scholarly journals Ulipristal acetate. A new emergency contraceptive. Ethical aspects of its use

2010 ◽  
Vol 59 (1) ◽  
Author(s):  
Justo Aznar
Keyword(s):  
Sexual Intercourse ◽  
Mechanism Of Action ◽  
Emergency Contraception ◽  
Ethical Aspects ◽  
Unprotected Sexual Intercourse ◽  
Ethical Assessment ◽  
Ulipristal Acetate ◽  
Unwanted Pregnancies ◽  
Emergency Contraceptive ◽  
First Time

Così come si presenta la pillola del giorno dopo può essere utilizzata in modo efficace fino a 72 ore dopo il rapporto sessuale non protetto. Tuttavia, in alcuni casi, questo periodo può essere troppo breve. Per tale motivo, è stata commercializzata per la prima volta una pillola, l’acetato ulipristal (Ellaone), per la contraccezione d’emergenza post-coitale fino a 120 ore (5 giorni) dopo i rapporti sessuali non protetti o nel caso di insuccesso del contraccettivo. Un aspetto importante da considerare nella valutazione etica di un farmaco usato per la contraccezione d’emergenza è il suo meccanismo d’azione, in quanto tale valutazione sarà molto diversa se il farmaco agisce inibendo o ritardando l’ovulazione o impedendo l’impianto della blastocisti nell’utero materno, dal momento che in quest’ultimo caso eserciterebbe la sua azione portando a termine la vita di un embrione in vita, secondo dunque un meccanismo abortivo. In relazione al meccanismo d’azione dell’Ellaone, quando la pillola è assunta cinque giorni prima dell’ovulazione la sua azione sarà fondamentalmente anticoncezionale, e lo stesso se è assunta quattro giorni prima. Se assunta tre giorni prima dell’ovulazione, può essere anticoncezionale o anti-impiantatorio, ma da allora in poi, il meccanismo attraverso cui l’Ellaone è in grado di prevenire le gravidanze indesiderate sarà anti-impiantatorio o, in altre parole, abortivo. In sintesi, tra il 50% e il 70% del tempo, Ellaone agirà secondo un meccanismo abortivo. Ci sembra che questa sia la realtà oggettiva circa il meccanismo d’azione dell’acetato ulipristal (Ellaone), e quindi il suo effetto anti-impiantatorio dovrà essere preso in considerazione per l’elaborazione di un giudizio etico sul suo uso. ---------- Current presentations of the morning-after pill can be used effectively for up to 72 hours after unprotected sexual intercourse. However in some cases, this period can be short. For that reason, a pill, ulipristal acetate (Ellaone), which is licensed for post-coital emergency contraception up to 120 hours (5 days) following unprotected sexual intercourse or contraceptive failure, has now been marketed for the first time. An important aspect to consider in the ethical assessment of any drug used in emergency contraception is its mechanism of action, as this assessment will be very different if the drug acts by inhibition or delaying the ovulation or by preventing the implantation of the blastocyst in the maternal uterus, since in the latter case it would exert its action by terminating the life of an already living embryo, i.e. by an abortive mechanism. In relation to the Ellaone’s mechanism of action, when the pill is taken five days before ovulation its action will be basically anticonceptive, and the same if it is taken four days beforehand. When it is taken three days before ovulation, it may be anticonceptive or by prenventing implantation, but from then on, the mechanism by which Ellaone may prevent unwanted pregnancies will be by an anti-implantation mechanism, in other words, abortive. In summary, between 50% and 70% of the time, Ellaone will act by an abortive mechanism. It seems to us that this is the objective reality about the mechanism of action of ulipristal acetate (Ellaone), and therefore its anti-implantation effect will have to be taken into consideration when issuing an ethical judgement on its use.

scholarly journals Mechanism of Action, Efficacy and Safety of Emergency Hormonal Contraception (levonorgestrel and ulipristal acetate) and Attitudes of Pharmacists

2014 ◽  
Vol 31 (3) ◽  
pp. 155-161 ◽  
Author(s):  
Jelena Milosavljević ◽  
Katarina Ilić ◽  
Dušanka Krajnović
Keyword(s):  
Clinical Trials ◽  
Mechanism Of Action ◽  
Emergency Contraception ◽  
Hormonal Contraception ◽  
Published Data ◽  
Ulipristal Acetate ◽  
Attitudes And Practices ◽  
History Of ◽  
Emergency Contraceptive ◽  
History Of Use

