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Potential candidate for oral pericoital contraception: evaluating ulipristal acetate plus cyclo-oxygenase-2 inhibitor for ovulation disruption
  1. Erica P Cahill,
  2. Klaira Lerma,
  3. Kate A Shaw,
  4. Paul D Blumenthal
  1. Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
  1. Correspondence to Dr Erica P Cahill, Obstetrics and Gynecology, Stanford University, Stanford, California, USA; epcahill{at}stanford.edu

Abstract

Background There remains considerable global unmet contraceptive need, with almost 200 million women reporting desire to limit or space childbearing without contraceptive use. Researchers have documented worldwide interest in an oral, on-demand contraceptive option were it available. Candidates for use include ulipristal acetate (UA), levonorgestrel and cyclo-oxygenase-2 (COX-2) inhibitors alone or in combination.

Methods We performed an exploratory, prospective study of matched menstrual cycles: one baseline cycle and one treatment cycle of UA 30 mg plus meloxicam 30 mg just prior to ovulation. The primary outcome was ovulation disruption, defined as unruptured dominant follicle for 5 days. Secondary outcomes included comparing cycle length, endometrial stripe thickness, and side effects.

Results Nine participants completed all study procedures in both cycles. Ovulatory disruption occurred in 66.7% (n=6) of treatment cycles and all but one demonstrated features of ovulatory dysfunction. Cycle length (mean±SD) was longer in the treatment cycle (31.9±4.0 vs 28.6±3.5 days, p<0.01). Secondary outcomes did not differ between the two cycles.

Conclusions UA plus the COX-2 inhibitor meloxicam disrupts ovulation at peak luteal surge and is a promising candidate for evaluation as a pericoital oral contraceptive.

Trial registration number NCT03354117.

  • emergency contraception
  • family planning policy
  • contraception behavior
  • Sexual Health
  • family planning services

Data availability statement

Data are available upon reasonable request. All inquiries should be addressed to Dr EP Cahill.

Statistics from Altmetric.com

Data availability statement

Data are available upon reasonable request. All inquiries should be addressed to Dr EP Cahill.

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Footnotes

  • Twitter @drericacahll

  • Presented at This work was previously presented in part at the Annual Fellowship in Family Planning Meeting in Boston, Massachusetts, May 2019 and at the American Society for Reproductive Medicine Annual Meeting in Philadelphia, October 2019.

  • Contributors EPC and PDB conceived the presented idea. EPC developed the theory and performed the computations. KL and KAS verified the analytical methods. All authors discussed the results and contributed to the final manuscript. EPC is the guarantor.

  • Funding This study was supported by the Society for Family Planning Research Fund (SFPRF18-01).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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