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Double Dosing Levonorgestrel-Based Emergency Contraception for Individuals With Obesity: A Randomized Controlled

Alison B Edelman1, Jon D Hennebold, Kise Bond

  • 1Department of Obstetrics & Gynecology and the Biostatistics Shared Resource, Knight Cancer Institute, Oregon Health & Science University, Portland, and the Division of Reproductive & Developmental Sciences, Oregon Primate National Research Center, Beaverton, Oregon; Clinical Pharmacology, Gilead Sciences, Foster City, California; and the Clinical Research Center, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia.

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Doubling the dose of levonorgestrel emergency contraception did not improve outcomes in individuals with obesity. This study found no significant difference in preventing follicle rupture between standard and double doses.

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Area of Science:

  • Reproductive Health
  • Pharmacology
  • Obesity Medicine

Background:

  • Individuals with obesity and higher body mass index (BMI) face increased risks of emergency contraception failure with levonorgestrel (LNG).
  • Altered pharmacokinetic profiles in individuals with obesity may affect LNG efficacy.

Purpose of the Study:

  • To evaluate if escalating the dose of levonorgestrel (LNG) emergency contraception improves pharmacodynamic outcomes in individuals with obesity.
  • To determine if a doubled dose of LNG is more effective in preventing ovulation or delaying follicle rupture in this population.

Main Methods:

  • A randomized pharmacodynamic study enrolled healthy, reproductive-age individuals with BMI > 30 and weight ≥ 176 lbs.
  • Participants received either 1.5 mg or 3 mg (double dose) of oral LNG emergency contraception after ovulation confirmation.
  • Daily monitoring via transvaginal ultrasonography and blood sampling tracked hormonal changes and follicle development for up to 7 days post-dosing.

Main Results:

  • No significant difference was observed in the proportion of participants without follicle rupture more than 5 days post-dosing between the 1.5 mg (51.4%) and 3 mg (68.6%) LNG groups (P=.14).
  • The time to follicle rupture did not differ between the groups for those experiencing rupture before 5 days.

Conclusions:

  • A simple strategy of doubling the levonorgestrel dose does not appear to be an effective intervention to improve emergency contraception outcomes in individuals with obesity.
  • Further research may be needed to explore alternative strategies for effective emergency contraception in this demographic.