DOCSLIB.ORG

Review of Newer Contraceptive Agents

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Review of Newer Contraceptive Agents REVIEW MAHMOODA QURESHI, MD MARJAN ATTARAN, MD Department of General Internal Medicine, Department of Gynecology and Obstetrics, Cleveland Clinic Cleveland Clinic Review of newer contraceptive agents ABSTRACT WO THIRDS of reproductive-age women use some form of contraception, yet Advances in contraceptive technology have made birth 55% of the 6.3 million pregnancies each year control more effective, convenient, and safe. We review the in the United States are unplanned, and half newer products and some under development, including of these result in abortion. the latest oral contraceptives, injectable progesterone, Physicians should discuss contraception subdermal progestin implants, progesterone-releasing lUDs, with all sexually active patients of childbear- emergency contraception, and male contraception. ing age. Safe and effective contraceptive agents are available, but need to be adequate- KEY POINTS ly provided to at-risk populations. In this review we focus on the latest Newer oral contraceptives contain much lower doses of improvements in oral contraceptives, long- estradiol than older preparations and use newer progestins acting contraceptives such as injectable sus- with less androgenic activity. They therefore cause fewer pensions and subdermal implants, and med- side effects. icated intrauterine devices (IUDs). Advances in emergency postcoital contraception are also reviewed. Depomedroxyprogesterone acetate injections every 3 months are a good contraceptive option for women in • ORAL CONTRACEPTIVES whom compliance may be low. Oral contraceptives, the most popular method of reversible contraception in the United Progestin implants have a failure rate of 0.8 per 100 States,1 are highly effective, with a failure rate woman-years for the first 5 years of use, increasing to 2 per of 0.3 pregnancies per 100 woman-years of 100 woman-years by the 6th year. The implants should be typical use, or 0.1 per 100 woman-years of removed after 5 years. ideal use. Progesterone-releasing lUDs reduce the cramping and Mechanism of action increased menstrual bleeding that often occur with Used singly in high doses, both estrogens and nonmedicated lUDs. progestins can hinder ovulation but may cause side effects such as breakthrough bleeding, endometrial hyperplasia, acne, and weight gain. Used in combination, they act synergis- tically and suppress ovulation at much lower doses, with fewer side effects. These hormones work in several ways. Ethinyl estradiol diminishes follicle-stimulat- ing hormone (FSH) secretion, leading to impaired follicular maturation and insufficient estrogen production via the ovaries. Progestins primarily inhibit luteinizing hormone (LH) secretion and thus ovulation. In addition, progestins thicken the cervical mucus (mak- 358 CLEVELANDDownloaded CLINIC JOURNA fromL www.ccjm.orgOF MEDICINE on VOLUMSeptemberE 66 29,• NUMBE 2021. RFor 6 personalJUNE use199 only.9 All other uses require permission. ing it impermeable to sperm) and also cause TABLE 1 endometrial atrophy, thereby making implan- Progestins tation improbable. used in oral contraceptives Improvements in newer preparations First generation (no longer in use) Several refinements have made oral contra- Ethisterone ceptives much safer and better tolerated than Second generation when they were introduced in 1960, while Ethynodiol maintaining their high rate of effectiveness: Levonorgestrel Lower estrogen doses. Early oral contra- Norethindrone ceptives contained up to 150 |ig of the estro- Norethindrone acetate gen ethinyl estradiol; newer preparations con- Norgestrel tain only 20 to 50 jag. The side effects of Third generation (since 1992) estrogen increase with the dose and are less Desogestrel common with the lower-dose preparations. Gestodene (not available in the United States) On the other hand, breakthrough bleeding is Norgestimate seen more often with the low-dose prepara- tions but may also be due to missing pills or endometritis. Improved progestins. Progestins are syn- fibrinolytic enzymes, making thrombosis more thetic derivatives of testosterone, manipulated likely. The higher the dose, the greater the to be highly progestogenic and less andro- risk.5 Use of a second-generation or third-gen- genic. The progestins used in oral contracep- eration oral contraceptive is associated with 3 tives have evolved through three generations to 4 thromboembolic events per 10,000 (TABLE 1) and now have very little