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Human Reproduction Update Advance Access originally published online on June 10, 2004
Human Reproduction Update 2004 10(4):341-348; doi:10.1093/humupd/dmh027
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Human Reproduction Update Vol. 10 No. 4 © European Society of Human Reproduction and Embryology 2004; all rights reserved

Mechanisms of action of mifepristone and levonorgestrel when used for emergency contraception

K. Gemzell-Danielsson1 and L. Marions

Department of Woman and Child Health, Division of Obstetrics and Gynecology, Karolinska Hospital/Institute, S-171 76 Stockholm, Sweden

1 To whom correspondence should be addressed. Email: kristina.gemzell{at}kbh.ki.se

An emergency contraceptive method is used after coitus but before pregnancy occurs. The use of emergency contraception is largely under-utilized worldwide. One of the main barriers to widespread use is concern about the mechanism of action. Recently, treatment with either 10 mg mifepristone or 1.5 mg of levonorgestrel has emerged as the most effective hormonal method for emergency contraception with very low side-effects. However, the knowledge of the mechanism of action of mifepristone and levonorgestrel in humans, when used for contraceptive purposes and especially for emergency contraception, remains incomplete. The objective of this review is to summarize available data on the effects of mifepristone and levonorgestrel on female reproductive functions relevant to the emergency use of the compounds. When summarized, available data from studies in humans indicate that the contraceptive effects of both levonorgestrel and mifepristone, when used in single low doses for emergency contraception, involve either blockade or delay of ovulation, due to either prevention or delay of the LH surge, rather than to inhibition of implantation.

Key words: emergency contraception / endometrium / levonorgestrel / mifepristone / ovulation


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