Comparison of vaginal and oral administration of emergency contraception

Objective

To compare the physiologic effects of vaginally and orally administered emergency contraception.

Design

Prospective, open-label, crossover study.

Setting

University research center.

Patient(s)

Nine regularly menstruating volunteers.

Intervention(s)

Five subjects received 1,000 μg of levonorgestrel with 200 μg of ethinyl E₂ (twice the standard Yuzpe regimen dose) vaginally, and the standard Yuzpe regimen dose orally 1 week later. Four subjects received 1,500 μg of levonorgestrel (twice the standard Plan B regimen dose) vaginally and received the standard Plan B dose orally 1 week later. Serum samples were obtained at baseline and at frequent intervals after each dose.

Main Outcome Measure(s)

Serum gonadotropin, hepatic globulin, and androgen levels measured at baseline, at the time of peak levonorgestrel, and 24 hours later.

Result(s)

Gonadotropin, hepatic globulin, and androgen levels were suppressed to a similar degree among the four regimens, with a return to baseline levels after 24 hours.

Conclusion(s)

We conclude that high doses of levonorgestrel found in emergency contraception regimens lead to a transient direct suppression of gonadotropin, hepatic globulin, and androgen levels. This effect is similar after vaginal and oral administration of emergency contraception. Therefore, the vaginal route of administration of emergency contraception regimens may be as efficacious as the oral route.

Key Words:  Emergency contraception , vaginal administration , Yuzpe regimen , Plan B regimen , levonorgestrel , gonadotropins , androgens , hepatic globulins