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Contraceptive Update: Contraceptive Pearls
(December 2003)
The "Contraceptive Pearls" offer answers to commonly asked questions about family planning. These "Pearls" were prepared by Dr. James D. Shelton, Senior Medical Scientist, Office of Population and Reproductive Health, United States Agency for International Development (USAID). They are reprinted with permission. To view archives of Jim Shelton's Pearls online, visit Jim Shelton's Pearls online.
How many cycles of pills?
Question: How many cycles of oral contraceptives should be provided at a client's initial visit?
- 1 cycle
- 1 cycle plus a "back up"
- 3 cycles
- Up to 1 year's supply depending on the woman's desires and anticipated use
- As many as the woman wants
Answer: According to the World Health Organization, the correct answer is D - up to one year's supply. The rationale for providing such an ample amount is that "restricting the number of cycles of pills can result in unwanted discontinuation of the method and increased risk of pregnancy."
The guidance includes the following comment: "Programmes must balance the desirability of giving women maximum access to pills with concerns regarding supplies and logistics."
Reference: World Health Organization, Reproductive Health and Research, Selected practice recommendations for contraceptive use. Geneva, 2002.
Single Dose Emergency Contraception
Question: The current 2-dose schedule for Emergency Contraception (EC) presents a problem for some clients coming to our clinic for EC. If the first dose is taken in the afternoon, then taking the second dose 12 hours later (as recommended) means they have to get up in the middle of the night to take it. We also worry some may forget to take the second dose at all.
We've heard that taking a double dose of EC at the outset may also be effective. Is that true?
Answer: Yes, according to a new World Health Organization multi-center randomized study just published in "Lancet." A single dose of 1.5 mg levonorgestrel was just as effective as the standard 2 doses of 0.75 mg taken 12 hours apart. In fact, the pregnancy rate with the single dose was slightly better: 1.5 percent versus 1.8 percent for the 2-dose regimen (though the difference was not significant). Moreover, side effects were mild and were virtually identical in the two groups.
Reference: Von Hertzen H et al. Low dose mifipristone and two regimens of levonorgestrel for emergency contraception: a WHO multicentre randomized trial. Lancet 2002; 360:1803-10.