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Hormonal postcoital contraception.

Wide availability of hormonal postcoital contraception (HPC) is likely to reduce the incidence of unplanned pregnancies. The two most common indications for HPC are unprotected intercourse and 'condom accidents'. The combined estrogen/progestogen HPC described by Yuzpe is the most widely used method. It is given within 72 h of unprotected intercourse. The efficacy of combined HPC is high. The crude failure rate is 1-5 per 100 woman-months while the true reduction in pregnancy risk is over 75%. Efficacy is not influenced by the exposure-treatment interval within the 72-h 'window'. The mechanisms of action is multifocal and depends on the cycle phase at which treatment is instituted. Data are presented suggesting a consistent endometrial effect. None of the side-effects of HPC are serious. When HPC fails, there is so far no evidence of an adverse effect of the treatment on the outcome of pregnancy. Counselling should include all the above together with discussion of possible side-effects such as nausea and vomiting. The clinician should ensure that the woman uses an effective contraceptive thereafter. There is renewed interest in progestogen-only postcoital contraception. Varying doses of levonorgestrel have been used. The efficacy of some regimens is similar to that of the combined HPC. Danazol has not proved to be as effective. Antiprogestins hold the greatest promise of emergency contraception with high efficacy and low side-effects.

Condoms↗

[Extrauterine pregnancy after hormonal postcoital contraception].

Postcoital contraception with estrogen-gestagen-combinations is a highly effective emergency measure in cases of unprotected sexual intercourse at midcycle. Pregnancies after hormonal postcoital contraception are rare and ectopic pregnancies are said to be an extreme rarity. At the Department of Obstetrics and Gynecology of the Philipps-University Marburg we could observe two women with ectopic pregnancies after administration of a ethinyestradiol-levonorgestrel combination (Tetragynon, Schering, Berlin). Both patients were operated by pelviscopy. We could not found a clear causal relationship between the administration of hormonal postcoital contraception and ectopic pregnancies, because both women had intrauterine operations in her history and therefore a certain level of tubal damage could not ruled out. Nevertheless, in cases of hormonal postcoital contraception a follow-up check after 3 weeks should be done and it should be kept in mind that ectopic pregnancies may occur, especially in patients with risk factors.

Adult↗

Hormonal postcoital contraception with an ethinylestradiol-norgestrel combination and two danazol regimens.

The ethinylestradiol-norgestrel combination (EE-NG) for postcoital contraception, as described by Yuzpe, has been shown to be an effective method but with frequent side effects. To overcome the problem of adverse effects a new approach using danazol was proposed, but the efficacy and acceptability of this treatment have not yet been tested in large studies. In a 5-year period at the AIECS Family Planning Centre in Milan we treated 2448 women requesting postcoital contraception using Yuzpe's regimen and two danazol regimens (800 mg/1200 mg). The patients' acceptability for danazol treatment was higher than for Yuzpe's regimen due to fewer, milder and shorter side effects. Nine pregnancies occurred in the EE-NG group (2.21%), 17 in the 800 mg group (1.71%) and 6 in the 1200 mg group (0.82%). Our study shows a statistically significant efficacy against expected pregnancy rates both with Yuzpe's regimen and with danazol. The 1200 mg danazol treatment seems to be more effective and can be considered a valid alternative to the EE-NG combination for hormonal postcoital contraception.

Adolescent↗

[Postcoital hormonal contraception: study on the attitudes and prescription of primary care physicians].

OBJECTIVE: To study the understanding, attitudes and practice of primary care doctors in the prescription of hormonal post-coitus interception, along with the social and demographic, educational, legal and ethical variables associated with this prescription. DESIGN: Cross-sectional descriptive study. SETTING: Area IV de INSALUD in Asturias. PARTICIPANTS: Family doctors, excluding locums (n = 178). MEASUREMENTS AND RESULTS: An anonymous self-administered questionnaire with 33 questions, re-sent once, between November 1999 and February 2000. The association-independence of variables was contrasted through the chi 2 test (a statistically significant association if p < 0.05). 77% responded, 51% of whom were men. Average age was 43 (SD = 6.69), with professional experience of 17 years worked (SD = 6.87). 47% were family doctors and 39% general practitioners. 85% worked in health centres; 46% in urban settings. 71% were catholics, 73% (95% CI: 66%-80%) had been asked on at least one occasion in the previous six months for the post-coitus pill (PCP), with demand greater in the urban environment (83%). 18% considered the PCP an abortion method. 88% said they would prescribe it (95% CI: 82.5%-93.5%), of which 30% (95% CI: 16%-44%) did so according to WHO recommendations. 100% of the "non-prescribers" were catholics. CONCLUSIONS: Most doctors receive requests for the PCP and prescribe it on demand, though prescription varies with age, categories and, in particular, religious belief. Only a third prescribes according to WHO recommendations.