androgenic woman-years—more than three times the risk activity. in nonusers, but small in absolute numbers, Phasic preparations. Whereas older oral considerably less than with older agents, and contraceptives contain the same amount of half the risk in pregnant women (TABLE 2).4-6 Screening for estrogen and progestin in each tablet and are In view of this risk, oral contraceptives are factor V Leiden taken for 21 consecutive days in a 28-day still contraindicated in patients at higher risk, cycle, some newer ones are phasic—ie, they ie, those with any of the following: mutation is not vary the dose of progestin to achieve fewer • A history of thromboembolism deemed metabolic side effects. Pills that vary the estro- • Age greater than 35 and cigarette gen dose (Estrostep 21) are also available—in smoking necessary for theory, these reduce the occurrence of break- • A coagulation disorder. Of these, fac- oral through bleeding. A new formulation tor V Leiden mutation is the most common, (Mircette) containing 10 |ig of ethinyl estra- affecting 3% to 5% of the Caucasian popula- contraceptive diol during days 22 through 26 of the 28-day tion. In contrast, genetic deficiencies of pro- users pack is now available and should reduce tein C, protein S, and antithrombin III are breakthrough ovulation as well as break- rare. Factor V Leiden mutation is associated through bleeding. with an incidence of venous thromboem- bolism of about 6 events per 10,000 woman- Estrogen-related side effects years, but taking an oral contraceptive Although estrogens can cause nausea, breast increases the incidence to 29 events per tenderness, headache, decreased libido, 10,000 woman-years, suggesting that the two depression, and cyclic weight gain, their most act synergistically to promote coagulation.5 serious potential side effect is venous throm- Should all patients therefore be screened boembolism. Use of current oral contracep- for factor V Leiden mutation before starting tives is not considered a risk factor for cardio- oral contraceptives? This step is not deemed vascular disease or breast cancer.2 necessary, since the absolute risk is still very Venous thromboembolism. Estrogen small. However, patients should be asked alters the synthesis of coagulation factors and about any personal or family history of Downloaded from www.ccjm.org on SeptemberCLEVELAN 29,D CLINI 2021.C ForJOURNA personalL OF useMEDICIN only.E All otherVOLUM usesE 6require6 • NU Mpermission. BE R 6 JUNE 1999 359 CONTRACEPTIVES QURESHI AND ATTARAN TABLE 4 Moreover, recent studies have demon- Incidence of venous thromboembolism strated that the use of second-generation and with oral contraceptive use third-generation oral contraceptives does not increase the risk of stroke.10-15 Smoking POPULATION AND TYPE OF ORAL CONTRACEPTIVE INCIDENCE PER and increased age are the main determinants 10,000 WOMAN-YEARS of coronary artery disease and stroke, regard- less of oral contraceptive use. Current oral Premenopausal women not taking contraceptives do not cause hypertension, oral contraceptives 0.8 which was seen to develop in 5% of women Women taking any combined taking high-dose (> 50 pg ethinyl estradiol) oral contraceptive 3-4 agents. Second-generation progestins Breast cancer. Monophasic levonorgestrel 2.5 In theory, oral contracep- Others (not levonorgestrel) 1.8 tives could induce or help propagate estro- Third-generation progestins gen-sensitive breast cancer, although several Desogestrel + 30 pg ethinyl estradiol 4.0 large epidemiologic studies have not con- Gestodene 4.4 firmed this risk.16.17 In one of these studies,16 Pregnant women 6.0 women who were taking oral contraceptives Women with factor V Leiden mutation did seem to have a higher incidence of early- Not taking oral contraceptives 5.7 stage breast cancer, but this finding was Taking oral contraceptives 28.5 attributed to better detection and closer health surveillance of women taking oral contraceptives. Investigation in this area continues. venous thromboembolism, and those with a positive history should be considered for Progestin-related side effects screening.7 Progestin side effects such as weight gain, In 1995, epidemiologic studies reported a acne, and hirsutism are due to their andro- Taking oral higher risk of venous thromboembolism with genic properties and are far less common with contraceptives the newer third-generation oral contracep- the new progestins. In fact, some of the newer tives than with the second-generation pills are used to treat some of these conditions. has a lower pills.8-9 Subsequent studies showed that the risk of apparent increase can be explained by dis- Potential progestin side effects crepancies in age and age ranges used for Dyslipidemia. The third-generation thrombosis controls, confounding factors, greater use of oral contraceptives may have less of an than does the older drugs in low-risk pateints (ie, the adverse effect on lipid levels than older oral "healthy user" effect), and bias due to differ- contraceptives. In fact, the newer agents pregnancy ences in prescription practice and venous increased
