Menstruation behavior after use of emergency contraception: Ulipristal acetate versus levonorgestrel in women of reproductive age
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Introduction The goal of this study was to investigate the contribution of emergency contraception (EC) with hormonal preparations: Ulipristal acetate and progestin-only pill (levonorgestrel 1.5 mg) concerning behaviour of vaginal bleeding in the subsequent cycles after the pills administration.Keywords:
Ulipristal acetate
Levonorgestrel
Emergency Contraception
Progestin
Pill
Menstruation
Intrauterine device
Hormonal contraception
Ulipristal acetate
Emergency Contraception
Levonorgestrel
Intrauterine device
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Objectives When ulipristal acetate (UPA) was introduced into the Contraceptive and Sexual Health Services service in June 2011 an algorithm was developed to guide method selection. The aim was to encourage clinicians to assess risk and to offer a copper intrauterine device (IUD) as first-line choice with hormonal methods as second-line choice. Methods UPA was the second-line choice for presentations up to 120 hours after high-risk episodes (i.e. around the time of ovulation). Women at lower risk were also offered UPA if presentation was between 72 and 120 hours after unprotected intercourse unless the risk was very low, in which case levonorgestrel 1.5 mg was the second-line choice. Results Prior to the protocol only 49% of women were offered an IUD compared with 61.6% afterwards. This improved further in the subgroup of women at high risk where 93.3% were offered an IUD compared with 59% initially. After the introduction of UPA the percentage of women accepting the IUD fell from 30% to 14.1%. Overall 14.5% of women received UPA compared to 7.8% receiving an IUD. Conclusions Introduction of a standardised protocol for the provision of emergency contraception has significantly increased the proportion of women offered an IUD as postcoital contraception, particularly in women at high risk of conception. Introduction of UPA has seen a halving of the number of women accepting the IUD. This is cause for concern. Further investigation into the reasons behind this decrease in IUD uptake needs to be undertaken.
Emergency Contraception
Ulipristal acetate
Intrauterine device
Levonorgestrel
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Ulipristal acetate
Emergency Contraception
Levonorgestrel
Mechanism of Action
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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 that
Ulipristal acetate
Emergency Contraception
Levonorgestrel
Unintended Pregnancy
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Introduction The goal of this study was to investigate the contribution of emergency contraception (EC) with hormonal preparations: Ulipristal acetate and progestin-only pill (levonorgestrel 1.5 mg) concerning behaviour of vaginal bleeding in the subsequent cycles after the pills administration.
Ulipristal acetate
Levonorgestrel
Emergency Contraception
Progestin
Pill
Menstruation
Intrauterine device
Hormonal contraception
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Ulipristal acetate
Emergency Contraception
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Summary Emergency hormonal contraception is used to prevent unintended pregnancy postcoitally. The mechanism of action of the most frequently used hormonal preparations for emergency contraception, levonorgestrel (LNG) and ulipristal acetate (UPA), is still not fully known, but clinical trials indicate that they act by inhibiting or delaying ovulation. LNG has a long history of use for emergency contraception, proven safety and high efficacy if administered in the preovulation period. The newest emergency contraceptive, UPA, available only with a prescription, is indicated within this period of 120 hours after sexual intercourse and the data indicate that UPA does not lose efficacy within this period. Clinical trials showed its noninferiority versus LNG and its effect on the potentially occurring pregnancy is being additionally monitored. However, many misconceptions and controversial opinions about emergency contraception are still present, even among pharmacists. A search of Medline database identified 20 papers published from January 1993 to December 2012, on pharmacists’ knowledge, attitudes and practices related to emergency contraception. In these papers, the attitudes of pharmacists pertaining to the dispensing regime of emergency contraception were different. Research in Australia has shown that personal attitudes and religious convictions influence the practice of dispensing emergency contraception. In the research conducted in New Mexico, 30% of pharmacists were against prescribing emergency contraception for religious or moral reasons. There were no published data in regards to pharmacists’ knowledge, attitudes and dispensing practice in Serbia and such research is highly recommended.
Ulipristal acetate
Emergency Contraception
Levonorgestrel
Intrauterine device
Hormonal contraception
Clinical Research
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Ulipristal acetate
Emergency Contraception
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Citations (2)
Ulipristal acetate
Emergency Contraception
Levonorgestrel
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