Clinical Question: Can a patient use ulipristal acetate (ella) for emergency contraception more than once a menstrual cycle?
Jodi K, FNP
New York, NY
Jodi’s patient took ulipristal for emergency contraception one week ago and had a second condom rupture six days later. The patient’s body mass index is 31, and she did not want to have a copper IUD inserted. Her sole sexual partner lives elsewhere and they see each other a few times each year.
Ulipristal acetate’s FDA label says, “Repeated use of ella within the same menstrual cycle is not recommended, as safety and efficacy of repeat use within the same cycle has not been evaluated.” However, after ulipristal was approved by the FDA, a small study examined repeat use in the same menstrual cycle. This study found that subjects who took repeat doses every 5-7 days experienced delayed follicular rupture. Eventually, most study subjects ovulated. The study’s authors concluded that ulipristal may be used again in the same cycle even though efficacy may be lower than that of the first dose.
Patients who need emergency contraception often may want to reconsider their ongoing contraceptive method.
Jesam C, Cochon L, Salvatierra AM, et al. A prospective, open-label, multicenter study to assess the pharmachodynamics and safety of repeated use of 30 mg ulipristal acetate. Contraception. 2016 Apr;93(4):310-316. doi: 10.1016/j.contraception.2015.
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