Load more

Recommended publications
  • Njm Vol 15.4 Final Correction
    REVIEW ARTICLE Current Concepts in Contraception A. M. Abasiattai MBBCH, FWACS Department of Obstetrics/Gynaecology, University of Uyo Teaching Hospital, Uyo, Nigeria ABSTRACT Background: Worldwide, contraceptive use has expensive contraceptives that are easier to deliver and increased substantially over the past two decades. The cause fewer side effects than currently available increased demand for wider choices of contraceptive options4. This article thus focuses on recent methods has resulted in extensive research and developments of existing contraceptive methods and rigorous clinical trials. This has led to improvements on also reviews recently developed methods currently in existing contraceptive methods and also the use worldwide. development of several new, more effective and acceptable methods with fewer side effects. Thus, this HORMONAL METHODS article presents a review of existing literature on recent Combined Oral Contraceptives (COCs) developments on existing contraceptive methods. It These are tablets that contain a combination of also reviews recently developed contraceptive methods oestrogen and progestin and are taken daily. Though currently in use worldwide. they act primarily by suppressing ovulation, they also Methods: Relevant literature was reviewed using thicken cervical mucus thus making it impervious to manual library search, electronic sources such as CD- sperm and alter the uterine endometrium 5,6. They are ROMS and internet articles. safe, very effective when used consistently and Conclusion: More effective methods of contraception accurately with a failure rate of 0.1 in 100 pregnancies in which are generally safer and easier to administer are the first year of use 6. Currently, the development of low increasingly being developed. Hopefully, as they dose formulations has led to a reduction in the side increasingly become available in our environment, they effects of COCs including venous thrombosis and will lead to and increase in acceptance and use of myocardial infarction 6,7.
    [Show full text]
  • Contraception Pearls for Practice
    Contraception Pearls for Practice Academic Detailing Service Planning committee Content Experts Clinical reviewer Gillian Graves MD FRCS(C), Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Dalhousie University Drug evaluation pharmacist Pam McLean-Veysey BScPharm, Drug Evaluation Unit, Nova Scotia Health Family Physician Advisory Panel Bernie Buffett MD, Neils Harbour, Nova Scotia Ken Cameron BSc MD CCFP, Dartmouth, Nova Scotia Norah Mogan MD CCFP, Liverpool, Nova Scotia Dalhousie CPD Bronwen Jones MD CCFP – Family Physician, Director Evidence-based Programs in CPD, Associate Professor, Faculty of Medicine, Dalhousie University Michael Allen MD MSc – Family Physician, Professor, Post-retirement Appointment, Consultant Michael Fleming MD CCFP FCFP – Family Physician, Director Family Physician Programs in CPD Academic Detailers Isobel Fleming BScPharm ACPR, Director of Academic Detailing Service Lillian Berry BScPharm Julia Green-Clements BScPharm Kelley LeBlanc BScPharm Gabrielle Richard-McGibney BScPharm, BCPS, PharmD Cathy Ross RN BScNursing Thanks to Katie McLean, Librarian Educator, NSHA Central Zone for her help with literature searching. Cover artwork generated with Tagxedo.com Disclosure statements The Academic Detailing Service is operated by Dalhousie Continuing Professional Development, Faculty of Medicine and funded by the Nova Scotia Department of Health and Wellness. Dalhousie University Office of Continuing Professional Development has full control over content. Dr Bronwen Jones receives funding for her Academic Detailing work from the Nova Scotia Department of Health and Wellness. Dr Michael Allen has received funding from the Nova Scotia Department of Health and Wellness for research projects and to develop CME programs. Dr Gillian Graves has received funding for presentations from Actavis (Fibristal®) and is on the board of AbbVie (for Lupron®).
