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Double-dose oral LNG EC may be no more effective than a single dose for women with obesity

Many clinical guidelines recommend increasing the dose of oral levonorgestrel (LNG) for emergency contraception (EC) from 1500 µg to 3000 µg in patients with overweight/obesity. This multicentre pharmacodynamic study in the USA randomised women with obesity to receive either 1500 µg or 3000 µg during a natural menstrual cycle to determine whether ovulation was more effectively inhibited with a higher dose. Ovulation was determined with a combination of biochemical and ultrasonographic measures. There was no statistically significant difference in inhibition of ovulation between groups suggesting that double-dose LNG does not confer benefit in this patient group compared with a standard (single) dose. This patient group may benefit more greatly from ulipristal acetate oral EC, which does not appear to be affected by obesity. Copper emergency intrauterine devices remain the most effective method of EC overall.

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests JJR-W has received an educational grant from Gedeon Richter.

  • Provenance and peer review Commissioned; internally peer reviewed.