Summary Emergency hormonal contraception is used to prevent unintended pregnancy postcoitally. The mechanism of action of the most frequently used hormonal preparations for emergency contraception, levonorgestrel (LNG) and ulipristal acetate (UPA), is still not fully known, but clinical trials indicate that they act by inhibiting or delaying ovulation. LNG has a long history of use for emergency contraception, proven safety and high efficacy if administered in the preovulation period. The newest emergency contraceptive, UPA, available only with a prescription, is indicated within this period of 120 hours after sexual intercourse and the data indicate that UPA does not lose efficacy within this period. Clinical trials showed its noninferiority versus LNG and its effect on the potentially occurring pregnancy is being additionally monitored. However, many misconceptions and controversial opinions about emergency contraception are still present, even among pharmacists. A search of Medline database identified 20 papers published from January 1993 to December 2012, on pharmacists’ knowledge, attitudes and practices related to emergency contraception. In these papers, the attitudes of pharmacists pertaining to the dispensing regime of emergency contraception were different. Research in Australia has shown that personal attitudes and religious convictions influence the practice of dispensing emergency contraception. In the research conducted in New Mexico, 30% of pharmacists were against prescribing emergency contraception for religious or moral reasons. There were no published data in regards to pharmacists’ knowledge, attitudes and dispensing practice in Serbia and such research is highly recommended.

scholarly journals Ulipristal acetate. An emergency contraceptive?

2011 ◽  
Vol 60 (2) ◽  
Author(s):  
Justo Aznar ◽  
Julio Tudela
Keyword(s):  
Chemical Composition ◽  
Emergency Contraception ◽  
Contraceptive Efficacy ◽  
Ulipristal Acetate ◽  
Human Love ◽  
Fundamental Part ◽  
Contraceptive Measure ◽  
Unwanted Pregnancies ◽  
Emergency Contraceptive ◽  
The Right

Il forte aumento delle gravidanze e degli aborti negli adolescenti sembra giustificare l’adozione di misure per prevenirli. Sebbene la giusta soluzione al problema è senza dubbio l’educazione dei giovani ad un uso corretto della sessualità, e soprattutto in una considerazione di quest’ultima come parte fondamentale di qualcosa di molto più ampio come l’amore umano, alcuni intendono risolvere il problema implementando l’uso della contraccezione d’emergenza come unica misura contraccetiva. Uno degli ultimi farmaci in commercio per questo scopo è Ulipristal acetato, che ha cominciato ad essere distribuito in alcuni paesi europei dal novembre del 2009. Questo articolo fa riferimento alla composizione chimica di Ulipristal acetato, la sua efficacia contraccetiva, gli effetti collaterali, che non sono molto significativi, e in particolare al meccanismo d’azione con cui questo farmaco impedisce le gravidanze indesiderate, giungendo alla conclusione che per almeno il 60% del tempo esso agisce secondo un meccanismo antiimpianto, anche se ciò dipende in larga misura dal giorno in cui la donna lo assume entro il suo ciclo riproduttivo, e dal tempo trascorso dal rapporto sessuale. ---------- The large increase in pregnancies and abortions in adolescents appears to justify taking measures to prevent them. Although the right solution to the problem is undoubtedly through educating young people in the proper use of sexuality, and especially in considering it as a fundamental part of something much wider like human love, certain classes advocate resolving it by implementing the use of emergency contraception as the only contraceptive measure. One of the latest drugs marketed for this purpose is Ulipristal acetate, which began to be distributed in some European countries in November 2009. This paper refers to the chemical composition of Ulipristal acetate, its contraceptive efficacy, the side effects, which are not very significant, and especially to the mechanism of action by which this drug prevents unwanted pregnancies, concluding that at least 60% of the time it acts by an anti-implantation mechanism, although this depends to a large extent on the day on which the woman takes it, within her reproductive cycle, and on the time from sexual intercourse until she takes the drug.

Knowledge and Use of Emergency Contraceptive Pills among Bachelor's Level Female Students of Kathmandu Valley

2020 ◽  
Vol 8 ◽  
pp. 109-118
Author(s):  
Bhu Dev Jha
Keyword(s):  
Sexual Intercourse ◽  
Unwanted Pregnancy ◽  
Sampling Technique ◽  
Female Students ◽  
Kathmandu Valley ◽  
Sources Of Information ◽  
Cross Sectional ◽  
Unprotected Sexual Intercourse ◽  
Emergency Contraceptive ◽  
Emergency Contraceptives

 Emergency Contraceptive Pill (ECP) is used for preventing pregnancy after having unprotected sexual intercourse, contraceptive failure or forced sex. The use of ECP within 120 hours of sexual intercourse could prevent unwanted pregnancy and its adverse effects particularly unintended childbirth and unsafe abortion. The study, therefore, aimed to assess knowledge and use of emergency contraceptives among Bachelors level female students from Kathmandu Valley. A descriptive cross-sectional study was undertaken from August to November 2017 among 347 female students who were studying at the Bachelors's level. A random sampling technique was used to select study participants and a structured self-administered questionnaire was used to assess the knowledge and use of ECP after securing informed consent. Epi data and SPSS version 22 were used for data processing and analysis. The mean age of the female students was 21.5 years. Overall, 91.4% of the respondents had ever heard about emergency contraceptives. The main sources of information were radio or television, the internet and newspapers. About 4.6% of the undergraduate female students used ECP. Age, marital status, use of contraceptives and knowledge of ECP used within 72 hours were significantly associated with use of ECP. Although the findings of this study showed a high prevalence of knowledge among respondents, the improvement of female students’ knowledge on specific details of ECP and its advantages/disadvantages and timely utilization needs to be considered for any future awareness programmes.  

