Takaisin Tulosta

Interventions for emergency contraception

Evidence summaries
Editors
Last reviewed as up-to-date 9.5.2019Latest change 9.5.2019

Level of evidence: A

Mifepristone, levonorgestrel and ulipristal acetate are effective for emergency contraception.

A Cochrane review «»1 «...»1 included 60 479 women in 115 trials, most of which were conducted in China. Mid-dose mifepristone (25-50 mg) (RR 0.61, 95% CI 0.45 to 0.83; 27 trials, n=6052) or low-dose mifepristone (< 25 mg) (RR 0.72, 95% CI 0.52 to 0.99; 14 trials, n=8752) were significantly more effective than levonorgestrel (LNG), but the significance was marginal when only high-quality studies were included (RR 0.70, 95% CI 0.49 to 1.01; 4 trials). Mid-dose mifepristone was associated with fewer pregnancies than low-dose mifepristone (RR 0.73, 95% CI 0.55 to 0.97; 25 RCTs, n=11 914). Ulipristal acetate (UPA) appeared more effective than LNG at a marginal level within 72 hours of intercourse (RR 0.59, 95% CI 0.35 to 0.99; 2 RCTs, n=3 448). Single-dose LNG (1.5 mg) showed similar effectiveness as the two-dose regimen (0.75 mg 12 h apart) (RR 0.84, 95% CI 0.53 to 1.33; 3 trials, n=6653). LNG taken within 72 hours of intercourse was more effective than LNG taken after 72 hours (RR 0.51, 95% CI 0.31 to 0.84; 4 trials, n=7453). It was not evident that the coitus-treatment time affected the effectiveness of mifepristone and UPA. There was no conclusive evidence of a difference in the risk of pregnancy between the Cu-IUD and mifepristone (RR 0.33, 95% CI 0.04 to 2.74; 2 RCTs, n=395, low-quality evidence). Levonorgestrel and mifepristone were associated with fewer pregnancies than Yuzpe (estradiol-levonorgestrel combination) (RR 0.57, 95% CI 0.39 to 0.84; 6 RCTs, n=4 750 and RR 0.14, 95% CI 0.05 to 0.41; 3 RCTs, n=2 144, respectively).

References

  1. Shen J, Che Y, Showell E et al. Interventions for emergency contraception. Cochrane Database Syst Rev 2019;(1):CD001324. «PMID: 30661244»PubMed