contraceptives--postcoital and Vomiting

Emergency contraception is used to prevent pregnancy after a coital act not adequately protected by a regular method of contraception. In contrast to early medical abortion, emergency contraception prevents a pregnancy from starting and does not disrupt an established pregnancy. The most commonly used approaches consist of two oral doses of contraceptive steroids. The levonorgestrel-only regimen (levonorgestrel, 0.75 mg, repeated in 12 hours) appears to be more effective and better tolerated than the Yuzpe regimen (ethinyl estradiol, 100 microg, and levonorgestrel, 0.5 mg, repeated in 12 hours). In the largest randomized, controlled trial to date, levonorgestrel prevented about 85% of pregnancies that would have occurred without its use. Hormonal emergency contraception has no known medical contraindications, although it is not indicated for suspected or confirmed pregnancy. However, if hormonal emergency contraception is inadvertently taken in early pregnancy, neither the woman nor the fetus will be harmed. Nausea and vomiting associated with the Yuzpe regimen can be reduced by prophylactic use of meclizine. A strong medical and legal case exists for making hormonal emergency contraception available over the counter, as has happened in countries other than the United States. Easier access to and wider use of emergency contraception could dramatically lower the high rates of unintended pregnancy and induced abortion in the United States.

Topics: Age Factors; Contraceptives, Postcoital; Contraceptives, Postcoital, Hormonal; Contraindications; Drug Combinations; Drug Interactions; Drug Prescriptions; Emergencies; Female; Fetus; Humans; Intrauterine Devices; Jurisprudence; Mifepristone; Nausea; Pregnancy; Pregnancy Tests; Pregnancy, Unwanted; Smoking; Time Factors; Vomiting

Emergency contraceptives are methods that prevent pregnancy when used shortly after unprotected sex. Three different emergency contraceptive methods are safe, simple, and widely available in the United States. These are: (1) ordinary combined oral contraceptives containing ethinyl estradiol and levonorgestrel taken in a higher dose for a short period of time and started within a few days after unprotected intercourse; (2) levonorgestrel-only tablets used similarly; and (3) copper-bearing intrauterine devices inserted within approximately 1 week after unprotected intercourse. Emergency contraceptive use is best known for women who have been raped, but the methods are also appropriate for women who have experienced condom breaks, women who did not use any method because they were not planning on having sex, or women who had unprotected intercourse for any other reason. Unfortunately, few women know about emergency contraceptives, and few clinicians think to inform their patients routinely about the option. A nationwide toll-free hotline (1-888-NOT-2-LATE) and a website (http://not-2-late.com) can help women learn about these options. Sharing "family planning's best-kept secret" widely with women could prevent as many as a million unwanted pregnancies annually in the United States.

Topics: Contraceptives, Oral, Combined; Contraceptives, Postcoital; Emergencies; Female; Health Services Accessibility; Humans; Intrauterine Devices, Copper; Pregnancy; Pregnancy, Unwanted; United States; Vomiting; Women's Health

Emergency contraceptives can prevent unintended pregnancy after unprotected intercourse. The best-studied regimen ("Yuzpe") consists of ordinary combined oral contraceptives containing levonorgestrel and ethinyl estradiol. Women traditionally take one dose within 72 hours after unprotected intercourse, and a second dose 12 hours later. Historically, half experience nausea and a fifth vomit. The purpose of this study was to determine whether 1). women could use combined oral contraceptives other than those containing levonorgestrel and 2). eliminating the second dose improves comfort and convenience.. Women presenting within 72 hours after unprotected intercourse were randomized to receive 1). standard two-dose Yuzpe, 2). a variant of Yuzpe substituting norethindrone for levonorgestrel, or 3). only the first dose of Yuzpe, followed 12 hours later by a placebo.. Perfect-use failure rates were low in all groups and did not differ in a statistically significant way (standard Yuzpe 2.0% [n = 589], norethindrone-ethinyl estradiol 2.7% [n = 547], single dose of Yuzpe 2.9% [n = 546]). Typical-use failure rates were slightly higher but similarly did not differ significantly. Side effects were similar across groups, except that women taking the single dose reported half the vomiting. Taking the pills with food did not seem to reduce nausea or vomiting, and the pills were not more effective when started sooner after unprotected intercourse.. Oral contraceptives containing norethindrone-ethinyl estradiol work approximately as well for emergency contraception as levonorgestrel-ethinyl estradiol formulations and should be offered when first-line therapies are not available.

