Efficacy of ulipristal acetate for emergency contraception and its effect on the subsequent bleeding pattern when administered before or after ovulation
ESC Congress Library. Li H. May 6, 2016; 126959; A-133
Dr. Hang Wun Raymond Li
Dr. Hang Wun Raymond Li
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Abstract
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Objectives: Research carried out in the area of emergency contraception (EC) has aimed at finding agents that are more effective and less restrictive in timing of use after unprotected sexual intercourse. Levonorgestrel is effective as an emergency contraception (EC) only when administered before but not after ovulation. Whether the same applies to ulipristal acetate (UPA) is not known. This study aimed at comparing the efficacy of UPA for EC when administered before and after ovulation. 

Design and Methods: This was a prospective, open-label, uncontrolled clinical study conducted between May 2011 and March 2014 at the Family Planning Association of Hong Kong. A total of 700 women with regular menstrual cycles who were requesting EC within 120 hours of a single act of unprotected sexual intercourse in the current menstrual cycle were recruited. Of them, 693 completed follow-up. Each participant received a single oral dose of UPA 30 mg. The main outcome measure was the percentage of pregnancies prevented (PPP). Secondary outcome measures included failure rate and changes in the next menstrual bleeding.

Results: The PPP was significantly higher in subjects who were pre-ovulatory (77.6%) compared to those who were post-ovulatory (36.4%) at the time of UPA administration (p<0.0001). The observed pregnancy rate following UPA administration was significantly lower than the expected pregnancy rate only in the pre-ovulatory group (p<0.0001) but not the post-ovulatory group (p=0.281). The overall failure rate was 1.7% (1.4% vs 2.1% in the pre- and post-ovulatory groups respectively). Pre-ovulatory administration of UPA resulted in a small delay (median of 3 day), whereas post-ovulatory administration resulted in a minimal advancement (median of 1 day), of the next menstruation respectively compared to that predicted from the subjects previous menstrual pattern. More pre-ovulatory subjects (19.1%) than post-ovulatory subjects (7.8%) had deviation of the next menses by more than 7 days (p<0.001).

Conclusions: The efficacy of UPA-EC was significantly better when administered before than after ovulation. UPA-EC taken in the pre-ovulatory or post-ovulatory phases resulted in different bleeding patterns.

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