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Latebreakers

Breast cancer risk when there is a family history

Body weight link to breast and endometrial cancers (and 11 others)

Family Planning in 2017 and Beyond

Make Me Cry: Depression Link (Again)?

Managing implant users’ bleeding and spotting

Zika: Updated guidance for providers

Pharmacist-prescribed contraceptives

Hot off the press! 2016 MEC and SPR

Zika virus fears prompt increased request for abortion in nations outlawing abortions

Opioid use epidemic among reproductive-age women

Good news on the family planning home front!

War Against Planned Parenthood Hurts Women

Win-win for both treatment and prevention

Center of the Storm

Ambivalence

Menopause, mood, mental acuity, and hormone therapy

Emergency contraception for teens

Postpartum Contraception: Now, Not Later

Reproductive tract infections, sexually transmitted infections, or sexually transmitted diseases: “a rose by any other name…”

Are we practicing what we preach?

Be alert to VTE in hormonal contraceptive users

LARC among teens increased 15-fold, but not enough

Brain cancer and hormonal contraception

Free tools: Easy access to the US Medical Eligibility Criteria for Contraceptive Use

Alcohol consumption when pregnancy is unwanted or unintended

Latest Data on Contraceptive Use in the United States

LateBreaker sampler from Contraceptive Technology conference

Emergency Contraceptive Pill Efficacy and BMI/Body Weight

Handout on Unintended Pregnancy and Contraceptive Choice

Ask About Withdrawal (Really!)

Rules to Practice By: Safety First and Cleanliness is Close to. . .

What’s Vanity Fair Got Against the NuvaRing?

Promising New Treatment for Hepatitis C

Numbers matter, so make them simple for patients

The Recession’s Effect on Unintended Pregnancies

Lessons Learned from the Contraceptive CHOICE Project: The Hull LARC Initiative

Applying the “New” Cervical Cytology Guidelines in Your Practice

Acute Excessive Uterine Bleeding: New Management Strategies

Medical indications for IUD use in teens

Whatever happened to PID?

Update on Emergency Contraception

Contraceptivetechnology.com New and Improved

Emergency Contraceptive Pill Efficacy and BMI/Body Weight
November 2014

 

Analysis of data from the two randomized trials of the ulipristal acetate (UPA) and levonorgestrel (LNg) regimens[1], 2] found that when compared with women who were not obese, obese women taking LNg had a significantly higher risk of pregnancy whereas women taking UPA did not. LNg showed a rapid decrease of efficacy with increasing body mass index (BMI), reaching the point where it appeared no different from pregnancy rates expected among women not using EC at a BMI of 26 compared with a BMI of 35 for UPA.[3] The manufacturer of NorLevo (a 1.5 mg LNg) requested a change to the product label to reflect the findings from further analyses of these data. In November 2013, European regulatory authorities approved a label change to include the following: “In clinical trials, contraceptive efficacy was reduced in women weighing 75 kg or more and levonorgestrel was not effective in women who weighed more than 80 kg [176 lbs].”[4] However, the European Medicines Agency, after reviewing additional data from three WHO trials[5],[6],[7] that did not find reduced efficacy with increasing weight or BMI, removed that statement from the Norlevo label in July 2014.[8] These trials were not specifically designed to study the relationship between efficacy and weight, and ascertainment of both weight and pregnancy were based on self-report in some of the studies. The effect of weight on the efficacy of combined emergency contraceptive pills (ECPs) has not been studied.

There is no conclusive answer about the precise relationship between the efficacy of EC and body weight, although the evidence suggests that it would be prudent to counsel patients at higher weights to use a copper IUD or UPA for EC. These methods are more effective than LNG for all women, but may in particular have additional benefit for women at higher body weights. There are obstacles to getting a prompt IUD insertion (including cost for uninsured women and service delivery issues such as clinic flow and two-visit protocols) and to getting UPA (such as the need for a prescription and the product frequently being out of stock). There is no health risk to taking LNG, so a heavier woman who does not have access to, or who does not want, an IUD or UPA for EC should still consider using LNG if she can afford it.

—James Trussell, PhD, and Kelly Cleland, MPA, MPH,

Office of Population Research, Princeton University

www.not-2-late.com

 

References

[1]  Creinin MD, Schlaff W, Archer DF, Wan L, Frezieres R, Thomas M, Rosenberg M, Higgins J. Progesterone receptor modulator for emergency contraception: a randomized controlled trial. Obstet Gynecol. 2006;108:1089-97.

[2] Fine P, Mathé H, Ginde S, Cullins V, Morfesis J, Gainer E. Ulipristal acetate taken 48-120 hours after intercourse for emergency contraception. Obstet Gynecol. 2010;115:257-63.

[3] Glasier A, Cameron ST, Blithe D, Scherrer B, Mathe H, Levy D, Gainer E, Ulmann A. Can we identify women at risk of pregnancy despite using emergency contraception? Data from randomized trials of ulipristal acetate and levonorgestrel. Contraception. 2011;84:363-7.

[5] von Hertzen H, Piaggio G, Ding J, Chen J, Song S, Bártfai G, Ng E, Gemzell-Danielsson K, Oyunbileg A, Wu S, Cheng W, Lüdicke F, Pretnar-Darovec A, Kirkman R, Mittal S, Khomassuridze A, Apter D, Peregoudov A. Low dose mifepristone and two regimens of levonorgestrel for emergency contraception: a WHO multicentre randomised trial. Lancet. 2002;360:1803-10.

[6] Task Force on Postovulatory Methods of Fertility Regulation. Randomised controlled trial of levonorgestrel versus the Yuzpe regimen of combined oral contraceptives for emergency contraception. Lancet. 1998;352:428-33.

[7] Dada OA, Godfrey EM, Gilda Piaggio G, von Hertzen H. A randomized, double-blind, noninferiority study to compare two regimens of levonorgestrel for emergency contraception in Nigeria. Contraception. 2010;82:373-78.