Emergency contraception: is it time to change method?BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7180.342 (Published 06 February 1999) Cite this as: BMJ 1999;318:342
A variety of methods offers choice and increased access
- Anne Webb, Consultant in family planning and reproductive health care
- Abacus, Liverpool L2 1TA
It is nearly 25 years since Yuzpe published his work on a combination of estrogen and progestogen for emergency contraception.1 Overall this method prevents three out of four pregnancies that would have occurred if no treatment had been used2 and has an excellent safety record. Now a group from the World Health Organisation has confirmed that levonorgestrel alone is effective and has fewer side effects than combined oestrogen-progestogen.3 Should we now be changing to levonorgestrel for emergency contraception?
The combined oestrogen-progestogen method produces nausea and vomiting, but otherwise has a good safety record. The World Health Organisation has stated that there are no contraindications,4 though the latest guidelines from the Faculty of Family Planning and Reproductive Health Care of the Royal College of Obstetricians and Gynaecologists still regard a history of thromboembolism as a relative contraindication and migraine at presentation, with a history of migraine with aura, an absolute contraindication.5
Unfortunately, since Yuzpe's original publication no further work has been published on either timing or dosage. Work has, however, …