    [Show full text]
  • Recommendations for Contraceptive Use, 2013 Adapted from the World Health Organization Selected Practice Recommendations for Contraceptive Use, 2Nd Edition
    Morbidity and Mortality Weekly Report Early Release / Vol. 62 June 14, 2013 U.S. Selected Practice Recommendations for Contraceptive Use, 2013 Adapted from the World Health Organization Selected Practice Recommendations for Contraceptive Use, 2nd Edition Continuing Education Examination available at http://www.cdc.gov/mmwr/cme/conted.html. U.S. Department of Health and Human Services Centers for Disease Control and Prevention Early Release CONTENTS CONTENTS (Continued) Introduction ............................................................................................................1 Appendix A: Summary Chart of U.S. Medical Eligibility Criteria for Methods ....................................................................................................................2 Contraceptive Use, 2010 .................................................................................. 47 How To Use This Document ...............................................................................3 Appendix B: When To Start Using Specific Contraceptive Summary of Changes from WHO SPR ............................................................4 Methods .............................................................................................................. 55 Contraceptive Method Choice .........................................................................4 Appendix C: Examinations and Tests Needed Before Initiation of Maintaining Updated Guidance ......................................................................4 Contraceptive Methods
    [Show full text]
  • Página 1 De 8 Uptodate®: 'Emergency Contraception'
    UpToDate®: 'Emergency contraception' Página 1 de 8 ® ©2005 UpToDate Emergency contraception Mimi Zieman, MD Robert L Barbieri, MD UpToDate performs a continuous review of over 330 journals and other resources. Updates are added as important new information is published. The literature review for version 13.2 is current through April 2005; this topic was last changed on April 25, 2005. The next version of UpToDate (13.3) will be released in October 2005. INTRODUCTION — Emergency contraception (also known as postcoital contraception) typically refers to the administration of drugs to prevent pregnancy in women who have had recent unprotected intercourse (including sexual assault), or to those who have had a failure of another method of contraception (eg, broken condom) (show table 1). Advisory committees to the United States Food and Drug Administration (FDA) have recommended that emergency contraception (Plan B, levonorgestrel only) be made available without prescription, as in many other countries [1]. Arguments for this approach are that women will have easier access to treatment; thus, they will be more likely to use it and can begin treatment sooner when it is most effective [2,3]. This should reduce the number of unplanned pregnancies and pregnancy terminations (see "Advance planning" below). The major argument against over-the-counter status is that the opportunity for evaluation and counseling by a health care provider is lost. An office encounter could be used to determine whether nonconsensual sex occurred and discuss risk and prevention of sexually transmitted infections, use of regular contraception, and prepregnancy issues. However, studies have shown that most women are able to use emergency contraception appropriately without formal evaluation and counseling by a health care provider [4].
