sexual health service is essential.
The trial compared the effectiveness of the standard two dose regimen of 0.75 mg levonorgestrel repeated after 12 hours with the effectiveness of a double dose (1.5 mg levonorgestrel) taken all at once.2 Women in a third group took low dose (10 mg) mifepristone. Women could participate if they were able to start taking emergency contraception within 120 hours of unprotected intercourse, rather than just the traditional …
Emergency Contraception
Levonorgestrel
Ulipristal acetate
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