The use of emergency hormonal contraception in South Africa: current and future perspectives

Abstract

Emergency hormonal contraceptives play an important role in preventing unplanned pregnancies in South Africa. In this review, we discuss the levonorgestrel emergency contraceptive, the combined estrogen and progestin regimen (also known as the Yuzpe method) and the use of Ulipristal acetate. The levonorgestrel and the combined estrogen, progestin regimen are available in South Africa. The specific mechanisms of action of each of these emergency hormonal contraceptives will be discussed as well as their efficacy, the side effects associated with each of these preparations and the drug interactions. Levonorgestrel can be used as a single dose (1.5 mg) instead of two doses (0.75 mg) 12 hours apart. Levonorgestrel is very effective, with fewer adverse effects than the combined estrogen and progestogen administration. Levonorgestrel and the Yuzpe method have demonstrated good efficacy when utilised within 72 hours after unprotected intercourse or contraceptive failure. These emergency hormonal contraceptives should not be used as regular contraception. It is essential that all health professionals and educators inform women of reproductive age about the risks and common side effects of emergency hormonal contraceptives.

Emergency contraception for the South African healthcare professional

“…7 Ordinary combined oral contraceptives can also be used as long as each 12-hourly dose contains at least 100-120 μg EE and a progestin of 0.5-0.6 mg LNG or 1.0-1.2 mg norgestrel. 8 Another option is to use Nordette® as each tablet contains 30 μg EE and 0.15 mg LNG. To attain the acquired dose the woman thus needs to take four Nordette® tablets stat and to repeat the dosage 12 hours later.…”

“…9 Other studies have reported an efficacy of 98-99% in preventing pregnancies. 8 The sooner after unprotected coitus it is used, the more effective it is. This is also generally true for all methods of EC.…”

“…Therefore, antiemetic drugs are recommended, such as prochlorperazine 5-10 mg, domperidone 10 mg or metoclopramide 10 mg, when Yuzpe's regimen is prescribed. 8,9 The method of action whereby Yuzpe's regimen prevents pregnancy is mostly by inhibiting ovulation. There may also be effects on the functioning of the endometrium and thus preventing implantation of the embryo.…”

“…There may also be effects on the functioning of the endometrium and thus preventing implantation of the embryo. 8 The cumulative effect on fertilisation, gamete transport and corpus luteum functioning is not clear and due to ethical considerations is very difficult to study in humans. 10 There are almost no contraindications to the use of Yuzpe's regimen.…”

“…Drugs known to be enzyme inducing include rifampicin, griseofulvin, carbamazepine, phenytoin, St John's Wort, nevirapine and efavirenz. 8,9 Levonorgestrel LNG as an EC is given orally in one of two dosages. It can be given as 0.75 mg 12 hourly for two doses or a single dose of 1.5 mg which is now more commonly used -thus two pills are taken stat.…”