- Combination Therapy Boosts Morning-After Pill’s Effectiveness, Study Shows
- Efficacy of Levonorgestrel Significantly Improved with Addition of Piroxicam
- Implications for Emergency Contraception and Clinical Guidelines Highlighted by Researchers
Researchers have discovered that the morning-after pill is more effective when consumed in conjunction with an anti-arthritis drug.
Levonorgestrel, sold as Levonelle in the UK and Plan B in the US, was 63% effective alone.
This increased to 95% when combined with the anti-inflammatory drug piroxicam, which costs approximately 30 pence per dosage.
Their findings, which were published in the prestigious medical journal The Lancet, were deemed ‘promising’ by experts.
A Hong Kong University team recommends providing piroxicam to women seeking emergency contraception.
836 women who sought the morning-after pill within 72 hours of unprotected intercourse participated in the study.
Throughout the four-year study, volunteers were randomized into two categories.
The other half received a placebo and levonorgestrel, a synthetic progesterone that slows egg release. Others were given both the morning-after tablet and 40 mg of piroxicam.
Appointments for follow-up were scheduled after their next expected period. If it had not occurred, a pregnancy test was conducted.
None of the 418 women in the piroxicam cohort became pregnant. The placebo group had seven adverse events.
Researchers estimated that 19 of the 418 women, or 4.5%, would become impregnated without emergency contraception.
They concluded that the combination of piroxicam and levonorgestrel prevented 18 of the 19 pregnancies (95 percent), compared to 12 of the 19 pregnancies prevented by the tablet alone (63 percent).
No significant adverse effects were observed.
Professor Kristina Gemzell-Danielsson of the Karolinska Institute in Sweden, the co-author of the study, stated, ‘Levonorgestrel prevents pregnancy by inhibiting or delaying the luteinizing hormone surge, which disrupts the ovulatory process.
‘Piroxicam may operate by targeting prostaglandins, a different type of hormone.
Multiple reproductive processes, including ovulation, fertilization, and embryo implantation, are facilitated by prostaglandins.
Therefore, we hypothesize that piroxicam may have a contraceptive effect on both pre- and post-ovulation by inhibiting the ovulatory process and embryo implantation, respectively.
IUD coils can be used as emergency contraception up to five days following sexual activity to avoid unwanted pregnancy.
It works by preventing ovulation or altering the uterine membrane to prevent an egg from becoming implanted, thereby preventing pregnancy.
The UK National Health Service delivers the morning-after pill free at GP offices, sexual health clinics, and walk-in clinics.
However, this option is unavailable on weekends, and women are typically interviewed before receiving the tablet.
After a consultation, emergency contraception can also be purchased from pharmacies.
However, the authors of the new research cautioned that there may be limitations.
These included excluding women who were presently using or had recently used hormonal contraception, as well as those who had multiple unprotected sexual encounters before receiving emergency contraception.
Studies indicate that the morning-after pill may not work for overweight women.
The study’s findings may not apply to all patients, according to Stanford University School of Medicine’s Dr. Erica Cahill.
Most participants in this study were Asian and under 70 kilogrammes.
Levonorgestrel emergency contraception is less effective in obese people, hence it may not work for higher BMI patients.
However, Dr. Sue Lo of the Family Planning Association of Hong Kong and co-investigator of the study stated that the results were “extremely encouraging.”
She added, “The levonorgestrel emergency contraceptive pill is one of the most popular emergency contraception options in many regions of the globe.”
Therefore, the discovery that a widely available medication increases levonorgestrel’s efficacy when taken together is very intriguing.
Dr. Raymond Li of The University of Hong Kong, the study’s author, stated: ‘Our study is the first to suggest that a readily available and safe medication taken concurrently with the levonorgestrel pill can prevent more pregnancies than levonorgestrel alone.
We hope that these findings will lead to additional research and, ultimately, changes in clinical guidelines that will make emergency contraception more accessible to women worldwide.
Dr. Cahill added, ‘Overall, this study suggests that anyone administering levonorgestrel as emergency contraceptive pills should consider the addition of 40mg piroxicam orally, as it improves efficacy with minor adverse effects.’
A group of British MPs called for same-day morning-after pill delivery from the NHS about a year ago.
It followed a Deliveroo-style pilot with students in Manchester during orientation week.
The trial, which was the first of its kind in the United Kingdom, utilized a bicycle courier to deliver emergency contraception to women hours after they completed an online questionnaire.
