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Interventions for emergency contraception.

Jie Shen1, Yan Che, Emily Showell

  • 1Centre for Clinical Research and Training, Key Laboratory of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, 2140 Xie Tu Road, Shanghai, China.

The Cochrane Database of Systematic Reviews
|August 3, 2017
PubMed
Summary
This summary is machine-generated.

Emergency contraception (EC) methods vary in effectiveness. Mifepristone and ulipristal acetate (UPA) generally show higher pregnancy prevention rates than levonorgestrel and the Yuzpe regimen, with fewer side effects.

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Area of Science:

  • Reproductive Health
  • Pharmacology
  • Evidence-Based Medicine

Background:

  • Emergency contraception (EC) prevents pregnancy post-unprotected intercourse using drugs or copper IUDs.
  • Comparative data on EC method effectiveness, safety, and convenience is vital for healthcare providers and patients.
  • This review updates previous analyses from 2009 and 2012.

Purpose of the Study:

  • To identify the most effective, safe, and convenient EC method for preventing pregnancy after unprotected intercourse.
  • To compare the efficacy and safety profiles of various EC interventions.

Main Methods:

  • A systematic review of randomized controlled trials (RCTs) was conducted.
  • Searches included multiple databases (CENTRAL, MEDLINE, Embase, etc.) and clinical trial registries up to February 2017.
  • Primary outcome was observed pregnancies; secondary outcomes included side effects and menstrual changes.

Main Results:

  • Levonorgestrel and mid-dose mifepristone were more effective than the Yuzpe regimen.
  • Both low- and mid-dose mifepristone were likely more effective than levonorgestrel; mid-dose mifepristone was more effective than low-dose.
  • Ulipristal acetate (UPA) was more effective than levonorgestrel. Nausea and vomiting were less common with mifepristone and levonorgestrel compared to Yuzpe. Menstrual delay was more frequent with mifepristone.
  • Copper IUDs showed no conclusive difference versus mifepristone but may increase abdominal pain risk.

Conclusions:

  • Mifepristone (especially mid-dose) and UPA demonstrate higher effectiveness in preventing pregnancy compared to levonorgestrel and Yuzpe.
  • Levonorgestrel and mifepristone are associated with fewer side effects like nausea and vomiting than the Yuzpe regimen.
  • Menstrual cycle changes, particularly delay with mifepristone, are important considerations. Copper IUDs may pose a higher risk of abdominal pain.