Adult↗

Safety and effectiveness of hormonal postcoital contraception: a prospective study.

OBJECTIVE: The aim of this study was to evaluate the demographic characteristics of the population attending our hospital requesting postcoital contraception and to determine the effectiveness of the method and its side-effects. METHODS: A total of 503 women asking for postcoital contraception were included in a prospective open trial. After filling in a questionnaire dealing with demographic and contraceptive data, we prescribed an ethinylestradiol-levonorgestrel combination (100 micrograms/500 mg for two doses 12 h apart). RESULTS: Only 487 women were available for analysis of demographic data. A further 77 were excluded because they presented irregular menstrual cycles and 55 cases were lost for follow-up. Mean age was 22.6 +/- 5.25 years and 35.9% of cases came to the center within the first 5 h after unprotected intercourse. Only 18.8% had previously asked for postcoital contraception. Breakage of condom was the most common reason for request (81.9%). Two pregnancies occurred in the remaining 355 women. According to Dixon's method 15.5 pregnancies should be expected being the overall efficacy of 87.14%. There were no serious adverse effects. Nausea and vomiting (16.33%) were the most prevalent and 59% of the users menstruated at the expected time whilst menses were delayed in 6% of the cases. CONCLUSION: The combination of ethinylestradiol and levonorgestrel in low doses is an effective and safe method of postcoital contraception.

Adolescent↗

[Postcoital contraception with steroid hormones].

Large doses of estrogens employed for postcoital contraception have definitely been shown to be effective, but estrogens used in such high doses would result in a high incidence of side-effects. Therefore this method should be reserved for the occasional emergency. Postcoital estrogen-progestogen-combination is suitable for women exposed to an isolated act of intercourse in midcycle. The advantage of this method is the possibility of a delayed administration after intercourse. Progestogens alone can be used after each coital exposure. One of the most frequent problems is the alteration of the menstrual pattern. Continued use can be recommended for women with occasional intercourse in cycle. Possible mechanisms of action of steroidal postcoital contraceptives are discussed involving problems of this contraceptive method.

Contraceptives, Oral, Combined↗

Ethinyl oestradiol and D-norgestrel is an effective emergency postcoital contraceptive: a report of its use in 1,200 patients in a family planning clinic.

We describe a prospective study of 1,200 patients using the Yuzpe regimen of hormonal postcoital contraception. There was an 85% follow-up rate, and of the 1,015 patients followed there were 13 pregnancies, giving a pregnancy rate of 1.3%. The number of expected pregnancies at mid-cycle was reduced by 83%; 12 of the 13 pregnancies went on to abortion. The patients were young: 86% were under 25, and 10% were under 15. The most frequent reason for presentation was that no contraception had been used (57%). All patients received an antiemetic; 57% experienced no side-effects, 28% had some nausea and 9.6% some vomiting. It is concluded that this is a safe form of emergency contraception, which is an effective way of reducing the number of unwanted pregnancies, especially in the very young.

Adolescent↗

Inhibition of luteal phase progesterone levels in the rhesus monkey by epostane.

This study examined the effect of epostane, a new antifertility drug, on normal and hCG-stimulated progesterone production during the luteal phase of the menstrual cycle in rhesus monkeys. When administered once each day for five days, epostane inhibited normal luteal phase progesterone levels in a dose-related fashion. Epostane also reduced the elevated luteal phase progesterone levels of animals treated with hCG indicating that the drug acts directly on the corpus luteum. These data suggest that epostane interferes with corpus luteum function in a primate and that the drug would be effective as an interceptive agent during early pregnancy.

3-Hydroxysteroid Dehydrogenases↗