    [Show full text]
  • Managing Adverse Effects of Hormonal Contraceptives NANCY GROSSMAN BARR, MD, David Geffen School of Medicine at the University of California, Los Angeles, California
    Managing Adverse Effects of Hormonal Contraceptives NANCY GROSSMAN BARR, MD, David Geffen School of Medicine at the University of California, Los Angeles, California Adverse effects of hormonal contraceptives usually diminish with continued use of the same method. Often, physi- cians only need to reassure patients that these symptoms will likely resolve within three to five months. Long-acting injectable depot medroxyprogesterone acetate is the only hormonal contraceptive that is consistently associated with weight gain; other hormonal methods are unlikely to increase weight independent of lifestyle choices. Switching com- bined oral contraceptives is not effective in treating headaches, nor is the use of multivitamins or diuretics. There are no significant differences among various combined oral contraceptives in terms of breast tenderness, mood changes, and nausea. Breakthrough bleeding is common in the first months of combined oral contraceptive use. If significant abnormal bleeding persists beyond three months, other methods can be considered, and the patient may need to be evaluated for other causes. Studies of adverse sexual effects in women using hormonal contraceptives are inconsistent, and the pharmacologic basis for these symptoms is unclear. If acne develops or worsens with progestin-only contra- ceptives, the patient should be switched to a combination method if she is medically eligible. There is insufficient evidence of any effect of hormonal contraceptives on breast milk quantity and quality. Patient education should be
    [Show full text]
  • FPP 44-48 Ellertson
    ARTICLES History and Efficacy of Emergency Contraception: Beyond Coca-Cola By Charlotte Ellertson s affirmed at the 1994 International the Netherlands applied the veterinary take a tablet as soon as possible within three Conference on Population and practice of postcoital estrogen adminis- hours after intercourse and could use the Development in Cairo, women tration to a 13-year-old girl who had been method as often as necessary; some con- A 3 6 have the right to control the number and raped at midcycle. tinued to use this method for two years. timing of their pregnancies. To realize this At around the same time, U.S. re- The results showed that the lower doses right, women throughout the world need searchers were investigating the efficacy were not efficacious and caused some men- access to a broad range of contraceptives, of high-dose estrogens, and toward the strual disruption, chiefly a shortening of the as well as to safe abortion services. While end of the decade, these preparations be- cycle. This experiment marked the first most contraceptives are intended for use came the standard. Women typically re- major venture into ongoing postcoital con- before or during intercourse, some meth- ceived either conjugated estrogens, the traception and laid the groundwork for the ods can be used within a short time after steroidal estrogen ethinyl estradiol or the levonorgestrel methods that have become unprotected intercourse. Rumored folk nonsteroidal estrogen diethylstilbestrol available in many developing countries methods such as postcoital douching with (DES). Today, in places where high-dose and in Eastern Europe. Coca-Cola are of dubious efficacy, but for- estrogens are still used, they are adminis- The late 1970s were to offer the chief tunately are not a woman’s only alterna- tered in the so-called 5x5 regimen: 5 mg nonhormonal method available today, the tive.
    [Show full text]
  • Emergency Contraceptive Pills ??? a Review
    International Journal of Pharmacy Teaching & Practices 2011, Vol.2, Issue 1, 27- 33 Emergency Contraceptive Pills – A Review Gajanan S Sanap*, Sachin S Laddha, Antariksha Singh Ideal College of Pharmacy and Research, Bhal, Kalyan, India from ECPs because of the increased prevalence of first- Research Article time sexual intercourse, and unreliable or inconsistent primary contraceptive use in this population. Proportion Please cite this paper as: Gajanan S Sanap, Sachin S Laddha, of such unwanted pregnancies is subsequently high in Antariksha Singh. Emergency Contraceptive Pills – A Review. South Asian countries. In India, although the Family IJPTP, 2011, 2 (1), 27-33. Welfare Program has made commendable success in Corresponding Author: helping couples to achieve their desired family size, unplanned pregnancy continues to be a concern. Women Gajanan Suryabhan Sanap in India, regardless of their age, will no longer need a Assistant professor, Department of Pharmaceutics, doctor's prescription to purchase emergency Ideal College of Pharmacy and Research, contraceptive pills. Health ministry has decided to make Adarsh Vidya Nagari, Via Kalyan Rly. Station, Malang Road, the pill an over-the-counter drug. This decision has been At-Bhal, Post: Dwarli, Dist: Thane (MS) 421301, India. taken to counter and avoid unwanted pregnancies and Mobile: +919960532135; +919930297070 Fax: +91251-2362525, E-mail: [email protected] unsafe abortions. In India, a baby is born every 1.25 seconds. Couple Abstract protection rate is still only 41%. Seventy-eight percent of the pregnancies in India are unplanned and at least 25% Objective: This article provides an overview of the clinical are unwanted. Every year 11 million abortions take place management of emergency contraceptive pills (ECPs).