Topics: Adolescent; Adult; Contraceptives, Oral, Combined; Contraceptives, Postcoital; Double-Blind Method; Drug Administration Schedule; Ethinyl Estradiol; Female; Half-Life; Humans; Middle Aged; Nausea; Norethindrone; Norgestrel; Pregnancy; Treatment Failure; Vomiting

Emergency contraception was introduced in Nigeria over two decades ago, but few women have used this method even in emergency situations because of the side effects. To find an acceptable levonorgestrel regimen for emergency contraception in our community, the two-dose regimen 0.75-mg levonorgestrel 12 h apart (group A) and the single dose 1.5-mg levonorgestrel (group B) were studied in 1118 volunteers. Mild side effects such as nausea, vomiting, lower abdominal pains, menorrhagia, dizziness, headache, and breast tenderness were reported. Significantly more women in the high-dose group reported headache, breast tenderness, and heavy menstrual flow. Eleven pregnancies (1.0%) were reported (7 in group A and 4 in group B). The crude relative risk of pregnancies was similar in the two groups (RR = 0.71, 95% CI = 0.32-1.55; p > 0.05) [corrected]. On the other hand, the estimated effectiveness rate of 86.80% in group A was significantly lower than the 92.99% for group B (p < 0.05). The pregnancy rates increased with delay in starting treatment and if further acts of unprotected sexual intercourse took place after treatment. It was concluded that both regimens were effective and safe.

Topics: Abdominal Pain; Adult; Contraceptives, Postcoital; Double-Blind Method; Female; Headache; Humans; Levonorgestrel; Menorrhagia; Nausea; Nigeria; Placebos; Pregnancy; Safe Sex; Vomiting

We conducted a randomized trial to determine whether pretreatment with meclizine reduces the incidence of nausea and vomiting associated with the Yuzpe regimen of emergency contraception.. We randomly assigned 343 women aged 18-45 years who were not at risk for pregnancy to pretreatment with 50 mg of meclizine, placebo, or no drug 1 hour before the first of two doses of emergency contraceptive pills. We asked participants to complete three questionnaires over the following 48 hours.. The incidence of nausea was 47% in the group pretreated with meclizine and 64% in the other two groups (relative risk adjusted for center 0.7, 95% confidence intervals 0.6, 0.9 for comparisons of meclizine with both placebo and no drug). The severity of nausea and the incidence of vomiting were also significantly lower in the meclizine pretreatment group than in the other two groups. Drowsiness was reported by about twice as many women in the meclizine pretreatment group (31%) than in the other two groups (13% in the placebo group, 16% in the no-pretreatment group; P < .01 for both comparisons).. Meclizine is effective for preventing nausea and vomiting associated with the Yuzpe regimen of emergency contraceptive pills. Women using this drug should be cautioned to anticipate drowsiness.

Topics: Adolescent; Adult; Antiemetics; Contraceptives, Oral, Combined; Contraceptives, Postcoital; Female; Humans; Meclizine; Middle Aged; Nausea; Premedication; Severity of Illness Index; Surveys and Questionnaires; Vomiting