scholarly journals Assessment of knowledge and attitude about emergency contraception: a cross sectional study among medical students in North India

2017 ◽  
Vol 6 (9) ◽  
pp. 4042
Author(s):  
Rajiv Kumar Gupta ◽  
Parveen Singh ◽  
Rashmi Kumari ◽  
Bhavna Langer ◽  
Pawan Sharma ◽  
...  
Keyword(s):  
Medical Students ◽  
Sexual Intercourse ◽  
Health Care Providers ◽  
Emergency Contraception ◽  
Early Years ◽  
North India ◽  
Care Providers ◽  
Cross Sectional ◽  
Unprotected Sexual Intercourse ◽  
Knowledge And Attitude

Background: Emergency contraception (EC) which is the only method indicated after the unprotected sexual intercourse prevents unintended pregnancies and its harmful consequences like unsafe abortion or unintended child delivery. Since medical students are the future medical professional and would be the main channel to provide preventive, promotive and curative services to the population at large, their knowledge and attitude towards EC is an important context in the overall health scenario of India. The study aimed to assess the knowledge and attitudes of medical students towards use of EC.Methods: This cross sectional questionnaire based study was conducted among 2nd professional MBBS students in a Government Medical College in North India. The self administered questionnaire intended to seek information on knowledge and attitude of the students. The data so collected was expressed in percentages and Chi square test was used as test of significance.Results: All the respondents had heard of EC with mass media as the main source of information. More than 90% of the respondents knew about the indications for use of EC as well as the timing of the use of EC. Female respondents had better knowledge about composition of EC as well mechanism of action (p<0.05). More than 90% would recommend EC in case of unprotected sexual intercourse and 83.5% had positive attitude towards EC.Conclusions: Although knowledge about EC was good on certain parameters, yet lack of in depth knowledge among future health care providers is a cause of concern. So, attention be given to special issues relating to EC from early years of medical education till internship. 

scholarly journals Emergency contraception among doctors and people without higher medical degree

2018 ◽  
Vol 67 (4) ◽  
pp. 34-39
Author(s):  
Sergey S Aganezov ◽  
Anastasiya V Morotskaya ◽  
Natalia V Aganezova
Keyword(s):  
Menstrual Cycle ◽  
Sexual Intercourse ◽  
Emergency Contraception ◽  
Complete Information ◽  
Education Level ◽  
Repeated Application ◽  
Current Analysis ◽  
Unprotected Sexual Intercourse ◽  
Men And Women ◽  
Medical Degree

Background. In Russia, adherence to planned highly effective methods of contraception is still at a low level; therefore, emergency contraception (EC) can be the option for protection against unplanned pregnancy.Study design, materials and methods. The current analysis was undertaken to determine the frequency of EC use among women with and without higher medical degree (MD) and to find out the level of awareness about EC among women and men of the same categories. In order to this, the method of anonymous voluntary questioning was used. The questionnaire included items about the theoretical aspects of EC (filled in by both men and women) and data on the gynecological history and experience of EC application (filled in by women only).Results. Half of respondents (49.8%) had experience of EC use, 80% of them used EC only if unprotected sexual intercourse occurred in the middle of the menstrual cycle. Every forth (24.6%, n = 29) obstetrician-gynecologist mistakenly believes that repeated application of EC can lead to infertility. 45% (n = 64) participants without MD and 42% (n = 61) of doctors of other specialties have the same opinion. The use of EC is considered justified by 86% (n = 227) of doctors and 65% (n = 94) participants without MD. Every tenth responder, irrespective of education level, mistakenly believes in not using EC due to severe negative side effects.Conclusion. Almost a third (30%) of obstetrician-gynecologists do not possess complete information on EC. Awareness about EC is extremely inadequate and comparable to that of doctors of other specialties and people without MD. (For citation: Aganezov SS, Morotskaya AV, Aganezova NV. Emergency contraception among doctors and people without higher medical degree. Journal of Obstetrics and Women’s Diseases. 2018;67(4):34-39. doi: 10.17816/JOWD67434-39).

scholarly journals KNOWLEDGE, ATTITUDE AND PRACTICE OF EMERGENCY CONTRACEPTION AMONGST HEALTHCARE WORKERS IN IDP CAMPS AND HOST COMMUNITY CLINICS IN JERE AND MAIDUGURI METROPOLITAN LOCAL GOVERNMENT AREAS, BORNO STATE

