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Quick starting hormonal contraception after using oral emergency contraception: a systematic review
Lauren Ee Murphy1,2, Zhong E Chen3, Valerie Warner3
1Department of Reproductive and Developmental Sciences, University of Edinburgh, Edinburgh, UK.
Summary
Quick starting hormonal contraception after emergency contraception is safe and effective. This practice improves contraceptive adherence without compromising efficacy or increasing side effects, ensuring continuous pregnancy prevention.
Area of Science:
- Reproductive Health
- Contraception
- Pharmacology
Background:
- Unprotected intercourse post-emergency contraception (EC) elevates pregnancy risk, highlighting the need for immediate, effective ongoing contraception ('quick starting').
- Theoretical concerns exist regarding potential adverse interactions between quick starting hormonal contraception (HC) and EC, or within HC regimens themselves.
Purpose of the Study:
- To systematically review the safety and efficacy of quick starting hormonal contraception (HC) after oral emergency contraception (EC).
- To evaluate potential interactions between EC (levonorgestrel or ulipristal acetate) and concurrently initiated HC.
Main Methods:
- A systematic review of randomized controlled trials was conducted.
- Searches included major databases (PubMed, EMBASE, Cochrane) and clinical trial registries up to February 2016.
- Meta-analysis was not possible due to a lack of comparable studies.
Main Results:
- Two studies indicated that quick starting combined oral contraception (COC) after ulipristal acetate (UPA) did not affect ovarian quiescence or cervical mucus impenetrability.
- Quick starting progestogen-only pills (POP) after UPA reduced UPA's ability to delay ovulation.
- No significant differences in side effects or unscheduled bleeding were observed when quick starting COC after UPA.
- Quick starting POP after levonorgestrel (LNG) was associated with higher self-reported contraceptive use at 8 weeks.
Conclusions:
- Quick starting hormonal contraception after ulipristal acetate emergency contraception appears safe regarding ovarian function and cervical mucus, though ovulation delay may be reduced with POPs.
- Quick starting hormonal contraception after levonorgestrel emergency contraception may improve contraceptive adherence.
- Further research is needed to fully elucidate interactions and optimize quick starting protocols.
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