[Application of the assays for progesterone and estradiol in saliva in family planning research].
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We studied the knowledge and use of hormonal emergency contraception (EC) in Finland by mailing a questionnaire to a national sample of 3000 women aged 18-44 years (response rate 74%). Ten percent of the women aged under 25 and 4% of all respondents had sometimes used EC. Unmarried women were more likely to report having used hormonal EC than were married women, and nulliparous women reported more use than did parous women. However, no statistically significant difference in EC use among women with or without previous abortion history was observed. Older women were less aware of EC than of other methods; only one-third of the women aged over 35 knew about this method. Current contraceptive practices were otherwise similar among ever-users and never-users of EC, but EC users more commonly reported using condom together with oral contraceptives or IUD. Nobody reported using EC as her only contraceptive method. Our findings suggest that EC is appropriately used in Finland, but more information about use of the method is still needed.
A prospective randomized study was conducted at the Family Planning Association of Hong Kong to compare the efficacy of the Yuzpe regimen and levonorgestrel (0.75 mg for two doses 12 h apart) in post-coital contraception. A total of 424 subjects were recruited into the Yuzpe group and 410 subjects into the levonorgestrel group; 77 subjects in the Yuzpe group and 79 subjects in the levonorgestrel group had further acts of intercourse during the treatment cycle. Fifteen pregnancies (3.5%) occurred in the Yuzpe group and 12 pregnancies (2.9%) in the levonorgestrel group. After excluding the patients who had further acts of intercourse, the failure rates in the Yuzpe group and the levonorgestrel group were 2.6 and 2.4% respectively. The incidence of nausea, vomiting and fatigue in the Yuzpe group was significantly higher than those in the levonorgestrel group. We conclude that levonorgestrel is an effective drug for post-coital contraception with a lower incidence of side-effects than the Yuzpe regimen.
We describe a prospective study of 1,200 patients using the Yuzpe regimen of hormonal postcoital contraception. There was an 85% follow-up rate, and of the 1,015 patients followed there were 13 pregnancies, giving a pregnancy rate of 1.3%. The number of expected pregnancies at mid-cycle was reduced by 83%; 12 of the 13 pregnancies went on to abortion. The patients were young: 86% were under 25, and 10% were under 15. The most frequent reason for presentation was that no contraception had been used (57%). All patients received an antiemetic; 57% experienced no side-effects, 28% had some nausea and 9.6% some vomiting. It is concluded that this is a safe form of emergency contraception, which is an effective way of reducing the number of unwanted pregnancies, especially in the very young.
Ethinylestradiol (EE), at a dosage of 5 mg/day for 5 consecutive days (5 mg EE), has generally been used for interception. A combination of 200 micrograms EE and 2 mg dl-norgestrel (EE + NG) was proposed as an effective alternative. Efficacy and tolerance of these methods were compared in a randomized, double-blind study. A group of 465 women was studied with a follow-up rate of 94.3%. In the 5 mg EE group a pregnancy rate of 0.9% was observed, and in the EE + NG group a rate of 0.4% was found. These rates differ significantly from the expected rates (P less than 0.0005, in both series). Nausea was noted in 59.1% of the 5 mg EE group and in 54.0% of the EE + NG series. Nausea and vomiting occurred in 20.8% and 15.8%, respectively. The efficacy of both methods as alternative morning-after medication was confirmed. The new method is preferable because treatment is limited to only 1 day.
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Five-hundred-thirty-eight patients received a complete follow-up to the first menses after post-coital contraception (PCC). Hormonal contraception (pill) was used in 436 women and mechanical contraception (IUD) was used in 102 women. No pregnancies were observed in the IUD group, while 8 pregnancies were found in the hormonal group. A comparative evaluation of the effectiveness and side effects of the two methods was made. The usefulness of PCC after an unprotected intercourse in order to avoid a pregnancy is confirmed.
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The ethinylestradiol-norgestrel combination (EE-NG) for postcoital contraception, as described by Yuzpe, has been shown to be an effective method but with frequent side effects. To overcome the problem of adverse effects a new approach using danazol was proposed, but the efficacy and acceptability of this treatment have not yet been tested in large studies. In a 5-year period at the AIECS Family Planning Centre in Milan we treated 2448 women requesting postcoital contraception using Yuzpe's regimen and two danazol regimens (800 mg/1200 mg). The patients' acceptability for danazol treatment was higher than for Yuzpe's regimen due to fewer, milder and shorter side effects. Nine pregnancies occurred in the EE-NG group (2.21%), 17 in the 800 mg group (1.71%) and 6 in the 1200 mg group (0.82%). Our study shows a statistically significant efficacy against expected pregnancy rates both with Yuzpe's regimen and with danazol. The 1200 mg danazol treatment seems to be more effective and can be considered a valid alternative to the EE-NG combination for hormonal postcoital contraception.