Digital Family Planning: the Future is Now
Irregular Bleeding Due to Contraceptives
Ouch! Best approaches to menstrual pain
Contraceptive efficacy: understanding how user and method characteristics play their part
Strategizing treatment for chronic heavy menstrual bleeding
Untangling the literature on obesity and contraception
High tech apps for no-tech FABM
Menstrual exacerbation of other medical conditions
From Princeton University: Thomas James Trussell (1949-2018)
The Short and Long of IUD Use Duration
Selecting a Method When Guidance Isn’t Clear-cut
Healthcare in the Time of Digital Expansion
The Scoop on Two New FDA-Approved Contraceptive Methods
Pregnancy of unknown location—meeting the challenge
Big “yes” (with caveats) to CHCs during perimenopause
The role of IUDs (LNG IUDs, too!) in emergency contraception
Combined pills’ effect on mood disorders
Abortion in the U.S.: safe, declining, and under threat
Hope for ovarian cancer screening test
Breast cancer still a small risk with some hormonal contraceptives
Record rate of HPV-related throat cancer
Viruses in semen potentially transmissible
Don’t Abstain from Your Role in Abstinence
Teens births declining but geographic ‘hotspots’ defy trend
Online Medical Abortion Service Effective and Safe
Do Women Really Need to Wait That Long?
Reassuring news on depression and OC use
PMDD: Genetic clues may lead to improved treatment
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
Menopause, mood, mental acuity, and hormone therapy
Emergency contraception for teens
Postpartum Contraception: Now, Not Later
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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

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.
[4] http://www.medicines.ie/medicine/11933/SPC/Norlevo+1.5mg+tablet/ (Accessed July 22, 2014)
[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.