By Emily Stearn, Health Reporter For Mailonline
23:30 August 16, 2023, updated 23:38 August 16, 2023
- Levonorgestrel was found to be 63 percent effective when taken alone
- This rises to 95 percent when only the prescription drug piroxicam is given
The morning after pill worked better when taken in combination with medications normally given to arthritis patients, the researchers found.
Levonorgestrel, sold as Levonelle in the UK or Plan B in the US, was found to be 63 percent effective on its own.
This jumps to 95 percent when given with piroxicam, an anti-inflammatory drug that costs around 30p per tablet.
Experts said their findings, published in the prestigious medical journal The Lancet, were “exciting”.
Doctors should now consider prescribing piroxicam to women seeking emergency contraception, the University of Hong Kong team claims.
Their trial involved 836 women who took the morning after pill within 72 hours of having unprotected sex.
Volunteers were randomly divided into two groups over the four year study.
Half were given levonorgestrel — a synthetic version of progesterone, which delays egg release — on a placebo. The other got the morning after pill with 40mg of piroxicam
Follow-up appointments are arranged after the next expected period. If it doesn’t happen, they do a pregnancy test.
Only one pregnancy occurred among the 418 women in the piroxicam group. Seven occurred among women who were given a placebo.
What are the different types of emergency contraception? And when was the last time it could be picked up?
There are two types of emergency contraception.
The first, the morning after pill, also known as the morning aftercare pill, is sold as Levonelle or ellaOne.
Everything else is birth control—the IUD or the coil.
Emergency contraceptive pills must be taken within 3 days (Levonelle) or 5 days (ellaOne) after having unprotected sex to be effective.
The sooner it is taken, the more effective it is.
The IUD can be inserted up to 5 days after unprotected sex, or up to 5 days after the initial time you ovulated, to be effective.
IUDs are more effective than the contraceptive pill at preventing pregnancy — less than 1 percent of women who use IUDs become pregnant.
Side effects of the Levonelle or ellaOne ECPs can include headache, nausea, vomiting or stomach pain.
But if you vomit within two hours of taking Levonelle or three hours of taking ellaOne, you should go to your general practitioner, pharmacist, or genitourinary medicine (GUM) clinic, as you will need to take another dose or have an IUD inserted.
Emergency birth control pills can also make your next period quicker, slower, or more painful than usual.
If you are using an IUD as emergency contraception, it can be left alone and used as your regular method of contraception.
Researchers estimate that about 4.5 percent – or 19 out of 418 women – will get pregnant without emergency contraception.
Therefore, they concluded that piroxicam taken with levonorgestrel prevented 18 of 19 pregnancies (95 percent), compared with 12 of 19 taking the pill alone (63 percent).
No major side effects were noted.
Study co-author Professor Kristina Gemzell-Danielsson, from the Karolinska Institutet in Sweden, said: ‘Levonorgestrel prevents pregnancy by blocking or delaying the surge in luteinising hormone, which interferes with the ovulation process.
‘Piroxicam probably works by targeting a different type of hormone – prostaglandins.
‘Prostaglandins facilitate several reproductive processes including ovulation, fertilization, and implantation of the embryo.
‘Therefore, we speculate that piroxicam may exert contraceptive effects both pre-ovulatory – by blocking the ovulatory process – and post-ovulatory – by preventing embryo implantation.’
Emergency contraception, which also includes an IUD coil, can be taken up to five days after sex to avoid unwanted pregnancies.
It works by preventing ovulation or changing the lining of the uterus to stop an egg from implanting, avoiding pregnancy.
In the UK, emergency contraceptive pills are offered free on the NHS at GP surgeries, sexual health clinics and walk-in centers across the UK.
But this option is not available on weekends and women are usually consulted by a health professional before receiving the tablets.
Emergency contraception can also be purchased from the pharmacy after the consultation.
The academics behind the new study, however, warn there are potential limitations.
This includes excluding women who are currently or have recently used hormonal contraceptives, as well as those who had more than one unprotected sex prior to using emergency contraception.
Studies also show that the morning after pill can fail if taken by overweight women.
Commenting on the study’s findings, Dr Erica Cahill, from the Stanford University School of Medicine, said: ‘This conclusion may not apply to all patients.
‘The study was limited by the specific population, with the majority of participants being of Asian ethnicity and weighing less than 70kg.
‘Given that levonorgestrel ECPs are less effective in obese individuals, the efficacy shown here may not be generalizable to patients with higher BMIs.’
But Dr Sue Lo, from the Hong Kong Family Planning Association and one of the study’s investigators, said the findings were “very exciting”.
She added: ‘The levonorgestrel ECP is one of the most popular emergency contraceptive options in many parts of the world.
‘So finding out if there are drugs widely available that increase the efficacy of levonorgestrel when taken together is really exciting.’
Meanwhile, study author Dr Raymond Li from The University of Hong Kong, said: ‘Our study is the first to show that a drug that is readily available and safely taken in combination with levonorgestrel pills can prevent more pregnancies than levonorgestrel alone.
‘We hope these results will lead to further research and ultimately change clinical guidelines to enable women around the world to access more effective emergency contraception.’
Dr Cahill added: ‘Overall, this study recommends that anyone giving levonorgestrel as an ECP should consider adding piroxicam 40mg orally, as it increases efficacy with minor side effects.’
The research comes nearly a year after a group of MPs backed calls for the NHS to provide same-day delivery services for the morning-after pill in England.
It follows a Deliveroo style pilot with students during their first week in Manchester.
The trial, which is the first in the UK, is giving emergency contraception to women using bicycle couriers hours after they have completed a brief online questionnaire.
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