The traditional Yuzpe system of em...

The traditional Yuzpe system of emergency contraception (two doses of 01-mg ethinyl estradiol and 05-mg levonorgestrel, taken 12 hours apart) is being replaced through more effective treatments with fewer side validitys The two principal newer regimens are based onward levonorgestrel (two doses of 075 mg administered 12 hours apart) or up to 600 mg of mifepristone in a single dose. A single dose of 10-mg mifepristone has been shown to be as effective as larger doses however with fewer side effects, leading to speculation that levonorgestrel could also be effective in a single dose. Von Hertzen and colleagues deportment ed a large international clinical trial to compare a single dose of 10-mg mifepristone, a single dose of 15-mg levonorgestrel, and pair doses of 0.75-mg levonorgestrel for juncture contraception.

Women requesting pinch contraception within 120 hours of unprotect intercourse at 15 family planning clinics in 10 countries were eligible for the subject of attention if they had regular menstrual revolution of times and agreed to refrain from unprotect sex for the remainder of their generally received menstrual cycle. After results from a human chorionic gonadotropin pregnancy criterion were determined to be negative, the women were randomly assigned to single of the three treatment clusters All women took two treatments and the same number of pills with placebos to make secure that the same regimen was followed at all participants. The women kept daily diaries of side weights and were reassessed one week after the date of the nearest anticipated menses. If menstruation had not occurr a pregnancy ordeal was performed. If pregnancy was suspected, the gestation was estimated by way of ultrasonography.

More than 1300 women complet the cogitation in each of the treatment clumps In each group, about 20 women were thrown away to follow-up or had unprotect sex during the reflection The three groups were comparable; the mean age of the women was 27 years; more than single in kind half had previously been pregnant; about single half had not used any contraception; and 44 percent reported failure of a condom. Overall, 65 pregnancies were diagnosed following treatment. The pregnancy rates were not statistically different between the three treatment clusters (see the accompanying table).

The treatments precludeed 77 to 82 percent of anticipated pregnancies. Women treated more than 72 hours after intercourse had higher pregnancy rates (24 percent) than those treated earlier (15 percent) moreover the difference was not statistically significant. The mostly common side effects were bleeding (19 to 31 percent) nausea (14 to 15 percent) fatigue (13 to 15 percent) lower abdominal pain (14 to 15 percent) and headache (10 percent) Bleeding was more used by all in women taking levonorgestrel, and delay of menstruation was more habitual in those taking mifepristone, if it be not that otherwise the treatment groups were comparable in side effects

The authors decide that all three regimens effectively stop a high proportion of pregnancies if they are taken within five days of unprotect intercourse. The use of single-dose regimens with subdued side effect profiles is look fored to increase acceptability and succes rates of crisis contraception.

ANNE D WALLING, MD

von Hertzen H et al. soft dose mifepristone and two regimens of levonorgestrel for pinch contraception: a WHO multicentre randomised trial. Lancet December 7 2002;360:1803-10

EDITOR'S NOTE: The topic of pinch contraception is fraught with medical, ethical, and personal difficulties. more [i]or[/i] less physicians and patients believe the proces hangs on preventing implantation and is thus unacceptable because it is equivalent to abortion. Others point to the ne for strategies to manage human or technical failure of contraception. This application of mind demonstrates that pregnancy can be obstructed safely using a single treatment of at least brace commonly available agents with an acceptable side tenor profile. How shall we use this knowledge? The obvious consequence could be fewer induced abortions if women felt confident to petition the treatment soon after lapses of taste or contraceptive technique. The nightmare would be the repeated use of this technique to substitute for responsible contraception. Is it old-fashioned to believe that each child should be conceived as a deliberate choice by means of loving parents who are in an enduring relationship?--A.D.W.

COPYRIGHT 2003 American Academy of Family Physicians

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