EC has limited effect on bleeding patterns
EC has limited effect on bleeding patterns
In the first study specifically designed to evaluate bleeding patterns after use of the emergency contraceptive pill (ECP) Plan B (Barr Pharmaceuticals, Pomona, NY), data indicate that intermenstrual bleeding following treatment is uncommon.1
Researchers found that the single-dose regimen alters the timing and duration of the menstrual period that immediately follows emergency contraception.1 If taken early in the cycle, EC use causes the menstrual period to begin earlier than usual, and if taken late in the cycle, it prolongs the next menstrual period. Menstrual timing resumes in a normal pattern by the second cycle.
The findings support the recommendation that a pregnancy test should be considered if menses are delayed, says Elizabeth Raymond, MD, MPH, associate medical director at Family Health International in Research Triangle Park, NC. In addition, women should be informed that after using this ECP regimen, their next ovulation may come earlier than expected and, therefore prompt initiation of regular contraception is advisable, she adds.
Previous studies have suggested that ECPs provoke intermenstrual bleeding.2,3 Data from the new study suggest that ECPs hasten the end of the current menstrual cycle, but thereafter the hormonal cycle is "reset" and proceeds normally.1
Take a closer look
While the Plan B dosing regimen approved by the Food and Drug Administration (FDA) calls for 0.75 mg levonorgestrel, followed by an identical second dose 12 hours later, more recent research supports the safety and efficacy of a single-dose (1.5 mg) regimen.2,4
To perform the bleeding pattern study, researchers asked 120 women who had been treated with the regimen to keep daily bleeding diaries for nine weeks. Investigators compared bleeding patterns observed after treatment with usual patterns reported by the participants and with patterns observed in a prior study on women who had not taken ECPs.
Treatment in the first three weeks of the menstrual cycle significantly shortened that cycle as compared both with the usual cycle length and with the cycle duration in a comparison group. The magnitude of this effect was greater the earlier the pills were taken.
In contrast, the duration of the first menstrual period after treatment increased significantly with cycle week of treatment and was longer in women who used the treatment than in those who did not, researchers report. Intermenstrual bleeding occurred in only 5% of women in the first cycle after treatment.1
How do you discuss the implications of the new study with patients? Anita Nelson, MD, professor in the obstetrics and gynecology department at the University of California in Los Angeles (UCLA) and medical director of the women's health care programs at Harbor-UCLA Medical Center in Torrance, offers this approach:
"Rather than emphasizing the single-dose regimen, I just say, 'Plan B,' then mention that it's given as a single dose; because [if not], it raises the issue that if I gave it traditionally, would it have the same effects?" she explains. "I think it is the EC itself, rather than the way it is given, that is making the difference."
If your family planning facility hasn't yet implemented advance prescriptions for EC, take advantage of a new public awareness campaign implemented by the American College of Obstetricians and Gynecologists (ACOG). Called "Ask Me," the campaign is aimed at educating women about EC and encouraging them to get an advance prescription from their provider. The campaign was unveiled in May at the organization's annual meeting, held in Washington, DC.
ACOG developed the campaign to help eliminate the logistical and political barriers that make EC largely inaccessible to women. The campaign's theme centers on "Accidents happen. Morning afters can be tough." Campaign materials include posters for physician examination and waiting rooms and an "Ask me" button, which is designed to promote dialogue between the patient and provider about emergency contraception. (Editor's note: As of CTU deadline, ACOG planned a late May mailing of posters and buttons to its members. The association is reviewing plans for material sales; CTU will publish ordering information when it is released.)
"By getting women to ask about emergency contraception and by OB/GYNs giving them an advance prescription for it, we hope to make EC a forethought, not an afterthought," says ACOG president Michael Mennuti, MD.
References
- Raymond EG, Goldberg A, Trussell J, et al. Bleeding patterns after use of levonorgestrel emergency contraceptive pills. Contraception 2006; 73:376-381.
- Arowojolu AO, Okewole IA, Adekunle AO. Comparative evaluation of the effectiveness and safety of two regimens of levonorgestrel for emergency contraception in Nigerians. Contraception 2002; 66:269-273.
- Arowojolu AO, Okewole IA. Vaginal bleeding following the use of a single dose of 1.5 mg levonorgestrel for emergency contraception. West Afr J Med 2004; 23:191-193.
- Von Hertzen H, Piaggio G, Ding J, et al. Low dose mifepristone and two regimens of levonorgestrel for emergency contraception: A WHO multicentre randomised trial. Lancet 2002; 360:1,803-1,810.
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