    [Show full text]
  • Comparison of Yuzpe Regimen, Danazol, and Mifepristone
    mediated immune function in elderly long-stay patients: a randomised University of Manchester, controlled trial. Age Ageing 1991;20:169-74. Department of Obstetrics 13 Goode HF, Kelleher J, Walker BE, Hall RI, Guillou PJ. Cellular and muscle and Gynaecology, Palatine zinc to surgical patients with and without gastrointestinal cancer. Clin Sci Centre, Manchester 1990;79:247-52. 14 Goode HF, Kelleher J, Walker BE. Zinc concentrations in pure populations of M20 9LJ peripheral blood neutrophils, lymphocytes and monocytes. Ann Clin Anne M C Webb, clinical Biochemn 1989;26:89-95. researchfellow 15 Catignami GL, Bieri JG. Simultaneous determination of retinol and (t- BMJ: first published as 10.1136/bmj.305.6859.927 on 17 October 1992. Downloaded from tocopherol in serum or plasma by liquid chromatography. Clin Chemn 1983;29:708-12. Department of Medical 16 Denson KW, Bowers EF. The determination of ascorbic acid in white blood Statistics, University cells. Clin Sci 1961;21:157-62. Hospital of South Manchester, Manchester M20 8LR Jean17 MorganRussell,AG,medicalKelleher J, Walker BE, Losowsky MS, Droller H, Middleton statisticianRSW. A nutritional survey in the elderly: blood and urine vitamin levels. IntJ7 Vitam Nuir Res 1975;45:448-62. 18 Brown KM, Seabrook NA. Nutritional influences on recovery and length of Departmenthospital stayof Obstetricsin elderly women following femoral fracture [abstract]. Proc and Gynaecology,Nutr Soc (in press). University19 Schorah CJ,HospitalHabibzadehofN, Hancock M, King RFGJ. Changes in plasma and buffy layer vitamin C concentrations following major surgery: what do they Southreflect?Manchester,Ann Clin Biochem 1986;23:566-70. Manchester20 Taylor rv,M20Rimmer8LRS, Day B, Butcher J, Dymock IW.
    [Show full text]
  • Contraception
    Contraception Xandie Gold, MD Objectives • Review Different Methods of Contraception • Review the advantages and disadvantages of each method • Choose appropriate contraception based on different clinical situations • Review how to prescribe contraceptives Unintended Pregnancies • 49% of pregnancies in US are unintended • Rates: 82% in teenagers and 38% in perimenopausal women • Half of unintended pregnancies end in terminations Contraceptives • Hormonal Contraceptives: – oral, transdermal, intravaginal, IM, implanted • Barrier Devices – Diaphragm – Condoms: male and female – Cervical Caps Contraceptives • Surgical: – Tubal Ligation, Vasectomy • Intrauterine Devices: – IUDs: copper or progesterone releasing Oral Contraceptives • Introduced in early 1960s • Most widely used form of reversible birth control • Have contraceptive and noncontraceptive benefits • Estrogen + progestin combination or progestin alone Combination Pills • Synthetic estrogens – Ethinyl estradiol – Mestranol • Synthetic progestins – Many different progestins available Estrogen Component • Ethinyl estradiol doses range from 20 -150 mcg – Doses > 50mcg no longer available in US – Low dose estrogen (35 mcg or less) recommended as initial treatment • Higher doses increase incidence of VTE • Lower doses may result in significant breakthrough bleeding or spotting • 20 mcg dose helpful in premenopausal women or those with significant estrogen side effects – 50mcg dose needed in women on certain anticonvulsants – Ex: Genora 1/50; Nelova 1/50, Ortho-Novum 1/50, Demulen 1/50
    [Show full text]
  • Reproductive Health Research At