A previous randomised study suggested that the progestagen, levonorgestrel, given alone in two separate doses each of 0.75 mg caused nausea and vomiting in fewer women and might be more effective than the Yuzpe regimen of combined oral contraceptives for emergency contraception, although the difference was not significant. We compared these two regimens when started within 72 h of unprotected coitus.. We enrolled in the double-blind, randomised trial 1998 women at 21 centres worldwide. Women with regular menses, not using hormonal contraception, and requesting emergency contraception after one unprotected coitus, received levonorgestrel (0.75 mg, repeated 12 h later) or the Yuzpe regimen (ethinyloestradiol 100 microg plus levonorgestrel 0.5 mg, repeated 12 h later).. Outcome was unknown for 43 women (25 assigned levonorgestrel, 18 assigned Yuzpe regimen). Among the remaining 1955 women, the crude pregnancy rate was 1.1% (11/976) in the levonorgestrel group compared with 3.2% (31/979) in the Yuzpe regimen group. The crude relative risk of pregnancy for levonorgestrel compared with the Yuzpe regimen was 0.36 (95% CI 0.18-0.70). The proportion of pregnancies prevented (compared with the expected number without treatment) was 85% (74-93) with the levonorgestrel regimen and 57% (39-71) with the Yuzpe regimen. Nausea (23.1 vs 50.5%) and vomiting (5.6 vs 18.8%) were significantly less frequent with the levonorgestrel regimen than with the Yuzpe regimen (p<0.01). The efficacy of both treatments declined with increasing time since unprotected coitus (p=0.01).. The levonorgestrel regimen was better tolerated and more effective than the current standard in hormonal emergency contraception. With either regimen, the earlier the treatment is given, the more effective it seems to be.

Topics: Adult; Contraceptives, Oral, Combined; Contraceptives, Oral, Synthetic; Contraceptives, Postcoital; Double-Blind Method; Emergencies; Estradiol Congeners; Ethinyl Estradiol; Female; Humans; Levonorgestrel; Nausea; Pregnancy; Pregnancy, Unwanted; Risk; Time Factors; Vomiting

To compare the effectiveness and acceptability of three regimens of postcoital contraception.. Randomised group comparison of ethinyloestradiol 100 micrograms plus levonorgestrel 500 micrograms repeated after 12 hours (Yuzpe method); danazol 600 mg repeated after 12 hours; and mifepristone 600 mg single dose.. Community family planning clinic.. 616 consecutive women with regular cycles aged 16 to 45 years.. Number of pregnancies, incidence of side effects, and timing of next period.. The raw pregnancy rates (with 95% confidence intervals) for the Yuzpe, danazol, and mifepristone groups were 2.62% (0.86% to 6.00%), 4.66% (2.15% to 8.67%), and 0% (0% to 1.87%) respectively. Overall, these rates differed significantly (chi 2 = 8.988, df = 2; p = 0.011). The differences between the mifepristone and Yuzpe groups and between the mifepristone and danazol groups were also significant. Side effects were more common and more severe in the Yuzpe group (133 women (70%)) than in either the danazol group (58 (30%)) or the mifepristone group (72 (37%)). The Yuzpe regimen tended to induce bleeding early but mifepristone prolonged the cycle. Three women bled more than seven days late in the Yuzpe group compared with 49 in the mifepristone group.. Mifepristone was effective in reducing expected pregnancy rates and the Yuzpe method also had a clinical effect. Danazol had little or no effect. A further multicentre trial is needed.. In Manchester, England, a physician administered 3 different oral postcoital contraceptives to 616 16-45 year old women who came to the Palatine Centre obstetrics and gynecology clinic within 72 hours after intercourse, most of whom were 25 years old and primigravidae, to compare the effectiveness and acceptability of the 3 different postcoital methods. 66% were using a barrier method when they became pregnant. The probability of pregnancy was 34.7 pregnancies, but only 14 actually occurred. The researchers estimated 11.3 pregnancies for the women who followed the Yuzpe regimen (100 mcg ethinyl estradiol and 500 mcg levonorgestrel every 12 hours), but only 5 resulted for a pregnancy rate of 2.62%. 2 women continued their pregnancies and vaginally delivered full-term infants. They predicted 11.7 pregnancies for the women who took 600 mg danazol every 12 hours, but only 9 happened for a pregnancy rate of 4.66%. Only 1 woman continued her pregnancy and delivered a full term infant. They predicted 11.7 pregnancies for the women who took 1 dose of 600 mg mifepristone (RU-486) and no one became pregnant. There was a significant difference between the pregnancy rates of RU-486 and danazol (p=.004), but not between those of RU-486 and the Yuzpe regimen. The difference between the observed pregnancies and expected number of pregnancies had the women received no treatment was significant for RU-486 (p.001) and the Yuzpe regimen (p=.061). Women who followed the Yuzpe regimen were more likely to have nausea and vomiting (70% and 22%, respectively ) than those in the danazol (30% and 4%, respectively) and RU-486 groups (37% and 3%, respectively). The Yuzpe regimen was less likely to disrupt the regular menstrual cycle than the other 2 methods, however. For example, bleeding occurred 3 days late in only 6% of cases compared with 39% for RU-486 and 9% for danazol. RU-486 was the most effective method and was also acceptable due to minimal side effects.

