Schneider, A. P., 2nd., Kubat, C., & Zainer, C. M. (2016). Appreciation for analysis of how levonorgestrel works and reservations with the use of meloxicam as emergency contraception. The Linacre Quarterly, 83(1), 52-68. https://doi.org/10.1080/00243639.2016.1145894
Schneider AP 2nd, Kubat C, Zainer CM. Appreciation for analysis of how levonorgestrel works and reservations with the use of meloxicam as emergency contraception. Linacre Q. 2016;83(1):52-68. doi:10.1080/00243639.2016.1145894
Schneider, A. Patrick, 2nd., et al. "Appreciation for analysis of how levonorgestrel works and reservations with the use of meloxicam as emergency contraception." The Linacre Quarterly, vol. 83, no. 1, 2016, pp. 52-68.
Authors object to meloxicam as emergency contraception after assault
The authors argue that meloxicam as emergency contraception puts the embryo at risk, replying to a 2014 review. In one study of 87 women, about 7 out of 10 ovulated after taking levonorgestrel in the five days before ovulation. No pregnancy occurred among 13 expected.
Key Findings
In the Durand study of 45 sterilized women, 12 of 15 (80%) given levonorgestrel early in the cycle did not ovulate. All 30 women dosed later ovulated.
In the Noé study, 62 of 87 women who took levonorgestrel on days -5 to -1 ovulated (71%). Thirteen pregnancies were expected among the 87 women, and none occurred.
From the Novikova report of 99 women, the authors calculate that at most 3.7 percent of prevented pregnancies could come from blocked ovulation. The same calculation puts other mechanisms at 96.3 percent.
In macaques, 6.5 percent of meloxicam-treated females became pregnant against 33.3 percent of controls, an 80 percent calculated efficacy. The macaque authors conclude ovulation typically still occurs.
Interpretation
This reply commentary answers a 2014 review on emergency contraception. The authors redo the math from older human and animal studies. Levonorgestrel and meloxicam both let ovulation happen in most cycles, even close to ovulation. The authors say neither drug works mainly by blocking ovulation. They also argue from Catholic teaching on protecting the embryo. The findings support direct human trials that compare meloxicam to levonorgestrel.
RRM Context
The authors stress ovulation timing throughout their analysis. They cite a study in which only 23 percent of women in the peri-ovulatory phase named their cycle stage correctly. Fertility awareness-based methods record fertile-window signs day by day. The authors also separate levonorgestrel, a progestin, from progesterone, the body's own hormone.
Our editorial summary of this paper, not the article's abstract.
Abstract
This paper is a response to Dr. Kathleen Raviele's recent article on her critical analysis of the use of levonorgestrel given to women postsexual assault and her suggestion that the use of Meloxicam may be an ethical alternative.
Reproductive Endocrinology › Ovarian Hormones › Progesterone · Ethics and Policy › Reproductive Ethics › Embryo Status · Therapeutics › Hormonal Agents › Progesterone and Progestins
A Patrick Schneider 2nd, Christopher Kubat, Christine M Zainer
Chris Kubat, C Kubat, Chris Zainer, C Zainer
PMID 27833182 27833182 DOI 10.1080/00243639.2016.1145894 10.1080/00243639.2016.1145894 Schneider 2nd et al. 2016, Schneider 2nd 2016
Keywords
Abortifacient, Breakthrough Ovulation, Medically Induced Abortions, Mobic for Women, NSAID, Progesterone, Prostaglandins, The Use of Meloxicam Post Sexual Assault, The Use of Levonorgestrel Post Sexual Assault
