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Postcoital contraception.

Changes in sexual mores have led to the need for an effective emergency postcoital contraceptive agent. To meet this need various individual steroids, either alone or in combination, have been evaluated and shown to be effective in preventing pregnancy as a result of a single, unprotected coital act. No drug has received specific marketing approval in North America for this purpose. However, in western Europe, the combination of ethinyloestradiol and levonorgestrel is marketed specifically for use as a postcoital contraceptive agent. Intrauterine copper contraceptive devices have also been shown to be effective postcoital contraceptive agents, but their applicability is confined to a specific segment of the population. Other agents are also being investigated for their postcoital contraceptive effectiveness, including prostaglandins, anti-progestins, GnRH agonists, super agonists and antagonists, and HCG antagonists. Sufficient interest exists in postcoital contraception that the World Health Organization has undertaken, through their task force dealing with postcoital, once-a-month and menses-inducing agents, to develop other postcoital drugs.

Contraceptives, Postcoital↗

[Postcoital contraception with steroid hormones].

Large doses of estrogens employed for postcoital contraception have definitely been shown to be effective, but estrogens used in such high doses would result in a high incidence of side-effects. Therefore this method should be reserved for the occasional emergency. Postcoital estrogen-progestogen-combination is suitable for women exposed to an isolated act of intercourse in midcycle. The advantage of this method is the possibility of a delayed administration after intercourse. Progestogens alone can be used after each coital exposure. One of the most frequent problems is the alteration of the menstrual pattern. Continued use can be recommended for women with occasional intercourse in cycle. Possible mechanisms of action of steroidal postcoital contraceptives are discussed involving problems of this contraceptive method.

Contraceptives, Oral, Combined↗

Comparative cross-over pharmacokinetic study on two types of postcoital contraceptive tablets containing levonorgestrel.

A pharmaceutical and pharmacokinetic study was carried out on levonorgestrel tablets from two different sources (Hungarian- and Chinese-made). Both preparations contained 0.75 mg levonorgestrel and had been shown to have similar contraceptive efficacy and side effects when used for postcoital contraception. Absorption and bioavailability of the Hungarian-made tablets were greater as evidenced by higher serum concentrations of levonorgestrel, a greater area under the concentration-time curve during the first 24 hours, and a more marked suppressive effect on SHBG levels. These differences most probably reflect differences in their pharmaceutical formulation, in particular the extent of tablet dissolution and the degree of micronisation of levonorgestrel.

Absorption↗

Knowledge and use of postcoital contraception: a survey among health professionals in Tower Hamlets.

The knowledge and estimated retrospective use of postcoital contraception was ascertained from health professionals in Tower Hamlets in the summer of 1988 using a postal questionnaire. Eighty five per cent of general practitioners responded and 91% of these had received requests for postcoital contraception within the previous six months. Only one third of general practitioners had information about postcoital contraception available in their surgeries. Family planning doctors and nurses had the most accurate knowledge of the method but many health professionals appeared to lack sufficient knowledge to ensure appropriate prescribing and to publicize this method to their women patients. It is concluded that if the high rate of abortion in the borough is to be reduced, health professionals as well as women need to be further educated as part of a postcoital contraception publicity campaign. Use of the term 'emergency contraception' rather than the non-medical term 'the morning after pill' may be more effective and reduce the present confusion among both groups.

Adult↗

A possible mechanism of action of danazol and an ethinylestradiol/norgestrel combination used as postcoital contraceptive agents.

Twenty-seven women requesting postcoital contraception were randomly allocated to take an ethinylestradiol/dl-norgestrel combination or danazol. Urine specimens were assayed for luteinising hormone (LH) and pregnanediol-3-glucuronide (P3G) levels from the day of the postcoital treatment to the next period. In addition, the urine samples of these recruits and 12 additional women were assayed for the Beta-subunit of human chorionic gonadotropin (B-hCG). A consistent pattern of alteration in urinary steroids was lacking, indicating a heterogeneous effect on ovarian function. There was no evidence of early pregnancy in successfully treated cases. We suggest that the main mechanism of action of these drugs is at the endometrial level.

Chorionic Gonadotropin↗