Topics: Adolescent; Adult; Contraceptives, Oral, Combined; Contraceptives, Postcoital; Danazol; Ethinyl Estradiol; Female; Humans; Levonorgestrel; Menstruation; Middle Aged; Mifepristone; Nausea; Pregnancy; Treatment Outcome; Vomiting

The New Zealand Family Planning Association undertook a prospective study of Yuzpe's postcoital method of contraception (0.1 mg ethinyloestradiol and 1 mg d1-norgestrel taken within 72 hours of unprotected intercourse and repeated 12 hours later). The study also used pills containing levonorgestrel. Both pill formulations were equally effective. All participants were drawn from six family planning branches throughout the country. The study covered a period of one year. There were 909 participants with 8% lost to follow up. Strict criteria excluded women on medication or hormone therapy. The ages ranged from 11 to 43 years with 92% aged 19 years and under. Results revealed an overall failure rate of 2.3% and a significantly higher failure rate (4.49%) if the method was taken after 48 hours of unprotected intercourse and a significantly lower failure rate (1.22%) if taken before 12 hours of unprotected intercourse. Vomiting occurred in 17% but it did not affect the failure rate.

Topics: Adolescent; Adult; Child; Contraceptives, Oral, Hormonal; Contraceptives, Oral, Synthetic; Contraceptives, Postcoital; Ethinyl Estradiol; Ethinyl Estradiol-Norgestrel Combination; Evaluation Studies as Topic; Family Planning Services; Female; Follow-Up Studies; Humans; Menstrual Cycle; Multicenter Studies as Topic; Norgestrel; Pregnancy; Prospective Studies; Random Allocation; Time Factors; Vomiting

A postcoital contraceptive with a lower incidence of nausea and vomiting than oestrogen-progestogen combinations would be a significant advance. During a nine-month period, 101 women were treated at the Margaret Pyke Centre in London with either an oestrogen-progestogen combination or with danazol. A comparison of the side effects of each drug is reported. Those treated with danazol were six times less likely to experience nausea and none vomited. With the exception of breast symptoms, other side effects were five times less common in women receiving danazol. These differences give danazol a clear advantage in terms of patient acceptability. Further experience will enable the efficacy of danazol to be evaluated and so determine whether this drug should become the preferred hormonal postcoital treatment.

Topics: Adult; Contraceptives, Oral; Contraceptives, Oral, Combined; Contraceptives, Postcoital; Danazol; Ethinyl Estradiol; Female; Follow-Up Studies; Humans; Nausea; Norgestrel; Pregnadienes; Vomiting

Topics: Contraceptives, Postcoital; Contraceptives, Postcoital, Hormonal; Estradiol Congeners; Female; Humans; Nausea; Vomiting

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.. This prospective study comprised 1200 patients who were using the Yuzpe regimen of postcoital hormonal contraception. There was an 85% follow-up rate, and of the 1015 patients followed, there were 13 pregnancies for a pregnancy rate of 1.3%. The number of expected pregnancies at midcycle was reduced by 83%; 12 of the 13 pregnancies went on to abortion. The patients were young--86% were under age 25 and 10% were under age 15. The most frequent reason for presentation was that there had been no contraception used (57%). All patients received an antiemetic and 57% experienced no side effects while 28% had some nausea, and 9.6% had vomiting. It is concluded that this is a safe form of emergency contraception, which is thus an effective way to reduce the number of unwanted pregnancies, especially in the very young.

