Recommendations for quickstarting hormonal contraception after UPA EC

Over the past year, there have been discussions around whether hormonal contraception should be resumed immediately after the intake of UPA EC. The concern is that using a progestin-containing contraceptive could counteract the effects of UPA EC. UPA is an anti-progestin that works by delaying or inhibiting ovulation; if a progestin-containing contraceptive is administered at the same time, it might cancel out the effects of UPA, thereby putting the woman at risk of pregnancy from the act of intercourse that already occurred. Until recently, there was no published evidence addressing this question. However, in an article recently published by Dr. Vivian Brache and colleagues in Human Reproduction in which woman were given UPA EC and started a desogestrel-only daily pill on the same day, they found that ovulation occurred within 5 days in 45% of cycles in which the desogestrel-only pill was taken daily, starting on the same day as UPA; among women taking UPA followed by a placebo, ovulation occurred in only 1 cycle (3%). This indicates that taking this type of oral contraceptive pill can indeed make UPA ineffective in some woman, but the sample is small and the results might not apply to all hormonal contraceptives. Dr. Anna Glasier also published a commentary discussing the available evidence and recommending that women not start a new pack of oral contraceptives within 5 days of taking UPA. The UK Faculty of Sexual and Reproductive Healthcare released (and duly updated) a guidance, making a similar recommendation. This is an important issue, because women presenting for EC at a clinic or doctor’s office may miss a crucial opportunity to begin ongoing contraception if they are told not to start their pills right away, or if they are told to come back in 5 days for a long-acting method.