The use of emergency hormonal contraception in South Africa: current and future perspectives

Emergency hormonal contraceptives play an important role in preventing unplanned pregnancies in South Africa. In this review, we discuss the levonorgestrel emergency contraceptive, the combined estrogen and progestin regimen (also known as the Yuzpe method) and the use of Ulipristal acetate. The levonorgestrel and the combined estrogen, progestin regimen are available in South Africa. The specific mechanisms of action of each of these emergency hormonal contraceptives will be discussed as well as their efficacy, the side effects associated with each of these preparations and the drug interactions. Levonorgestrel can be used as a single dose (1.5 mg) instead of two doses (0.75 mg) 12 hours apart. Levonorgestrel is very effective, with fewer adverse effects than the combined estrogen and progestogen administration. Levonorgestrel and the Yuzpe method have demonstrated good efficacy when utilised within 72 hours after unprotected intercourse or contraceptive failure. These emergency hormonal contraceptives should not be used as regular contraception. It is essential that all health professionals and educators inform women of reproductive age about the risks and common side effects of emergency hormonal contraceptives

Long-acting reversible hormonal contraception

Long-acting reversible hormonal contraceptives are effective methods of birth control that provide contraception for an extended period without requiring user action. Long-acting reversible hormonal contraceptives include progesterone only injectables, subdermal implants and the levonorgestrel intrauterine system. These methods have several advantages over other reversible contraceptive methods. More importantly, once in place, they require minimal maintenance and their duration of action ranges from 8 weeks to 5 years. Despite the advantages of long-acting reversible hormonal contraceptive methods, they are infrequently used in South Africa. Short-acting methods, specifically oral contraceptives and condoms, are by far the most commonly used reversible methods. A shift from the use of short-acting methods to long-acting reversible contraceptive methods could help reduce the high rates of unintended pregnancies in South Africa. In this review of long-acting reversible hormonal contraceptive methods, we discuss the long-acting progesterone injectables, the etonogestrel implant and the levonorgestrel intrauterine system available in South Africa, the side effects of each of these preparations and the non-contraceptive benefits. It is imperative that health professionals and educators inform women of reproductive age about the benefits, risks, and common side effects of long-acting reversible hormonal contraception to improve consideration and recognition of these methods