Topics: Adolescent; Adult; Ambulatory Care Facilities; Contraceptives, Postcoital; Contraceptives, Postcoital, Hormonal; Drug Administration Schedule; Emergencies; Ethinyl Estradiol; Family Planning Services; Female; Humans; Nausea; Norgestrel; Prospective Studies; Vomiting

294 women between 18 and 35 years of age -- without absolute contraindications to estrogen use, with regular menses, who had had intercourse from 3 days before to 2 days after presumptive ovulation -- were given ethinyl estradiol (EE) in dosages of 5 mg/day and domperidon 20 ng twice/day for 5 days between and 72 hours from intercourse. Follow-up visits 30 days later showed that only 243 women had adhered to the protocol. It was calculated that 32.9 pregnancies were statistically probable in the absence of therapy in the study group; none actually occurred. Even among the 27 women who presented not having followed the therapeutic protocol correctly, there were no pregnancies. Side-effects such as vomiting, nausea and breast tenderness occurred in 54% of the patients, even though domperidon is an efficacious anti-emetic.

Topics: Adolescent; Adult; Contraceptives, Postcoital; Contraceptives, Postcoital, Hormonal; Domperidone; Estrogens; Female; Humans; Pregnancy; Vomiting

During a 9-month period, 84 female patients received post-coital contraception consisting either of an association of ethinyl estradiol/norgestrel or of danazol, in order to compare the safety and any adverse reaction of these 2 treatments. Overall, the patients treated with danazol presented 1/3 as many side effects. Nausea was reduced to 1/3 in frequency and vomiting to 1/9 in this group. 5 pregnancies were confirmed in the ethinyl estradiol/norgesterol group and 2 in the danazol group. Although more cases are needed, it would appear that danazol is characterized by greater efficacy and patient acceptability.

Topics: Biology; Contraception; Contraceptive Agents; Contraceptive Agents, Female; Contraceptives, Oral, Hormonal; Contraceptives, Postcoital; Digestive System; Endocrine System; Ethinyl Estradiol; Family Planning Services; Hormones; Nausea; Norgestrel; Physiology; Signs and Symptoms; Vomiting

The experience of the Utrecht State University with postcoital estrogens in high and low combined doses and with postcoital placement of IUDs since 1964 with over 4000 patients is summarized. The high dose postcoital estrogen treatment consists of 5 mg ethinyl estradiol for 5 days, either orally, or in case of vomiting not controlled by an antiemetic, estradiol benzoate 30 mg by injection. Side effects recorded in 3016 women were nausea in 54%, vomiting in 24%, tender breasts in 23%, menorrhagia in 11%, altered cycle length in 24%. Complications were 1 case of non-fatal pulmonary edema and 1 case of an 8 kg weight gain during treatment. There were 3 pregnancies. The overall failure rate in the whole series was 0.15%, with 10% ectopic pregnancies. There were no thromboembolisms or teratogenic effects. The combined estrogen treatment consisted of 50 mc ethinyl estradiol with 250 mc levonorgestrel (Neogynon oral contraceptive), 2 pills followed by 2 pills 12 hours later. A double-blind randomized trial resulted in no significant differences in pregnancy rates or side effects between the high and low dose regimens. The alternate treatment, if the woman presents more than 72 hours after intercourse, or if estrogens are contraindicated, is postcoital insertion of an IUD. The Dept. of Obstetrics and Gynecology does not place an IUD in a woman with infection nor in case of rape unless there is time for a complete work-up. Nulliparas are informed of the increased risk of pelvic inflammatory disease. Recently, the Multiload-copper 250 and later ML 375 were used exclusively, to achieve better blastocidal effect and lower expulsion rates. The ethical debate over use of postcoital methods centers around the morality of "procuring a miscarriage," but this argument is not relevant since these methods will not terminate a pregnancy once implantation has occurred. In the Netherlands, 25% of all abortion clients become pregnant during their 1st intercourse. In 1982, 35,000 postcoital contraceptives were administered, (roughly 16% of all pregnancies), compared to 15,000 abortions (7% of pregnancies; a total of 23% of pregnancies terminated). Compare these figures with 29% unwanted pregnancies all terminated by abortion in Sweden in that year. The postcoital methods are cheap, effective, and invaluable in emergency cases of rape, incest, intoxication, failure of barrier contraceptives, or unwanted pregnancy in women fearful or opposed to abortion.

