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Contraceptive Pearl: EC and Hormonal Contraception

My health center pharmacy just started stocking ella. Can I quick start my patients with ella?

Family Nurse Practitioner, Bangor, ME

Quick start may not work after ulipristal (ella).

Ulipristal may lower the efficacy of hormonal contraceptives; and hormonal contraceptives may lower the efficacy of ulipristal.

The FDA recently changed the label for ulipristal emergency contraception (EC), recommending that patients wait five days after taking ulipristal to initiate or continue hormonal contraception. This change was prompted by a study published in 2015. This study’s 71 participants took either ulipristal EC or a placebo, followed by either a desogestrel progestin-only pill or a placebo the next day. Those who started desogestrel the day after ulipristal had a significantly higher chance of ovulation within five days.

The pill used in this study, a desogestrel progestin-only pill, is not available in the US, but it is biologically plausible that similar effects would occur with other types of hormonal contraceptives. Until further studies examine other hormonal contraceptives and ulipristal EC, clinicians should advise patients who take ulipristal to wait five days before starting a hormonal contraceptive. Patients should use a barrier method for seven days after taking ulipristal, as ulipristal may lower efficacy of hormonal contraceptives.

The Copper IUD remains the most effective form of emergency contraception.

 

Sources

Curtis, K. et.al. U.S. selected practice recommendations for contraceptive use, 2016. Center for Disease Control. Recommendations and Reports. 2016. 65(4);1-66

Providing ongoing hormonal contraception after use of emergency contraceptive pills. American society for emergency contraception. November 2016.

Brache, V. et.al. A prospective, randomized, pharmacodynamic study of quick-starting a desogestrel progestin-only pill following ulipristal acetate for emergency contraception. Oxford Academic. 2015. 30(12); 2785-2793. doi.org/10.1093/humrep/dev241

 

Pharma-free

The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.