    ReproductiveReproductive healthhealth researchresearch atat WHOWHO PaulPaul F.A.F.A. VanVan Look,Look, MDMD PhDPhD FRCOGFRCOG DepartmentDepartment ofof ReproductiveReproductive HealthHealth andand ResearchResearch WorldWorld HealthHealth OrganizationOrganization Geneva,Geneva, 2121 SeptemberSeptember 20012001 Department of reproductive health and research Département santé et recherche génésiques PVL_HUG_STUDS_SEP01/1 “Health“Health isis aa statestate ofof completecomplete physical,physical, mentalmental andand socialsocial well-well- beingbeing andand notnot merelymerely thethe absenceabsence ofof diseasedisease oror infirmity.”infirmity.” 77 AprilApril 19481948 Department of reproductive health and research Département santé et recherche génésiques PVL_HUG_STUDS_SEP01/2 WorldWorld HealthHealth OrganizationOrganization 191 Member States (as of September 2001) Department of reproductive health and research Département santé et recherche génésiques PVL_HUG_STUDS_SEP01/3 MissionMission ““TheThe objectiveobjective ofof thethe WorldWorld HealthHealth OrganizationOrganization shallshall bebe thethe attainmentattainment byby allall peoplespeoples ofof thethe highesthighest possiblepossible levellevel ofof health.”health.” (WHO(WHO Constitution,Constitution, ArticleArticle 1)1) Department of reproductive health and research Département santé et recherche génésiques PVL_HUG_STUDS_SEP01/4 FunctionsFunctions ““InIn orderorder toto achieveachieve itsits objective,objective, thethe functionsfunctions ofof thethe OrganizationOrganization shallshall
    [Show full text]
  • Emergency Contraception DAVID G
    Emergency Contraception DAVID G. WEISMILLER, M.D., SC.M. Brody School of Medicine at East Carolina University, Greenville, North Carolina Women can use emergency contraception to prevent pregnancy after known or suspected failure of birth control or after unprotected intercourse. Many patients do not ask for emergency contraception because they do not know of its availability. Emergency contraception has been an off-label use of oral contraceptive pills since the 1960s. Dedicated products, the Yuzpe regimen (Preven) and levonorgestrel (Plan B), were marketed in the United States after 1998 but had been available in Europe for years before that. A third approved method of emergency contracep- tion is the insertion of an intrauterine device. Emergency contraception is about 75 to 85 percent effective. It is most effective when initiated within 72 hours after unprotected intercourse. The mechanism of action may vary, depending on the day of the menstrual cycle on which treatment is started. Despite the large number of women who have received emergency contraception, there have been no reports of major adverse outcomes. If a woman becomes pregnant after using emergency contraception, she may be reassured about the lack of negative effects emergency contraception has on fetal development. It may be beneficial for physicians to offer an advance prescription for emergency contraception at a patient’s regular gyneco- logic visit to help reduce unwanted pregnancies. Advance provision of emergency contraception can increase its use significantly without adversely affecting the use of routine contraception. (Am Fam Physician 2004;70:707-14,717-8. Copyright© 2004 American Academy of Family Physicians.) � See editorial on page mergency contraception, some- emergency contraception,7 supports esti- 655.
    [Show full text]
  • Selected Practice Recommendations for Contraceptive Use Third Edition 2016 WHO Library Cataloguing-In-Publication Data
    World Health Organization Department of Reproductive Health and Research Selected practice recommendations for contraceptive use Third edition 2016 WHO Library Cataloguing-in-Publication Data Selected practice recommendations for contraceptive use – 3rd ed. 1.Contraception – methods. 2.Contraceptive Agents, Female. 3.Contraceptives, Oral, Combined. 4.Intrauterine Devices. 5.Natural Family Planning Methods. 6.Vasectomy. 7.Practice Guideline. I.World Health Organization. ISBN 978 92 4 156540 0 (NLM classification: WP 630) © World Health Organization 2016 All rights reserved. Publications of the World Health Organization are available on the WHO website (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for non-commercial distribution– should be addressed to WHO Press through the WHO website (http://www.who.int/about/licensing/copyright_form). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned.
    [Show full text]