A new Cochrane review of 87 trials finds that emergency contraceptive mifepristone averts a higher number of pregnancies and produces fewer adverse effects than other widely used pills, including levonorgestrel.
Emergency contraception is used to prevent pregnancy after unprotected sex, and can be used when no contraception was used or if a contraceptive method fails, as with a broken condom, or in the event of sexual assault.
Common Methods and Effectiveness
Common methods of emergency contraception include copper intrauterine devices and pills, with levonorgestrel being the most widely used pill, sold in many countries as “Plan B,” “Next Choice,” or similar brand names.
The review, led by researchers from Oregon Health & Science University, USA, pooled data from 87 randomized controlled trials involving approximately 36,000 women of reproductive age, with the majority of studies conducted in China, and additional trials from the UK, Cuba, and multi-country settings.
Compared with levonorgestrel, both low-dose and mid-dose mifepristone prevented more pregnancies and were associated with fewer overall side effects, with low-dose mifepristone showing a 27% relative reduction in pregnancies compared with levonorgestrel.
Comparison with Other Methods
When compared with the Yuzpe regimen, mifepristone showed an even larger advantage, cutting pregnancy risk substantially while also sharply reducing rates of nausea and vomiting.
Read Also: Chile becomes first South American nation to eliminate dog-transmitted rabies
Evidence comparing mifepristone with copper intrauterine devices remained too limited to draw firm conclusions, based on only two included trials.
Mifepristone in low-to-mid doses is a highly effective emergency contraceptive option that clinicians should know about, working differently than other steroid hormone-based methods to delay or block ovulation.
The main trade-off identified across nearly all comparisons was a lower risk of nausea and vomiting with mifepristone, but a higher likelihood of delayed menstruation compared with other types of emergency contraception.
Access and Barriers
Despite the strong evidence behind the drug’s effectiveness as emergency contraception, there are still many barriers to access, with mifepristone facing intense political scrutiny, legal restrictions, and targeted bans and barriers in various countries.
According to Dr. Shaalini Ramanadhan, lead author of the review, “Expanding options for emergency contraception is important,” and recognition of mifepristone’s additional use may help expand access, increase familiarity with the medication, and create new opportunities for people to benefit from it.
