[Risk of an unwanted pregnancy following a single unprotected coitus; observations on the current hormonal postcoital contraceptive methods] [letter]
Nederlands Tijdschrift Voor Geneeskunde, 1993
A UK physician reminds readers of a Dutch medical journal that predicting risk of pregnancy is no... more A UK physician reminds readers of a Dutch medical journal that predicting risk of pregnancy is not easy particularly when a woman does not know when her period is due as is often the case when a woman seeks emergency contraception. There also may be significant individual variations in the length of the follicular and luteal phase. 2 Dutch physicians believe as daily dose of 5 mg ethinyl estradiol for 5 days is an effective postcoital contraceptive. In the UK the Yuzpe regime (100 mcg ethinyl estradiol and 500 mcg levonorgestrel repeated after 12 hours) is the accepted method of postcoital contraception. The UK physician points out that claiming a postcoital method has a gross failure rate of 3% does not mean it is 97% effective because it is not easy to estimate how many pregnancies would have been expected. The UK physician and some medical colleagues have compared the Yuzpe regime with 600 mg of danazol repeated after 12 hours and 600 mg mifepristone state (N = 616). The Yuzpe regime had the lower crude failure rate (2.6% vs. 4.7%). Its standardized ratio (0.443 vs 0.767 for danazol) indicated its clinical effect. They noted that an unacceptably high number of observed pregnancies would have had to occur to prove any clinical effect for danazol so they concluded the study. Thus the UK physician considers this study to be a trial against a placebo. Yet this study and another study in Scotland found no failures in women using the 600 mifepristone stat. This regime holds considerable promise as a postcoital contraceptive. It did pose problems with delayed bleeding however. Even though other postcoital contraceptive methods do have a clinical effect they do fail. There has been only 1 case of failure with postcoital insertion of an IUD. The UK physician calls for the colleagues to look forward to newer regimes instead of retesting effective methods which still do fail resulting in unwanted pregnancies.
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