Abstract

PIP: The World Health Organization (WHO) multicenter, randomized trial reported in this issue of "The Lancet" confirms that levonorgestrel-only (two 750-mcg doses) is significantly more effective in preventing pregnancy after unprotected intercourse than the standard Yuzpe regimen (two doses of 500 mcg levonorgestrel and 100 mcg ethinyl estradiol) and is further associated with significantly less nausea and vomiting. When initiated within 24 hours of coitus, the failure rate was only 0.4% for levonorgestrel compared with 2.0% for the combined hormonal method. A further advantage of a progestogen-only emergency contraceptive method is avoidance of contraindications in women with past proven arterial or venous thrombosis or a current attack of migraine with focal aura. Although only one pharmaceutical company (Gedeon Richter in Budapest, Hungary) currently manufactures 750 mcg of levonorgestrel in a single tablet, others are likely to follow this example given the findings of the WHO study. Strong pressure exists to increase availability of postcoital contraception through trained nurses and retail pharmacists. However, potential users will still require counseling on the importance of selecting a long-term method of contraception and a family planning provider.