Topics: Biology; Birth Rate; Breast; Contraception; Contraception Behavior; Contraceptive Agents; Contraceptive Agents, Female; Contraceptives, Oral; Contraceptives, Oral, Combined; Contraceptives, Oral, Hormonal; Contraceptives, Postcoital; Demography; Developed Countries; Digestive System; Disease; Embryo Implantation; Embryonic Development; Endocrine System; Ethics; Ethinyl Estradiol; Europe; Family Planning Services; Fertility; Hormones; Infections; Intrauterine Devices; Intrauterine Devices, Copper; Levonorgestrel; Menstruation Disturbances; Nausea; Netherlands; Parity; Pelvic Inflammatory Disease; Physiology; Population; Population Dynamics; Pregnancy; Pregnancy Complications; Pregnancy Trimester, First; Pregnancy, Ectopic; Reproduction; Signs and Symptoms; Vomiting

The new low-dose hormonal postcoital method, a combination of 200 mcg ethinylestradiol and 2 mg norgestrel was used in 633 women, and a statistically significantly lower observed pregnancy rate was found compared to the expected number of pregnancies if no contraception was used. Patterns of menstruation, its onset and duration, after use of this morning-after pill, are documented in respect to follicular, midcycle and luteal administration. Individual side effects such as nausea, vomiting and mastalgia are noted, but antiemetics did not reduce the incidence. Though efficacy of this technique is not found to be favorable in comparison to the 5 mg ethinylestradiol treatment, the low-dose of steroid, the one-day treatment and its lesser side effects show this alternative morning-after pill suitable for use as a first choice in case of an unprotected sexual encounter.

Topics: Adolescent; Adult; Contraceptives, Oral; Contraceptives, Oral, Combined; Contraceptives, Postcoital; Contraceptives, Postcoital, Hormonal; Ethinyl Estradiol; Female; Humans; Menstrual Cycle; Middle Aged; Nausea; Norgestrel; Pregnancy; Vomiting

Various postcoital contraceptive regimens are described. An antiemetic can be given to minimize the nausea and vomiting which are side effects of high-dosage estrogen. If pregnancy occurs despite treatment, the possible risk to the fetus is unknown. This method of contraception is only for emergency use. Regular contraception should be employed if sexual exposure is to be continuing.

Topics: Biology; Contraception; Contraceptive Agents; Contraceptive Agents, Female; Contraceptives, Oral, Hormonal; Contraceptives, Postcoital; Diethylstilbestrol; Disease; Embryo, Mammalian; Embryo, Nonmammalian; Endocrine System; Estrogens; Estrogens, Conjugated (USP); Estrone; Ethinyl Estradiol; Family Planning Services; Fetus; Hormones; Nausea; Neoplasms; Physiology; Pregnancy; Reproduction; Signs and Symptoms; Vomiting

Topics: Administration, Oral; Adolescent; Adult; Contraceptives, Postcoital; Diethylstilbestrol; Drug Evaluation; Estrogens; Ethinyl Estradiol; Female; Humans; Menorrhagia; Nausea; Pregnancy; Time Factors; Vomiting

Topics: Coitus; Contraceptives, Postcoital; Diethylstilbestrol; Drug Evaluation; Female; Fertilization; Humans; Menstruation; Nausea; Ovulation; Time Factors; Vomiting

Topics: Animals; Breast Diseases; Contraceptives, Postcoital; Embryo Implantation; Estrogens; Female; Haplorhini; Humans; Menorrhagia; Pain; Time Factors; Vomiting