2021 ◽  
Vol 15 (1) ◽  
pp. 1-8
Author(s):  
Babagana Bako ◽  
◽  
Bala Mohammed Audu ◽  
Mohammed Bello Kawuwa ◽  
Asta Mana ◽  
...  
Keyword(s):  
Local Government ◽  
Sexual Intercourse ◽  
Emergency Contraception ◽  
Healthcare Workers ◽  
Host Community ◽  
Community Clinics ◽  
Unprotected Sexual Intercourse ◽  
Attitude And Practice ◽  
Nurse Midwives ◽  
Knowledge Attitude And Practice

Background: Emergency contraception (EC) offers women a second chance to avoid unintended pregnancy after unprotected sexual intercourse. Besides its availability, requisite knowledge and positive attitude of the healthcare works will encourage its utilization by the Internally Displaced Persons (IDP) and host community. Objectives To determine the knowledge, attitude and practice of EC by healthcare workers (HCWs) in IDP camps and host community clinics in Jere and Maiduguri metropolitan local government areas (LGAs) of Borno state, Nigeria. Methodology: Self-administered questionnaires were issued to HCWs attending a workshop on child spacing counselling and service organized by the Society of Gynaecology and Obstetrics of Nigeria, North-East sector (SOGON-NE). The questionnaire inquired about knowledge, attitudes and practice of emergency contraception. Results: Eighty-nine (89.0%) of the respondents were aware of EC and 88.0% have approved of its provision. The most common indication for the EC was unprotected sexual intercourse (91.0%), followed by rape, failed contraception and missed pills. Sixty-five (84.4%) of Nurse/Midwives and CHEWs were willing to provide EC for prospective clients and 59(76.6%) of them had provided EC in the past. The commonest form of EC known to the respondents was Levonorgestrel (Postinor 2), followed by oral contraceptive pills (OCP) and intrauterine device (IUCD). Mifepristone and ulipristal were known to only 23.6% and 11.2% of the respondents respectively. Majority (79.6%) will give EC immediately after intercourse. Only 46.1% of the respondent would institute EC within 7 days of unprotected intercourse and among them, 50% were Nurse/Midwives and 46.4% were CHEWs. Conclusion: Both the knowledge and approval of EC among the HCWs in the IDP camps and host community clinics in Jere and Maiduguri metropolitan LGAs of Borno state are high. This can be harnessed to encourage the wide utilization of the EC by adolescents and other vulnerable womenin the IDP camps and Host communities.

Ulipristal acetate in emergency contraception: mechanism of action

2013 ◽  
Vol 34 (4) ◽  
pp. 195-196 ◽  
Author(s):  
Bruno Mozzanega ◽  
Erich Cosmi ◽  
Giovanni Battista Nardelli
Keyword(s):  
Mechanism Of Action ◽  
Emergency Contraception ◽  
Ulipristal Acetate

scholarly journals Emergency Oral Contraceptive Consultations in Pharmacies in a Rural Setting: An Epidemiological Analysis

2020 ◽  
pp. 089719002096169
Author(s):  
Emma Pearce ◽  
Kate Jolly
Keyword(s):  
Emergency Contraception ◽  
Intrauterine Device ◽  
Rural Setting ◽  
Chlamydia Screening ◽  
Unprotected Sexual Intercourse ◽  
Epidemiological Analysis ◽  
Ulipristal Acetate ◽  
Age Appropriate ◽  
Pharmacy Setting ◽  
Copper Intrauterine Device

Background: Emergency contraception has been available in pharmacies across England since 2001.There is a paucity of evidence describing those women accessing the service, particularly in rural locations, where pharmacies are integral to improving healthcare accessibility. Methods: Routinely collected data from all pharmacy consultations for emergency contraception in Shropshire, England, were obtained and anonymized for the study period April 1, 2016 to January 31, 2019. Consultations were described by time, age of consultee, rationale for consultation, method dispensed (levonorgestrel or ulipristal acetate), referral for copper intrauterine device fitting, chlamydia screening where appropriate and reason for choosing pharmacy setting. Repeat attenders were also described separately. Results: 3499 consultations occurred during the study period; 39% were aged between 16-20 years, and 52% attended following unprotected sexual intercourse. Levonorgestrel was initially most prescribed, however ulipristal acetate overtook it in 2018. Onward referral for copper intrauterine device and age-appropriate chlamydia screening took place in 3% and 4% of the eligible populations respectively. Women overwhelmingly chose the pharmacy setting owing to its convenience. Repeat attenders tended to be younger than single attenders, but otherwise similar. Conclusion: Pharmacy-based emergency contraception is an important and well-utilized service in this rural location and continued funding and possible service expansion should be considered.

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